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High Transglutaminase


trishatrue

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trishatrue Rookie

Help! My daughter was diagnosed with Celiac 6 months ago and had followed a strict diet since. Recent blood results indicate that transglutaminase has increased instead of decreasing. Her doctor insists she has not been honest about her diet. I vehemently disagree, as she and I read everything that goes in her lips and on her body and we are extremely careful concerning cross-contamination. I need help! Has anyone had a similar experience? Is there another disease that could cause hight translutaminase to be present?


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cruelshoes Enthusiast

There are other conditions that can cause an elevated tTg reading, including Type 1 Diabetes, Hashimoto

trishatrue Rookie
There are other conditions that can cause an elevated tTg reading, including Type 1 Diabetes, Hashimoto
cruelshoes Enthusiast

I don't know enough about refractory celiac to comment about that. I did find this, however:

Open Original Shared Link

Refractory celiac disease. For the purpose of this review, patients with refractory celiac disease are patients with true celiac disease and villous atrophy (i.e., not a misdiagnosis) who do not, or no longer, respond to a GFD. Although the most common reason for failure to respond to a GFD is dietary indiscretion or unknown exposure to gluten, refractory celiac disease also occurs in patients on a GFD who have developed a complication such as ulcerative-jejunoileitis, or enteropathy-associated lymphoma. Patients with refractory celiac disease do not necessarily have positive serology for celiac disease. Refractory celiac disease was reviewed in the context of the requested objectives.

I know you said you have already done this, but I would go back again and triple check everything that goes on or in her body. This includes food, supplements, OTC and prescription medications, shampoo, hand lotion, etc. Gluten can hide in the darndest places. Do you have any gluten in the home at all? Would you be willing to make your home totally gluten-free for a few months to see if it made any difference? CC is so hard to track down sometimes, and some people are extremely sensitive to it.

I would also ask the doctor to run the Anti Gliadin antibodies. This is another tool in determining dietary compliance. Maybe it would tell a different story than the TtG.

Open Original Shared Link

How often should follow-up testing occur?

New celiacs should receive follow-up testing twice in the first year after their diagnosis. The first appointment should occur three to six months after the diagnosis, and the second should occur after 1 year on the gluten-free diet. After that, a celiac should receive follow-up testing on a yearly basis.

.....

Follow Up Test #1:

tTG-IgA: This test result should be negative

The numerical value of the test doesnt matter as long as the result is negative.

Follow Up Test #2

Anti-gliadin IgA: This result should have a very low negative value

In this case, the numerical value does matter, because a high negative test result still indicates that a patient is eating gluten. A low negative indicates that the diet is working well.

.

I truly hope you get to the bottom of things soon.

trishatrue Rookie
I don't know enough about refractory celiac to comment about that. I did find this, however:

Open Original Shared Link

I know you said you have already done this, but I would go back again and triple check everything that goes on or in her body. This includes food, supplements, OTC and prescription medications, shampoo, hand lotion, etc. Gluten can hide in the darndest places. Do you have any gluten in the home at all? Would you be willing to make your home totally gluten-free for a few months to see if it made any difference? CC is so hard to track down sometimes, and some people are extremely sensitive to it.

I would also ask the doctor to run the Anti Gliadin antibodies. This is another tool in determining dietary compliance. Maybe it would tell a different story than the TtG.

Open Original Shared Link

I truly hope you get to the bottom of things soon.

Thank you for the advice. I spent my weekend going over everything in my cupboard's (kitchen & bath) that she consumes and I found a hair product she uses with her hair straightener, mascara, and hand lotion she had in her locker at school. My question is: since these products are not digested, can they elevate her TtG? She does not suffer from any rashes or apparent complications from them (actually, she is completely asymptomatic except for extreme osteopenia that has caused bone deformity in her legs; it took 3 years to figure out it was celiac causing this). Regardless, they have gone in the garbage, as will the rest of the products in my home if it compromises my daughters health.

We did have her blood re-drawn yesterday to confirm the previous results. I wish they had suggested the Anti Gliadin test as well! However, if the results are the same we will ask for it.

I am grateful for your help. Thank you.

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    • Mmoc
      Thank you kindly for your response. I have since gotten the other type of bloods done and am awaiting results. 
    • Aretaeus Cappadocia
      I wanted to respond to your post as much for other people who read this later on (I'm not trying to contradict your experience or decisions) > Kirkland Signature Super Extra-Large Peanuts, 2.5 lbs, are labeled "gluten free" in the Calif Costcos I've been in. If they are selling non-gluten-free in your store, I suggest talking to customer service to see if they can get you the gluten-free version (they are tasty) > This past week I bought "Sliced Raw Almonds, Baking Nuts, 5 lbs Item 1495072 Best if used by Jun-10-26 W-261-6-L1A 12:47" at Costco. The package has the standard warning that it was made on machinery that <may> have processed wheat. Based on that alone, I would not eat these. However, I contacted customer service and asked them "are Costco's Sliced Almonds gluten free?" Within a day I got this response:  "This is [xyz] with the Costco Member Service Resolutions Team. I am happy to let you know we got a reply back from our Kirkland Signature team. Here is their response:  This item does not have a risk of cross contamination with gluten, barley or rye." Based on this, I will eat them. Based on experience, I believe they will be fine. Sometimes, for other products, the answer has been "they really do have cross-contamination risk" (eg, Kirkland Signature Dry Roasted Macadamia Nuts, Salted, 1.5 lbs Item 1195303). When they give me that answer I return them for cash. You might reasonably ask, "Why would Costco use that label if they actually are safe?" I can't speak for Costco but I've worked in Corporate America and I've seen this kind of thing first hand and up close. (1) This kind of regulatory label represents risk/cost to the company. What if they are mistaken? In one direction, the cost is loss of maybe 1% of sales (if celiacs don't buy when they would have). In the other direction, the risk is reputational damage and open-ended litigation (bad reviews and celiacs suing them). Expect them to play it safe. (2) There is a team tasked with getting each product out to market quickly and cheaply, and there is also a committee tasked with reviewing the packaging before it is released. If the team chooses the simplest, safest, pre-approved label, this becomes a quick check box. On the other hand, if they choose something else, it has to be carefully scrutinized through a long process. It's more efficient for the team to say there <could> be risk. (3) There is probably some plug and play in production. Some lots of the very same product could be made in a safe facility while others are made in an unsafe facility. Uniform packaging (saying there is risk) for all packages regardless of gluten risk is easier, cheaper, and safer (for Costco). Everything I wrote here is about my Costco experience, but the principles will be true at other vendors, particularly if they have extensive quality control infrastructure. The first hurdle of gluten-free diet is to remove/replace all the labeled gluten ingredients. The second, more difficult hurdle is to remove/replace all the hidden gluten. Each of us have to assess gray zones and make judgement calls knowing there is a penalty for being wrong. One penalty would be getting glutened but the other penalty could be eating an unnecessarily boring or malnourishing diet.
    • trents
      Thanks for the thoughtful reply and links, Wheatwacked. Definitely some food for thought. However, I would point out that your linked articles refer to gliadin in human breast milk, not cow's milk. And although it might seem reasonable to conclude it would work the same way in cows, that is not necessarily the case. Studies seem to indicate otherwise. Studies also indicate the amount of gliadin in human breast milk is miniscule and unlikely to cause reactions:  https://www.glutenfreewatchdog.org/news/gluten-peptides-in-human-breast-milk-implications-for-cows-milk/ I would also point out that Dr. Peter Osborne's doctorate is in chiropractic medicine, though he also has studied and, I believe, holds some sort of certifications in nutritional science. To put it plainly, he is considered by many qualified medical and nutritional professionals to be on the fringe of quackery. But he has a dedicated and rabid following, nonetheless.
    • Scott Adams
      I'd be very cautious about accepting these claims without robust evidence. The hypothesis requires a chain of biologically unlikely events: Gluten/gliadin survives the cow's rumen and entire digestive system intact. It is then absorbed whole into the cow's bloodstream. It bypasses the cow's immune system and liver. It is then secreted, still intact and immunogenic, into the milk. The cow's digestive system is designed to break down proteins, not transfer them whole into milk. This is not a recognized pathway in veterinary science. The provided backup shifts from cow's milk to human breastmilk, which is a classic bait-and-switch. While the transfer of food proteins in human breastmilk is a valid area of study, it doesn't validate the initial claim about commercial dairy. The use of a Dr. Osborne video is a major red flag. His entire platform is based on the idea that all grains are toxic, a view that far exceeds the established science on Celiac Disease and non-celiac gluten sensitivity. Extraordinary claims require extraordinary evidence, and a YouTube video from a known ideological source is not that evidence."  
    • Wheatwacked
      Some backup to my statement about gluten and milk. Some background.  When my son was born in 1976 he was colicky from the beginning.  When he transitioned to formula it got really bad.  That's when we found the only pediactric gastroenterologist (in a population of 6 million that dealt with Celiac Disease (and he only had 14 patients with celiac disease), who dianosed by biopsy and started him on Nutramegen.  Recovery was quick. The portion of gluten that passes through to breastmilk is called gliadin. It is the component of gluten that causes celiac disease or gluten intolerance. What are the Effects of Gluten in Breastmilk? Gliaden, a component of gluten which is typically responsible for the intestinal reaction of gluten, DOES pass through breast milk.  This is because gliaden (as one of many food proteins) passes through the lining of your small intestine into your blood. Can gluten transmit through breast milk?  
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