Diagnosis: What To Expect
Since celiac disease tends to run in families, if you have a parent, child, brother, or sister with the disease, talk to your doctor about whether you should be tested. Celiac disease is more common in people with type 1 diabetes, autoimmune liver disease, thyroid disease, Down syndrome, Turner syndrome, or Williams syndrome. So if you have any of these conditions, you should also ask your doctor to test you for celiac.
When Is It Ordered
Celiac disease tests are ordered when someone has signs and symptoms suggesting celiac disease, malnutrition, and/or malabsorption. The symptoms are often nonspecific and variable, making the disease difficult to spot. The symptoms may, for a time, be mild and go unnoticed and then progressively worsen or occur sporadically. The condition can affect different parts of the body.
Digestive signs and symptoms may include:
- Abdominal pain and distension
- Failure to thrive
Many people with celiac disease have dermatitis herpetiformis, a disease that causes itchy blisters on the skin. There is also an increased risk for developing intestinal lymphoma, a form of cancer.
One or more antibody tests may be ordered when someone with celiac disease has been on a gluten-free diet for a period of time. This is done to verify that antibody levels have decreased and to verify that the diet has been effective in reversing the intestinal lining damage .
Asymptomatic people may be tested if they have a close relative such as a parent or sibling with celiac disease, but celiac disease testing is not recommended at this time as a screen for the general population.
When Should I See My Doctor
It is very important to be properly diagnosed with coeliac disease by a doctor because it is a serious medical condition that affects people for their whole life.
If you think you may have coeliac disease don’t stop eating foods that contain gluten until after you have been diagnosed as stopping gluten means the tests are unreliable. If you have started a gluten free diet then you will need to resume a normal diet for at least 6 weeks before you are tested. You will also need to eat a minimum of 4 slices of wheat-based bread for adults, and 2 slices for children, every day during this time. This is called a gluten challenge and will help to make sure your test results are reliable.
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Endoscopy And Intestinal Biopsy
An intestinal biopsy is considered the gold standard for celiac disease diagnosis and can give you a definitive answer to your childs health problems.
The biopsy is taken during an upper gastrointestinal endoscopy, which is a very safe and routine procedure. Some preparations are needed, and your child may be lightly sedated during the procedure. The actual endoscopy only takes about 15 minutes.
During the endoscopy, a pediatric gastroenterologist will use a small flexible camera scope to examine your childs intestinal wall/lining. They will be looking for damage or flattening of the villi . This damage is the hallmark of celiac disease. A few biopsies will be taken for microscopic review to confirm your childs diagnosis.
Clinical Gluten Intolerance Tests
In the case of celiac disease, we now have 4 different established blood tests to help identify it:
- Deamidated Gliadin Peptides
- IgA and IgG Antigliadin Antibodies
- IgA Endomysial Antibodies
- tgG Tissue Transglutaminase Antibodies
In addition, the following test is almost always ordered to identify patients whose test results will be skewed due to an IgA deficiency:
Total IgA antibodies
None of these are 100% specific or 100% sensitive, which is why a doctor experienced in diagnosing celiac disease and a non-celiac gluten sensitivity will order several of these tests.
Since none of these can give you a 100% accurate answer, your doctor will consider your lab results and determine if you need an endoscopy with biopsy. Doctors often use more than the lab results to make this decision: your symptoms, medical history and family history are all taken into consideration.
An intestinal biopsy is considered, by most doctors and researchers, to be the only definitive test for celiac disease. It is often referred to as the gold standard for celiac disease diagnosis.
If your doctor decides to do a blood panel for celiac disease, try to make sure he or she uses the most recent and accurate tests: Deamidated Gliadin Peptides and IgA Endomysial Antibodies.
In addition, the Total IgA Antibody test should always be taken to determine if you are IgA deficient. If you are IgA deficient, they will need to read the results of your other tests differently .
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Whats The Difference Between Gluten Intolerance And Wheat Allergy
Because wheat is one of the major sources of gluten, it can be easy to confuse symptoms of gluten intolerance with those of a wheat allergy. However, there are very distinct differences.
All allergic reactions, including wheat, involve the immune system. It responds to what it thinks is a foreign substance that must be removed from the body. Your immune system releases antibodies known as immunoglobulin E , which trigger a variety of symptoms, including the possibility of a life-threatening condition known as anaphylaxis.
Having a gluten intolerance is less severe than a wheat allergy and does not involve the immune system. In addition, a trained allergist can diagnose a wheat allergy with a skin-prick or blood test, whereas a healthcare provider can only diagnose gluten intolerance based on your reported symptoms and ruling out other conditions.
However, because the two conditions can share many common symptoms, it is important to first rule out a wheat allergy before assuming gluten intolerance.
What Are The Treatments For Gluten Allergy
There are different gluten allergy treatments available depending on the severity of your allergy. Nonetheless, when it comes to gluten intolerance conditions your physician will recommend going for a gluten-free diet for a certain period of time. In some cases, you may be asked to continue for life-long .
Gluten is a protein that is naturally seen in wheat, rye, and barley. Most cereals, grains, and pasta, as well as many processed foods, are gluten-rich. Beers and other grain-based alcoholic drinks can also be a source of high-gluten. Thus it is vital to check for the Gluten-free label on products that you buy.
Following are foods that do not contain gluten include:
- Cereals such as corn, millet, sorghum, and teff
- Fruits and vegetables
- Pasta, bread, baked goods, and other products labeled gluten-free
- Rice flour
- Ketchup
- Processed and canned meats and sausages
If you have avoided all the above gluten-rich foods and still having some symptoms persisting, then consider checking and staying away from the following nonfood products as they can also be a source of gluten:
- Cosmetics, including lipstick, lip gloss, and lip balm
- Communion wafers
- Some prescription and over-the-counter medications
- Toothpaste
- Vitamin products
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Understanding The Connection Between Gluten Intolerance And Autoimmune Disease
The hallmark of an autoimmune condition is that your immune system gets confused and attacks your body causing a long list of unpleasant symptoms. Some of the most popular forms of autoimmune disease are hyperthyroidism and hypothyroidism. In fact, roughly 20 million Americans suffer from thyroid disease, but since the symptoms are so variable over half of people with thyroid diseases dont even know they have it. In particular, women are five to eight times more likely to suffer from a thyroid condition than men.
Gluten is one of the most common exacerbating factors of a thyroid condition. Gluten is a mixture of two proteins found in wheat and other cereal grains. One of those proteins is called gliadin. The problem starts in your gut. If you have gluten sensitivity, gluten can begin to inflame your gut and degrade the lining of your small intestine. This next part is a little shocking, but its true. Over time, your inflamed small intestine can become permeable, allowing food particles to slip through, right into your bloodstream. This is what we in functional health circles call a leaky gut.
Well, free-floating food particles will raise the alarm of your immune system, which will rush in to destroy the invaders. Heres the rub. The protein gliadin looks a lot like the tissue of your thyroid. When your immune system identifies gliadin as an enemy that needs to be destroyed, it can also end up attacking your thyroid. Friendly fire!
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Gluten Blood Sugar And Diabetes
Both Type 1 and Type 2 diabetes have been linked to gluten. This population-based study showed the highest reported prevalence of celiac disease in Type 1 diabetes in Europe. Patients with celiac disease showed clinical improvements with a gluten-free diet . We recommend screening for celiac disease in all children with type 1 diabetes.
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Celiac Disease Vs Gluten Sensitivity
Celiac disease is an autoimmune disease where gluten triggers the bodys immune system to attack the lining of the small intestine.
Non-celiac gluten sensitivity is not an autoimmune disease however, gluten triggers a chronic state of inflammation in the small intestine instead, and its symptoms are similar even identical those with celiac disease.
People with a gluten sensitivity tap into their innate immune system. Innate immunity is your bodys first defense against foreign invaders that want to attack your cells, such as viruses, bacteria and parasites. Your innate immunity occurs naturally, as its innate. In order for a pathogen to attack your cells, its going to have to get past your innate immune response first.
On the other hand, people with celiac disease experience an adaptive or acquired immune system response to gluten over time. Adaptive immunity is your bodys second line of defense against invaders and is much more complex. Once an invader is introduced in the body, the adaptive immune system creates an army of immune cells designed to attack that specific antigen. The immune system remembers those antigens so it can initiate future attacks more efficiently.
I discuss, in detail, the differences between Gluten Intolerance vs. Celiac Disease in this article.
Us Food Intolerance Core Test
U.S. Food Intolerance offers several home tests for food sensitivities based on IgG measurements. Their basic test, the Core Test, can check for sensitivity to gluten and around 300 foods.
However, it is worth keeping in mind that no evidence indicates that food sensitivity tests based on IgG levels correlate with symptoms.
To take the test, a person needs to give a hair sample.
U.S. Food Intolerance says that results come back within 5 days of the lab receiving the sample. The report includes a complementary metals and nutritional deficiency test.
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What Is Coeliac Disease
Coeliac disease is an autoimmune disease where the lining of the small intestine is damaged by tiny amounts of gluten .
If you have coeliac disease, your immune systems response to gluten causes damage to the small intestine when the tiny, finger-like projections lining the bowel, called villi, become inflamed and flattened. This is called villous atrophy and it reduces the available surface area of the bowel to absorb nutrients from food.
It is a serious medical condition. If its not well controlled it can lead to complications such as osteoporosis, infertility, chronic poor health, depression and teeth problems. However, early diagnosis and treatment of coeliac disease significantly reduces the risk of most complications ever occurring.
Coeliac disease affects people of all ages and gender. It runs in families and can develop at any age from infancy to adulthood. If you have coeliac disease, you should tell close relatives who share your genes that you have coeliac disease, so they can be tested.
How Is Gluten Intolerance Diagnosed
Your healthcare provider carefully reviews your symptoms and medical history. If they suspect you have a gluten intolerance, these are the next steps to confirm the diagnosis:
- Step 1: You eat a diet containing gluten for about six weeks. During this time, your healthcare provider performs blood tests and skin tests to rule out a wheat allergy or celiac disease. There isnt a gluten intolerance test.
- Step 2: If you dont have a wheat allergy or celiac disease, your healthcare provider will ask you to exclude gluten from your diet for at least six weeks. Keep a thorough record of your symptoms during this time, noting which symptoms improve.
- Step 3: If your symptoms do improve while youre on a gluten-free diet, you gradually reintroduce gluten back into your diet. If symptoms return, you likely have a gluten intolerance.
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What Is A Gluten Allergy
Gluten is nothing but a combination of proteins that can be found naturally in some grains like wheat, rye, and barley, or as an additive in processed/canned foods.
Some people have this intolerance when gluten products are consumed and trigger allergy-like symptoms like abdominal discomfort, bloating, gas, constipation, or diarrhea. Gluten allergies are typically less complicated than other gluten-related conditions like Celiac Disease. When you start a strict gluten-free diet these symptoms can cease to occur.
There are 3 similar conditions that are somewhat related to gluten but they have some important differences that are worth noting to differentiate your condition, they are:
1. Celiac disease: This is a genetic disorder and an autoimmune disease where your immune system mistakenly triggers allergic symptoms to fight against certain invading foreign substances. Celiac disease is a more complex form of gluten sensitivity that damages the lining of the small intestine and can lead to malabsorption/indigestion of nutrients.
Your doctor will order if he/she suspects that you have a family history of celiac disease and other symptoms of celiac and endoscopy/biopsy might be done, but will not show any irregularities in gluten sensitivity. Some people tend to be okayish for a while, but most people have to avoid gluten completely to stop having adverse health issues.
How To Test For Celiac Disease
Testing for celiac disease is something that you should discuss with your doctor. Routine testing is not recommended unless you have symptoms of the disease or you are at increased risk of developing them. For example, if you have a first degree relative with the condition such as a parent, sibling or child, you may be at increased risk. Moreover, some symptoms in children and adults warrant testing. These include persistent unexplained gastrointestinal symptoms such as being sick, weight loss, mouth ulcers, type 1 diabetes and unexplained iron deficiency anaemia.
Testing involves having blood tests to identify whether or not you may have the condition, followed by a biopsy to confirm the diagnosis. During the testing process, you will need to consume gluten containing foods to ensure that the test results are accurate.In fact, avoiding gluten prior to your blood test could lead to an inaccurate result. In addition, you should not self-administer a gluten-free diet until the diagnosis of celiac disease is confirmed, even if your blood tests results are positive. If your blood tests show celiac disease antibodies, your doctor will refer you to get a biopsy for your gut cells.
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