What Is This Pesky Protein Composite
Gluten is a protein composite we call it a composite because it actually contains several proteins found in the triticae family of grassy grains the most common and potent forms are found in wheat, barley and rye. It provides dough its unique elasticity and strength, and gives baked goods form and texture.
Even if you avoid these grains, this pesky protein composite is added to so many products that it can be very difficult to completely remove it from your diet.
To better understand gluten and to learn just how pervasive it is in the western diet, see the following lesson: What Is Gluten?
Symptoms Of Celiac Disease
Although digestive issues are common in children with celiac disease, most adults do not experience these symptoms. Instead, the following signs are often a red flag for celiac disease in adults:
- Liver and biliary tract disorders
- Osteoporosis or osteopenia
- Peripheral neuropathy
- Seizures or migraines
- Unexplained iron-deficiency anemia
Whether or not you are experiencing any of these symptoms, it is crucial to undergo celiac disease testing if you have a first-degree relative with the condition, as this puts you at a one in ten risk of developing celiac yourself.
However, if you suspect that you have gluten intolerance rather than celiac, the single best way gluten intolerance test is to remove it from your diet, note how you feel without it, and how you feel when you add it back in.
Diagnosis Dilemma: Eating Gluten Again To Test For Celiac Disease
To diagnose celiac disease, the only sure way to determine whether a person has it is with a blood test and biopsy. A definitive blood test and biopsy can only be performed when a patient is eating gluten. Test results for someone following a gluten-free diet for any length of time are rendered inaccurate.
Many people face a dilemma when they decide to go gluten-free diet first, before getting tested for celiac disease, and then feel better. Then, in order to be tested for celiac disease, they must start eating gluten all over again.
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How Long Is Long Enough For A Gluten Challenge
You think gluten may be a problem for you so you remove gluten from your diet and feel so much better. You ask your GP to blood test you for celiac disease and youre asked to go back to eating 2-4 servings of gluten per day for six weeks first. Say what?!
It turns out that six weeks may not be long enough to re-trigger the disease so that doctors can measure the damage. Studies show that a gluten challenge may require three months or more.
A clinical review, published in 2013, of all relevant studies reporting on the clinical response to gluten challenge by adult or pediatric patients with suspected or diagnosed coeliac disease sought to determine a standardized approach regarding the amount and duration of dietary gluten necessary to provoke a clinical response in children and adults could provide guidance to physicians and investigators.
To diagnose pediatric patients with suspected CD on a gluten-free diet, a moderate-to-high dose gluten challenge for up to 3 months should be sufficient to induce changes in mucosal histology and antibodies in the majority of patients.
However, it was observed that in adults on a gluten-free diet, histological and serological relapse rates to gluten may be slower and prolonged challenge may be considered if no relapse is observed.
What to do?
A confirmed diagnosis for celiac disease provides you with the following benefits*
Giving Up Gluten Too Early A Mistake
It wasnt until well after this that I discovered that the fact I had given up gluten almost entirely for 2+ months prior to my blood test was basically invalid and that to be properly tested I would have to reintroduce gluten. By this point I had entirely given up gluten and was feeling much better for it .
I didnt even consider reintroducing gluten, the thought of eating it once again made me feel sick to the stomach so I just decided that I would permanently eat gluten free. I continued to go back and forth to the doctors because my stomach was still struggling badly.
It was a very stressful time in my life ?, having dropped out of uni and deciding whether to go back or not which definitely didnt help my gut. I was diagnosed with IBS and over the years was provided with a few different medications on prescription, none of which helped me.
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What To Eat While Waiting To Have A Blood Test
If you are having blood tests for coeliac disease, you will need to eat some gluten so that the tests can pick up the antibodies. If you take the tests without eating gluten, the results may not be accurate. You should eat some gluten in more than one meal every day for 6 weeks before you have the blood tests. You should carry on eating foods containing gluten until you have had coeliac disease confirmed by a specialist.
If you have already stopped eating gluten or have cut down, and you don’t want to eat it again or you can’t, the blood tests won’t be appropriate for you. You should be referred to see a doctor who specialises in treating people with stomach and intestine problems . They may want to perform a biopsy to find out more information. During a biopsy, your specialist will look inside your intestine for any inflammation or damage by passing a long thin tube with a camera attached down your throat and into your intestine. They will also take some tissue samples for testing. But your doctor should explain to you that it may not be possible to confirm a diagnosis of coeliac disease by having a biopsy.
Questions about finding out what is wrong
Please give me more details about the tests I should have.
What do these tests involve?
Why might a biopsy not be able to confirm the diagnosis?
How long will it take to get the results?
Can you give me any help or information about what I should and should not eat?
How Long Should I Fast Before Blood Test
You are required to fast for up to 12 hours before going for a blood test. Drinking coffee, tea or even water can affect blood test results.
Avoid Over Fasting, this particularly applies to diabetic individuals and pregnant women. Over fasting can cause dehydration and hypoglycemia in diabetics. Over fasting can also sometimes alter test results.
Make sure to carry some snacks to your physicians office so that you can eat immediately after blood is drawn. Blood glucose for postprandial levels requires you to eat and give a blood sample after an hour of a meal.
Hopefully, this article has given you a good idea about fasting for blood tests and which blood tests require fasting. These questions should additionally be clarified with your physician. This is because your physician will be able to guide you better.
Medically Reviewed By
Dr. Himanshi is a Homoeopathic consultant and currently working as a lecturer in Post-graduate faculty of Homeopathy, Parul University, Vadodara. Completed BHMS and MD in Homeopathy in January 2018 and also has a clinical experience of about 6 years. Personal interests include reading, spending time with family and traveling.
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Are You Confused About Your Celiac Disease Lab Results
We at Root Cause Medical Clinic San Jose know that, as if it wasnt hard enough to convince some doctors to do a celiac disease testlet alone one for gluten sensitivityonce you finally DO get tested, the interpretation of the results can be faulty.
While you shouldnt have to question your doctor, unfortunately when it comes to the interpretation of lab tests relating to celiac disease or gluten sensitivity, you may have to learn some test interpretation lingo in order to save your own health.
Dont worry about it being difficult to learn this data. Ill make it easy to understand. The important thing to know is that if you dont feel well, there is a reason. It may be a problem with gluten, it may be something else, but it IS something. Dont give up. If you need my help, Im here for you!
What Side Effects Can I/my Child Expect During A Gluten Challenge
While gluten challenges are uncomfortable for most people, symptoms can be different for everyone. Some people may not have side effects. Others notice symptoms return right away.
There are many side effects that you/your child might have during a gluten challenge. Side effects can include:
- Changes in bowel habits, such as constipation or diarrhea
- Bloating or gas
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What Is Being Tested
Celiac disease is an autoimmune disorder characterized by an inappropriate immune response to gluten, a protein found in wheat, and related dietary proteins in rye and barley. Celiac disease antibody tests help diagnose and monitor the disease and a few other gluten-sensitive conditions. These tests detect autoantibodies in the blood that the body produces as part of the immune response.
This immune response leads to inflammation of the small intestine and to damage and destruction of the villi that line the intestinal wall. The villi are projections, small tissue folds that increase the surface area of the intestine and allow nutrients, vitamins, minerals, fluids, and electrolytes to be absorbed into the body. When a susceptible person is exposed to gluten, the person’s body produces autoantibodies that act against constituents of the intestinal villi. When villi are damaged or destroyed, the body is much less capable of absorbing food and begins to develop signs and symptoms associated with malnutrition and malabsorption.
A tissue biopsy of the small intestine is still considered the gold standard to use to confirm a diagnosis of celiac disease, but the availability of less invasive blood tests to screen for celiac disease has reduced the number of biopsies needed.
See “How is the test used?” below for details on the tests.
What Is Coeliac Disease And When Should Testing Be Considered
Coeliac disease is defined as an autoimmune enteropathy of the small intestine, caused by exposure to dietary gluten in genetically pre-disposed individuals. In susceptible individuals, gluten ingestion generates an inflammatory reaction predominantly centered in the upper parts of the small intestine. This mucosal injury will eventually reduce the intestinal absorptive area and interfere with uptake of micronutrients.2
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Why Do Some Blood Tests Require Fasting
Certain blood tests require you to fast for 8-12 hours. The reason for asking you to fast is because when eat or drink beverages, certain nutrients, substances or vitamins enter into the bloodstream and can be responsible for giving a wrong result. Fasting before these advised blood tests ensures more accurate results.
Certain blood tests require you to not even drink water. Otherwise, drinking normal water will keep you hydrated and prevent your veins from collapsing, so drawing blood becomes easier since your veins are visible.
Avoid food, alcohol, soda or aerated drinks, tea, coffee, chewing gums and even exercising while fasting.
You need to consult your physician if you can take your regular dose of medications during fasting or adjust the dose timings for the purpose of fasting. This is because certain drugs can alter test results.
Raises Awareness Of Risks
If celiac goes untreated and/or you are still ingesting gluten, even accidentally, it can lead to intestinal damage.
This damage makes it more difficult to absorb essential nutrients properly, which can lead to deficiencies and a range of complications, such as bone loss, fertility issues, and increased risk of some cancers.
Generally, you can reduce your risk of complications by following a strict gluten-free diet. But you won’t know to do this without having undergone a gluten challenge to confirm celiac disease.
Knowing you have celiac helps your healthcare provider monitor for complications and take steps, such as recommending nutritional supplements, to avoid them.
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Do I Need To Follow A Gluten
If you have asymptomatic celiac disease, it is recommended that you follow a gluten-free diet. You will still have damaged villi in your intestines and you may have malabsorption problems that are causing silent conditions such as osteoporosis. If you have doubts about the accuracy of your diagnosis, you may want to work with your health practitioner to verify the findings.
What Does The Test Result Mean
Some celiac disease tests and possible results
|Possible celiac disease
All positive and indeterminate celiac disease tests are typically followed by an intestinal biopsy. A biopsy is used to make a definitive diagnosis of celiac disease.
If you have been diagnosed with celiac disease and you eliminate gluten from your diet, then the autoantibody levels should fall. If they do not fall and the symptoms do not diminish, then there may either be hidden forms of gluten in the diet that have not been eliminated or you may have one of the rare forms of celiac disease that does not respond to dietary changes.
If you have not consumed any gluten for several weeks to months prior to testing, then celiac disease tests may be negative. If your healthcare practitioner still suspects celiac disease, the practitioner may do a gluten challenge have you introduce gluten back into your diet for several weeks or months to see if your symptoms return. At that time, celiac disease tests may be repeated or a biopsy may be done to check for damage to the villi in the intestine.
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Why Gluten Is Needed For Celiac Tests
Whenever your body senses something foreign, it produces antibodiesblood proteins intended to “neutralize” the invader.
Gluten is, of course, not inherently harmful. But in those with celiac disease, the body believes otherwise and treats it as such.
Antibodies need time to build in the bloodstream before they can be detected by blood tests. If you think you have celiac and go gluten-free before getting an official diagnosis, your antibodies to gluten may disappear. You can have testing done, but the markers of celiac may simply not be there anymore.
Likewise, if you have celiac and don’t consume gluten for a period of time, your intestinal damage can heal. An endoscopy, which is a procedure to examine the small intestine, may not reveal any issues.
Though gluten may very well be causing your symptoms, following a gluten-filled diet in advance of testing is necessary to ensure accurate results.
In fact, that’s where the “challenge” part of a gluten challenge comes from: You are purposefully presenting the body with gluten to see if it can tolerate it.