Antigliadin Iga Results After 3 Years Strictly Gluten-Free

[naturegirl]

Hi there,

I frequently consult this site and find it both helpful and reassuring. I posted here a couple of times a while ago... but am now going to post a few separate questions in the hope of finding some answers, as my symptoms seem to be continually getting worse despite being strictly gluten free (to the best of my knowledge) for 3 years now (I'm 33).

Original Enterolab results (July 2009):

Fecal Anti-gliadin IgA: 18 Units

Fecal Anti-tissue Transglutaminase IgA: 13 Units

Quantitative Microscopic Fecal Fat Score: 558 Units

Recent results from a stool test done by a different lab (April 2012):

Anti-gliadin sIgA: 13.4 (flagged as 'high' - described as 'screening marker for gluten sensitivity').

Fecal sIgA: 135 (not flagged - range is 5-161 mg/dl)

All 'absorption' tests for fat malabsorption were in the normal range.

My understanding is that the original Enterolab results being above 10 Units show that "Intestinal antigliadin IgA antibody was elevated, indicating that you have active dietary gluten sensitivity."

My doctor is saying that the fact that my recent results also show an elevated anti-gliadin shows that I am definitely gluten intolerant and still being exposed to enough to be having an adverse response (and according to him this lab is less sensitive than Enterolab for this measurement - making them more significant, as it might have come out higher with an Enterolab test).

On a positive note, it seems that fat absorption is no longer an issue now - Although I was a very skinny child, I was always tall. I am not too thin now but relatively slender considering how much I eat!!! My doctor in Belgium felt that my cholesterol was too low about a year ago, and told me to eat butter (best doctor visit ever - not sure they'd take the same approach here in the US!) and so until a couple of months ago, that was the only dairy I was eating.

Would others agree from experience/knowledge that this result is a clear confirmation that I am still consuming gluten unknowingly? And also that I am definitely gluten intolerant?

Has anyone experienced this anti-gliadin IgA go down once they were totally gluten-free (and symptoms were subsiding)?

Also, when I previewed my post the lab name came up as (company name removed - they spammed this forum and are banned) - I am now wondering whether this lab is even 'trustworthy' or if I'd be advised to return to Enterolab (although the cost is very high!).

I'll post other questions elsewhere (as I don't want this to get any longer!) but really trying to determine how 'certain' I can be that getting even more careful about gluten is my next best step.

Thanks a lot for your help and any thoughts!

Josie

PS (in case this is useful):

Full Enterolab results:

Fecal Anti-gliadin IgA: 18 Units

Fecal Anti-tissue Transglutaminase IgA: 13 Units

Quantitative Microscopic Fecal Fat Score: 558 Units

Fecal Anti-casein (cow's milk) IgA: 7 Units

HLA-DQB1 Molecular analysis, Allele 1: 0202

HLA-DQB1 Molecular analysis, Allele 2: 0202

Serologic equivalent: HLA-DQ 2,2 (Subtype 2,2)

Fecal Anti-ovalbumin (chicken egg) IgA: 4 Units

Fecal Anti-saccharomyces cerevisiae (dietary yeast) IgA: 5 Units

Fecal Anti-soy IgA: 6 Units

[Skylark]

Fecal anti-gliadin IgA is not stable if you test it repeatedly. It also comes and goes in normal, non-celiac people. You might not realize this, but Enterolab's own data show that 30% of normal people who eat gluten just fine come up positive for anti-gliadin in their tests. (This is why your doctor is saying Enterolab is too sensitive.) Basically Enterolab fecal IgA is kind of unreliable and I personally wouldn't personally even consider paying for repeat testing.

I think you are focusing on the wrong test though. Was your fecal TTG above the normal range on Enterolab too? The fecal TTG might be worth repeating. It's a test that's more indicative of autoimmunity and gluten problems than anti-gliadin. It should fall gluten-free as your symptoms resolve.

[naturegirl]

Fecal anti-gliadin IgA is not stable if you test it repeatedly. It also comes and goes in normal, non-celiac people. You might not realize this, but Enterolab's own data show that 30% of normal people who eat gluten just fine come up positive for anti-gliadin in their tests. (This is why your doctor is saying Enterolab is too sensitive.) Basically Enterolab fecal IgA is kind of unreliable and I personally wouldn't personally even consider paying for repeat testing.

Thanks a lot Skylark. That is good to know and is sort of what I was 'guessing'. I found your other longer post about this, which was really interesting and informative. I have done some scientific research, so I know that peer-reviewed publications are a good indicator that the data is solid! And the lack thereof is of concern (especially considering the price of testing!!!).

My main issue is that despite being gluten-free for over 3 years, I am still experiencing auto-immune type symptoms. If I have to get even stricter about gluten to resolve the issues, I will gladly do so to get better (stop eating out...) but I just want to make sure that I'm not focussing my attention in the wrong place. The recent lab results came from meta-metrix and my doctor was indicating that these were 'not sensitive enough', unlike Enterolab, so if these came back positive, it really meant that I'm still getting contaminated with gluten.

I think you are focusing on the wrong test though. Was your fecal TTG above the normal range on Enterolab too? The fecal TTG might be worth repeating. It's a test that's more indicative of autoimmunity and gluten problems than anti-gliadin. It should fall gluten-free as your symptoms resolve.

I did not get a fecal TTG result in either test (as far as I know - all Enterolab results included in initial post above).

I have also done blood tests in Europe that give 'specific IgG' results. These have always come back negative for gluten, casein...

The Enterolab website is down right now but perhaps I will look into a fecal TTG test. Is Enterolab the best one to do this?

Thanks again.

[Skylark]

I did not get a fecal TTG result in either test (as far as I know - all Enterolab results included in initial post above).

"Fecal Anti-tissue Transglutaminase IgA: 13 Units"

TTG stands for Tissue TransGlutaminase.

[naturegirl]

"Fecal Anti-tissue Transglutaminase IgA: 13 Units"

TTG stands for Tissue TransGlutaminase.

Makes sense!

And you would recommend doing a repeat of that test to determine whether gluten contamination could be the source of my symptoms?

Thanks.

[Skylark]

In truth, I would recommend you go off ALL processed foods and grains and eat a diet of only whole foods that you can be sure are 100% gluten-free. In particular, strictly eliminate corn as if it were a gluten grain as it's starting to look like corn can be a problem for some celiacs. I assume you're not eating gluten-free oats? Quite a few celiacs react to oats as a gluten grain. A strict elimination tends to be more useful/accurate than fecal testing.

If you're dead-set on testing, I'd get both TTG and anti-gliadin. The anti-gliadin is prone to false positives but you might find it helpful to have as confirmation if the TTG is high.

[naturegirl]

In truth, I would recommend you go off ALL processed foods and grains and eat a diet of only whole foods that you can be sure are 100% gluten-free. In particular, strictly eliminate corn as if it were a gluten grain as it's starting to look like corn can be a problem for some celiacs. I assume you're not eating gluten-free oats? Quite a few celiacs react to oats as a gluten grain. A strict elimination tends to be more useful/accurate than fecal testing.

Good to know, thanks. I'm already off all oats but I do eat organic gluten-free bread, rice, quinoa and must admit, I have a sweet tooth (I love dark chocolate and sometimes indulge in gluten-free cake!). I would say that my diet is mostly organic wholefoods but by no means 100% and I consume grains, including organic corn and small amounts of soy (e.g. in chocolate or tamari). I also have not tried going off nightshades (as I've seen mentioned here by many).

The reason that I haven't yet got stricter with my diet is that there are days (sometimes even a week or so) when I am not having these episodes, whilst consuming organic almond milk, brown rice... But perhaps I am experiencing a delayed reaction?

Also, I did try an elimination diet, eating only fish and vegetables for around a week, but I couldn't get my system to 'settle' before introducing other foods. Things didn't get worse when I introduced grains (quinoa and rice). What is the idea behind eliminating all grains? Is it helpful for many celiacs?

If you're dead-set on testing, I'd get both TTG and anti-gliadin. The anti-gliadin is prone to false positives but you might find it helpful to have as confirmation if the TTG is high.

No, I'd happily save the money... I mostly just wanted to know what my recent test results really meant. Thanks!

[Skylark]

Also, I did try an elimination diet, eating only fish and vegetables for around a week, but I couldn't get my system to 'settle' before introducing other foods. Things didn't get worse when I introduced grains (quinoa and rice). What is the idea behind eliminating all grains? Is it helpful for many celiacs?

Yes, many celiacs find eliminating grains helpful. For starters, grain products, especially flours, are most likely to be CC'd with gluten. Even commercial gluten-free breads are only guaranteed to be below 10 ppm, not to have zero gluten. Even a random sample of soy flour in one of Tricia Thompson's studies had 2925 ppm of gluten.

Open Original Shared Link Also as I mentioned corn can cause issues for celiacs. Starches in general can be hard for people with abnormal gut flora, which tends to go hand-in-hand with celiac. You might look at the Specific Carbohydrate Diet for more info. Open Original Shared Link

For me a week on elimination isn't long enough. I can't tell a darned thing unless I stick to elimination for a good month. My body is way too inconsistent. What I'd suggest is eating fruit, nuts, seeds, veggies, fish, meats, and maybe a little white rice for at least a month. Stick to whole foods that you can look at and tell they are not CC'd with gluten. There is no way to tell whether a bag of flour is really gluten-free, while you know for sure that an apple, a banana, or a basic package of raw chicken is definitely gluten-free.