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Which Lab Tests are Best for Celiac Disease and Gluten Intolerance?

Don’t guess. Use objective modern science to your benefit.

by Dr. Kristen Halland - @BalanceDoc

Celiac disease is complex, highly variable, and affects 1% of healthy, average people (The University of Chicago Celiac Center, 2005). That’s approximately 3 million Americans ….. which would be almost 1,000 cruise ships full of people. And, the average length of time it’s taking for a person with symptoms to get a diagnosis is four years (Green, 2006)! Some studies are even showing a mean of 11 years before diagnosis (Sodano).

Expert opinions vary greatly on the prevalence of the related conditions. For example, Dr. Fine of EnteroLabs states that 25- 50% of Americans may experience a reaction when consuming wheat. Conversely, Dr. Fasano (researcher and director of the Center for Celiac Research at the University of Maryland) states that 6% of the United States may be gluten sensitive.

Examples of symptoms common to both conditions; though please note that there’s over 200 and can vary greatly:

  • Abdominal pain and bloating
  • Constipation
  • Diarrhea (a study done by the Celiac Disease Center at Columbia University Medical Center in New York revealed that 85% of patients celiac-disease-proven-by-biopsy reported diarrhea). 
  • Fatigue
  • Irritability or behavior changes
  • Headaches or migraines
  • Canker sores
  • Itchy skin rashes
  • Other conditions, such as: type I diabetes, osteopenia, IBS, thyroid disease, Sjogren’s, intestinal cancer, anemia, infertility, depression

Let’s clarify the difference between three conditions related to gluten or wheat:

Celiac Disease

  • Also known as Nontropical Sprue (sprue refers to diseases that damage intestinal mucosa).
  • A complex autoimmune disease with severe consequences.
  • The consumption of gluten, gliadin, and wheat proteins activate the immune system. This results in tissue destruction of the intestines and causes malabsorption of nutrients.  
  • There are no pharmaceutical treatments or cures for this condition. The only known treatment is a strict 100% gluten free lifestyle.
  • People with a first-degree relative with Celiac Disease have a 1 in 10 chance of developing it (Celiac Disease Foundation).

Non-Celiac Gluten Sensitivity (NCGS)

  • Also known as Non-Celiac Wheat Sensitivity (NCWS) or Gluten Intolerance
  • An emerging disorder where the consumption of gluten-containing foods causes symptoms (and subsequent tissue damage resulting in a “leaky gut” lining) associated with CD.
  • This is not a genetic condition. It is not an IgE allergic reaction and it is not an autoimmune reaction. It’s a reaction to stress, chemicals/toxins, and infections (Sodano).
  • Reactions can begin up to 48 hours after ingesting gluten and last for much longer (Gluten Intolerance Group).
  •  

Gluten or Wheat Allergy

  • This is an “allergic reaction” IgE response by the immune system to the hundreds of proteins in wheat.
  • Continued exposure to gluten causes the mast cells to release histamine thus triggering respiratory distress, urticaria (hives), anaphylaxis, swelling of the lips or face, or other allergic responses.
  • Wheat is one of the 8 most common allergies in the United States today. If diagnosed in childhood, it’s possible the allergy may be outgrown (Gluten Intolerance Group).
  • The only treatment available is a strict 100% wheat-free diet.

An excerpt from Functional Medicine University explains a pivotal study by Linus Pauling Award Winner Dr. Alessio Fassano on the impact of gluten on the non-celiac gut:

“The study explored the effects of the protein gliadin, a component of gluten that triggers immune responses in some patients, on the integrity of the intestinal barrier. Researchers took duodenal biopsies from four populations: patients with active celiac disease, patients with celiac disease in remission, patients with gluten sensitivity, and patients with no known gluten reactions. In all of the groups, intestinal permeability was significantly increased ("leaky gut") by exposure to gliadin; altered gut barrier function was especially pronounced for those with active celiac disease and those with gluten sensitivity.

In the images below, you’ll see two examples of the difference between a healthy gut lining and a gut lining affected by Celiac disease. Our intestinal villi (or, “little fingers”) in the tissue are degraded in this condition, which makes absorption of nutrients limited.

Image Credits: Celiac Disease Foundation and UCLA

Testing Options to Evaluate CD and NCGS:

There is no one single definitive test – a diagnosis like this will require accurate lab testing and clinical correlation. The symptoms of CD or NCGS could be caused by other allergies or intolerances, or an imbalanced gut microbiome. There are several other tests not mentioned here, but allow me to highlight the most common options.

  1. Screening with labs
    1. Genetic testing (specifically of the HLADQ2 and HLA-DQ8 genes) may indicate if a person is a carrier for celiac disease, but not if they have the disease.
      1. 99% of those with celiac disease have either one or both of these genes (Brighten).
  1. Serum IgA with Tissue Transglutaminase Antibodies (tTG IgA and tTG IgG) are very sensitive and is a first-line marker if the person is untreated (meaning, they aren’t 100% strictly gluten free).
    1. The considerable room for error and false negatives with these tests are because of limits in testing. Gluten is actually made up of several hundred peptides and gliadin is made up of 12 sub-fractions (Myers).
  1. A true diagnosis of Celiac Disease is done through a biopsy of the small intestine – this is considered the gold standard.  False blood tests (see above) are possible and in autoimmune conditions, it’s important to have an accurate diagnosis (Brighten).
  1. RAST or skin-prick test can be done to evaluate IgE food allergies, such as wheat.

Additional Testing that your Physician potentially may order for patients with CD or NCGS:

  • CBC and CMP
  • CRP and ESR (for inflammation)
  • Food Allergy Testing
  • Food (and Chemical) Sensitivity Testing
  • Nutrient deficiency testing
  • Gut tests such as stool testing, a Lactulose-Mannitol Test (for intestinal permeability)
  • A SIBO breath test, or urine organic acids
  • Dexa scan (to evaluate bone density)
  • Assessments, questionnaires, and diet journaling
  • And others dependent upon presentation or preventative concerns….

This has been a concise overview of the differences between three conditions involving gluten or wheat and it makes sense that different etiologies require unique approaches! Please work with your functional medicine practitioner, integrative nutritionist, or primary care physician to begin understanding the cause of your symptoms. When you understand the cause, you get the best results.

Please keep reading next week's article on The 5 Steps to Healing the Gut or see our Celiac / Gluten Free Starter Kit more information.

www.TheBalanceDoc.com

References

Brighten, J. Celiac Disease – more than just a tummy ache [Web Article]. Retrieved from https://drbrighten.com/celiac-disease-tummy-ache/.

Beyond Celiac. (2016). Celiac Disease Symptoms Checklist. Retrieved from https://www.beyondceliac.org/celiac-disease/symptoms-checklist/.

Celiac Disease Foundation. (2017). What Is Celiac Disease? Retrieved from https://celiac.org/celiac-disease/understanding-celiac-disease-2/what-is-celiac-disease/.

Gluten Intolerance Group. (2016). Celiac Disease, Non-Celiac Gluten Sensitivity, or Wheat Allergy: What is the Difference? Retrieved from https://www.gluten.org/resources/getting-started/celiac-disease-non-celiac-sensitivity-or-wheat-allergy-what-is-the-difference/.

Green, P.H. et.al. Characteristics of adult celiac disease in the USA: results of a national survey. American Journal of Gastroenterology, 2006.

Kresser, Chris. (November 13, 2014). Which Lab Tests are Essential? [Web Article]. Retrieved from https://chriskresser.com/which-lab-tests-are-essential/.

Myers, A. How to test for Gluten Intolerance and Celiac disease [Web Article]. Retrieved from http://www.amymyersmd.com/2013/07/how-to-test-for-gluten-intolerance-and-celiac-disease/.

Rubio-Tapia A, et al. The prevalence of celiac disease in the United States. Am J Gastroenterol. 2012 Oct;107(10):1538-44; quiz 1537, 1545. doi: 10.1038/ajg.2012.219. Epub 2012 Jul 31.

Sodano, W. and Grisanti, R. Functional Diagnostic Medicine Training Program – Module 3. Functional Medicine University. Retrieved from http://www.functionalmedicineuniversity.com/fdmt527aig.pdf.

Spectracell Laboratories. (2016). Micronutrient Testing in Celiac Disease – When a Gluten-Free Diet is Not Enough. Retrieved from: http://www.power2practice.com/micronutrient-testing-celiac-disease-gluten-free-diet-not-enough/?inf_contact_key=25fac9a84238dae1ba746faf109cc719ef4172cb0b8d0ff36934b5e031861cf3.

The University of Chicago Celiac Center. (Aug 2005). Celiac Disease Facts and Figures. Retrieved from http://www.uchospitals.edu/pdf/uch_007937.pdf.

Williams, J.E. (Sept 1, 2016). Learn the best tests for Celiac disease and non-Celiac gluten sensitivity [Web Article]. Retrieved from http://renegadehealth.com/blog/2016/09/01/learn-the-best-tests-for-celiac-disease-and-non-celiac-gluten-sensitivity/.

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