Blood Panels That Might Suggest A Problem
The following tests are often conducted by thorough doctors when evaluating patients for a non-celiac gluten sensitivity, a gluten intolerance or a verified case of celiac disease:
- Stool Fat test, to determine malabsorption level .
- Complete Blood count , to determine anemia.
- Erythrocyte Sedimentation Rate to look for inflammation.
- C-Reactive Protein to further watch for chronic inflammation.
- Vitamins A, D, E and K to check for vitamin deficiency relating to malabsorption in the proximal small intestine.
- Comprehensive Metabolic Panel to analyze protein, calcium and electrolyte levels as well as to check liver and kidney functions.
Ive also had readers inform me that theyve had doctors test and confirm a Non-Celiac Gluten Sensitivity with the gliadin IgG non-deamidated antibody test. I think many doctors and researchers would consider this too simple and narrow, but at least some anecdotal evidence suggests otherwise.
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.
The Saliva Gliadin Test
The saliva test is easy, can be done at home and is good as a screening tool since it tests only for gliadin, one small component of gluten. If your test is positive then you do have an immune reaction against that part of gluten, and need to avoid it.
However, if your test comes back normal, you may still have a reaction against other parts of gluten.
Since it can result in false negatives, the saliva test is best for someone who is not at high risk, for example, someone who does not have an immediate family member with gluten issues. I will use this as an add-on when running other tests when the suspicion of gluten intolerance is low.
If you have chronic health issues, an auto-immune condition, gut problems or brain fog then a more comprehensive test is indicated.
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Gluten Intolerance Testing At Home
I have found the single best way to determine if you have an issue with gluten is with an elimination diet. This means you remove gluten from your diet for at least 30 days and then reintroduce it. Please note that gluten is a very large protein. It can take months or even years to completely clear from your system. The longer you can eliminate it from your diet before reintroducing it, the better.
Heres the simple advice that I shared with all the patients in my clinic: If you feel significantly better when youre not eating gluten and worse when you reintroduce it, then gluten is likely a problem for you. Remember, to get accurate results from this testing method you must eliminate 100% of the gluten from your diet.
Celiac Disease Vs Gluten Sensitivity
Before discussing gluten sensitivity in depth, some distinction should be made between it and its cousin, Celiac disease. Celiac disease is an autoimmune condition affecting numerous systems in the body. But its main target is the digestive tract.
Gluten sensitivity on the other hand simply implies that there is some type of immune reaction occurring to gluten in the diet. For you clinical types, this immune reaction can be detected by anti-gliadin antibodies in the serum, stool or saliva.
In the end, the primary difference between the two is whether or not there is intestinal damage.
Gluten sensitivity + Intestinal damage = Celiac Disease
Gluten sensitivity + No intestinal damage = Gluten Sensitivity
Now, you might think that gluten sensitivity only occurs in a small percentage of the population, just like with Celiac Disease. If so, you might be surprised to learn that in non-celiac disease patients, anti-gliadin antibodies can be found in as high as 35 percent of the population.
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Complications Related To Diet
Carefully following a gluten free diet is very important for good management of coeliac disease. Long-term complications can occur when a gluten free diet is not followed. These include:
- increased risk of bowel lymphoma
- infertility
- chronic ill health
The risk of these complications is the same as the rest of the population when a gluten free diet is followed.
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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Celiac Disease Is More Common Than Most Doctors Realize
Many doctors still consider celiac disease to be relatively rare , so if your doctor doesnt bring up the possibility of celiac disease, you need to speak up and be your own health advocate.
According to recent research published in the BMC Journal, The mean delay to diagnosis from the first symptoms was 9.7 years, and from the first doctor visit it was 5.8 years. What this means is that, on average, it is taking doctors nearly six years to properly diagnose celiac disease after a patient first visits his or her doctor complaining about symptoms. Right now, millions of people all over the world are walking around with celiac disease but dont realize it.
In addition, please note that just because you test negative for celiac disease does not mean with certainty that you still do not have some form of gluten intolerance. It also does not preclude the possibility of a wheat allergy. For more on these distinctions, please read gluten intolerance symptoms.
Note that as of March 2011, a gluten sensitivity may exist as its own clinical entity, separate from celiac disease. Many doctors and researchers currently believe the only way to distinguish this form of gluten intolerance from celiac disease is to do an intestinal biopsy. This new condition has become widely known as NCGS, for non-celiac gluten sensitive.
Is There A Gluten Intolerance Test
If you often feel bloated or get constipation and stomach pain after eating, you should first be examined by your doctor before cutting things out of your diet or deciding to go gluten-free.
If you get the medical all-clear and think certain foods could be contributing to your symptoms, it is worth considering a food intolerance test. Food intolerance is characterised as a delayed onset food reaction and is estimated to affect 45% of the UK population.
Understanding your personal food and drink intolerances, or food fingerprint, can help you identify what your body is reacting to. A YorkTest Premium Food Intolerance Test can pinpoint precisely which foods are causing elevated levels of IgG antibodies in your blood, as it tests reactions to more than 200 ingredients and shows your degree of reaction through a traffic light system.
It is also important to get expert nutritional advice, so you can replace your trigger foods with balanced alternatives and maintain a healthy diet.
Dr Gill Hart, Scientific Director at YorkTest, says:
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What To Do If You Are Sensitive To Gluten
For sensitive individuals, avoiding gluten is mandatory for healing the gut lining, calming inflammation and restoring immune balance.
Depending on the level of sensitivity, eating out can be challenging, as many gluten-free foods can be contaminated if prepared in the same kitchen or fried in the same oil as gluten foods.
To remedy this you can preemptively take gluten digesting enzymes to block some of the inflammatory effects of ingesting trace amounts of gluten.
If you dont eat out, gluten exposure may still be an issue for you. Spices are notorious for being gluten contaminated. Nuts can be also.
You can test the foods at home with a Nima. This gluten-testing device uses small capsule to test samples of food for gluten. Put a mix of kitchen spices into the Nima and if it comes back positive, you need to test each spice. You use the Nima at restaurants to test your food before you eat it.
Its a good idea to double check that your supplements dont have hidden traces of gluten. Many supplements are certified gluten free.
In some cases, if gluten sensitivity is mild and caused by lack of enzymes, biome imbalances, leaky gut or inflammation, fixing these issue could reverse the sensitivity. If so, gluten will no longer trigger inflammation for you.
Symptoms Of Gluten Intolerance
Symptoms of non-celiac gluten sensitivity can manifest in many different ways. Here are the five most common signs of gluten intolerance in the absence of celiac disease:
- Gastrointestinal effects.
- Brain fog.
Gastrointestinal Effects
Skin Rash
Weinandy notes that a skin rash can sometimes signal a problem with gluten, and a family member of hers gets an eczema-like rash whenever he eats gluten. She says on several trials of taking gluten out of the diet and then trying to reintroduce it, the rash came back. Its amazing the difference.
However, some people with celiac disease also present with a skin rash as their primary or only symptom, a condition called dermatitis herpetiformis. If youve noticed a skin rash that seems linked to consuming gluten, you should have it biopsied by a dermatologist or have blood tests run by a gastroenterologist to rule out DH. People with DH who dont have any digestive symptoms may still be doing damage to their intestines when they consume gluten, so obtaining a proper diagnosis is key.
Migraines
Joint Pain
Brain Fog
Weinandy says brain fog or frequent difficulty focusing, concentrating or just an inability to think straight is also sometimes associated with gluten sensitivity or celiac disease. Again, inflammation seems to be the culprit in triggering this symptom.
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New Study Confirms This Theory
A new Norwegian study published in Gastroenterology looked at 59 people who did not have celiac disease yet found digestive relief with a gluten-free diet .
Subjects were randomly assigned to eat seemingly identical muesli bars with either gluten, fructans, or neither for seven days.
They then crossed over into a different group, until they had completed all three bar diets and recorded their digestive symptoms.
Researchers found that symptoms of IBS, especially bloating, were 15% worse after eating the fructan muesli bar compared to placebo.
Interestingly, the gluten bar had no effect on symptoms, which suggests gluten is not the culprit after all.
Lead author Gry Skodje believes these findings strongly support the idea that fructans in wheat are the trigger of digestive symptoms, not gluten.
It also helps explain why researchers have been left stumped trying to figure out how gluten causes issues for non-celiacs.
Ideally, the next step would be a larger study that controls the participants outside food intake as well.
Summary: Research shows 4 in 5 people who believe they are sensitive to gluten are actually not. A new clinical trial suggests the likely cause of their digestive symptoms are fructans, which are also found in wheat.
Is Gluten Making You Sick
Coeliac disease is an autoimmune disorder caused by a sensitivity to gluten. Exposure to gluten triggers an immune response which causes inflammation of the lining of the small intestine and can lead to abdominal pain, bloating and diarrhoea. Left untreated coeliac disease can also affect nutrient absorption resulting in additional symptoms such as anaemia, fatigue and headaches. In chronic cases, coeliac disease can even cause liver disease, diabetes, cancer, osteoporosis and even infertility. That’s why we’ve design this simple test.
If you have a family history of coeliac disease then its important to consider screening. But also consider this test if you are deficient in iron or other nutrients, have gastrointestinal symptoms, unexplained infertility, liver disease, or other autoimmune disease such as diabetes or thyroid disease. Coeliac disease is controlled by eliminating gluten from the diet – this helps to heal the small intestine, manage symptoms and reduce the long-term risk of complications.
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What Is A Fructan And Fructan Intolerance
Fructans are a type of short-chain carbohydrate often referred to as FODMAPs.
They can cause unpleasant digestive symptoms for sensitive people, especially those with irritable bowel syndrome and inflammatory bowel disease .
Fructans occur in large quantities in:
- wheat, barley and rye
- raisins
- watermelon
Those who experience digestive problems after eating fructans very likely have a fructan intolerance. Its basically the same concept as those with a lactose intolerance who eat dairy, or those with a fructose intolerance who eat honey.
Summary: Fructans are a type of carbohydrate often referred to as FODMAPs. They are likely to cause strong digestive symptoms in those who are fructan intolerant. Rich sources of fructans include wheat, garlic, onion, chickpeas and more.
But I Have Tried A Gluten
People with gut symptoms such as abdominal pain, bloating, wind and diarrhoea often feel better on a gluten-free diet. As explained above, this may mean you have IBS.
Removing gluten from your diet may have also removed the irritant causing the symptoms, such as the FODMAP fructan, which is found wherever there is gluten. It is better to get help from a dietitian to work out which is causing your symptoms so you only remove the food you need to.
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Its Not The Gluten But Gluten
The reason a gluten-free diet helps you feel better even though you arent sensitive to gluten is simple.
Gluten-free grains are automatically low in FODMAPs .
Likewise, the removal of gluten from wheat also removes the majority of FODMAPs. Thats why low FODMAP diet plans are gluten-free.
So by choosing gluten-free breads, pastas and cereal, people have inadvertently been cutting out their fructans as well, leading to symptom relief.
For this reason avoiding gluten can still be particularly useful for those with fructan intolerance.
A Special Note About Celiac Disease Testing
One important note to remember: if you are concerned that you may have Celiac Disease, speak with your healthcare provider before introducing gluten into your diet. In the event that you do have Celiac disease, it can be hazardous to your health. Celiac Disease is covered in greater detail in this blog post.
Science Based Amy Myers, MD
Amy Myers, M.D. is a functional medicine physician, trained and certified by The Institute of Functional Medicine. Dr. Myers earned her Doctor of Medicine at the LSU Health Science Center, and completed her Emergency Medicine residency at the University of Maryland Medical Center.
Dr. Myers retired from her functional medicine clinic, Austin UltraHealth, where she served thousands of patients, to empower those who were failed by conventional medicine. Shes a 2x New York Times bestselling author, and the founder and CEO of the health & lifestyle e-commerce brand, Amy Myers MD®.
Do you experience bloating, diarrhea, abdominal pain, or headaches after eating bread and other products containing wheat, barley, or rye? You could have a gluten intolerance, also known as non-celiac gluten sensitivity. Fortunately, gluten intolerance testing can help you pinpoint the problem.
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