How Is Gluten Intolerance Treated
Theres no cure for gluten intolerance. But most people find relief from symptoms by following a gluten-free diet. You should work with your healthcare provider and a dietitian to plan your diet.
You can also ask your healthcare provider about adding probiotics to your diet. Probiotics help increase the good bacteria in your gut. They may reduce symptoms of bloating, gas or constipation.
Some research suggests that taking certain enzymes may help you digest gluten. But experts are still investigating this treatment. Talk to your healthcare provider before taking any enzymes.
What Does The Test Measure
Each type of at-home celiac disease test provides specific measurements. Two types of at-home tests are antibody tests and genetic tests.
Antibody tests
One type of at-home test measures antibodies in the blood that are associated with celiac disease. The immune system develops antibodies to help defend the body. Antibodies typically work by focusing on a specific foreign target, such as a virus or bacteria. However, in autoimmune disorders, antibodies target a persons own healthy tissue. These are known as autoantibodies.
When people with celiac disease eat a gluten product, their body usually produces certain autoantibodies. At-home antibody tests can measure one or more of these autoantibodies that may be present when a person is consuming gluten.
Examples of these autoantibodies that may be detected in at-home testing include:
- Anti-tissue transglutaminase antibodies immunoglobulin A
- Anti-tissue transglutaminase antibodies immunoglobulin G
- Anti-endomysial antibody
Tests can also look for antibodies that target a part of the gluten protein called gliadin. Examples of these antibodies include:
- Anti-deamidated gliadin peptide antibodies immunoglobulin A
- Anti-deamidated gliadin peptide antibodies immunoglobulin G
Genetic tests
Genetic tests are another option for at-home celiac disease testing. These tests look for specific variations in a persons DNA that are associated with celiac disease.
Signs And Symptoms Of Gluten Sensitivity
Gastrointestinal-related gluten sensitivity symptoms
There are a number of gastrointestinal symptoms that can be related to the foods we eat, including gluten-containing foods.
- Bloating is an uncomfortable feeling of fullness that comes on after eating and is a possible sign of gluten sensitivity. But itâs important to keep in mind there may be other foods, or other factors, contributing to bloating.
- Abdominal pain can happen for many possible reasons, and it may be one of the signs of gluten sensitivity.
- Diarrhea and constipation are other symptoms that may be related to gluten sensitivity.
Having occasional digestive issues can be normal, but if you experience gastrointestinal symptoms frequently, sensitivity to gluten may be the reason why. Other conditions to consider as possible causes of gastrointestinal symptoms include irritable bowel syndrome , inflammatory bowel disease , lactose intolerance, and celiac disease.
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Explanation Of Gluten Intolerance Blood Test Results
One simple blood test is all that may be needed to determine if a person has a gluten intolerance issue or is suffering from Celiac disease. In both instances, there will discomfort within the digestive tract whenever gluten products are consumed. When Celiac disease is present, then there will be specific antibodies present that can be measured through the gluten intolerance blood test. In order for the test to be accurate, an individual must be eating gluten-containing foods for the antibodies to develop.
This means the first step in the diagnosis process for gluten intolerance and to distinguish it from an allergy to wheat or Celiac disease is to test for these antibodies. The name of this particular test is the tTG-IgA blood test. Its the most sensitive test out of all the blood tests which are available. 98% of people who have Celiac disease will test positive on this blood test.
A negative result does not confirm that the bothersome signs and symptoms are due to a gluten intolerance issue. 2% of the population with Celiac disease will also test negative on the tTG-IgA blood test. For this reason, additional testing is often ordered if this first gluten intolerance blood test comes back as being negative.
Are There Nutrients Of Concern For Someone Following A Long
Because gluten-free diets exclude many whole grains, people who follow the diet long term may need to supplement their intake of magnesium, selenium, riboflavin, niacin, and thiamine, which are minerals and B vitamins found in wheat and other gluten-containing grains, says Beacom. Additionally, they may have an increased need for folic acid, which is often added to enriched wheat products, and most gluten-free products are not enriched with vitamins and minerals.
A 2019 study suggests that people who have been following a gluten-free diet for six months or longer should test for nutritional deficiencies, such as low levels of folic acid, vitamin B12, vitamin D, calcium, iron, zinc, selenium and magnesium. They should then work with a registered dietitian to find strategies to increase non-gluten sources of these nutrients and/or establish a personalized supplementation plan.
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Symptoms And Causes Of Celiac Disease
People who have celiac disease commonly experience weight loss, as well as digestive symptoms, including diarrhea, abdominal pain, and bloating.
Some people notice mental and emotional symptoms, such as an inability to concentrate, commonly described as brain fog, or depression.
Not everyone with celiac disease experiences the same symptoms. Some people have no digestive complaints whatsoever, yet routine blood tests reveal low levels of vital nutrients, such as iron, vitamin B12, or vitamin D. NYU Langone doctors take all of these signs and symptoms into account when making a diagnosis.
The exact cause of celiac disease remains largely unknown. However, more than 99 percent of people with celiac disease test positive for two genetic variations known as HLADQ2 and HLADQ8. Not everyone who carries these variations develops celiac disease in fact, most people dont.
Some theories suggest environmental factors trigger celiac disease in people with these genetic variations, but more research is needed. Researchers have found that a family history of the disease increases a persons risk.
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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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.
When To See A Doctor
Home tests may indicate whether a person has celiac disease, but anyone with symptoms of gluten intolerance may have to visit their doctor for a diagnosis.
No effective gluten sensitivity blood or stool tests exist. Doctors diagnose it by ruling out other conditions and encouraging the person to try an elimination diet.
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What Foods Contain Gluten
Avoid the following items if you have gluten sensitivity:
- Barbecue sauce
Apart from the symptoms mentioned above, individuals with gluten sensitivity experience the following symptoms:
Gastrointestinal Symptoms
Gastrointestinal symptoms may occur as a result of gluten-containing foods. You may have gluten sensitivity if you experience:
- Bloating- An uncomfortable and persistent feeling of fullness that surfaces after eating or drinking something rich in gluten. However, remember that various other foods and factors can also cause bloating
- Abdominal Pain- Abdominal pain may occur due to the release of the bacteria residing on your stomachs tract lining. If these bacteria leak through your body and attack your intestine, youll likely experience inflammation and severe abdominal cramps
- Diarrhea and Constipation- Both are symptoms related to gluten sensitivity, but it can happen for a variety of different reasons, such as wheat allergy or gluten tolerance
Extra-intestinal Symptoms
In addition to gastrointestinal symptoms, people with gluten sensitivity report the following non-gastrointestinal signs:
- Anemia
- Headache and migraines
- Iron deficiency
To ensure an appropriate diagnosis, start creating a food journal. Write down which foods trigger a particular symptom and show it to your healthcare doctor during your next visit.
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.
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Gluten Intolerance: Foods To Avoid
Gluten is found in wheat, rye, barley and any foods made with these grains. It can be difficult to identify all the foods you need to avoid, as these grains are often used as thickening agents in processed foods, sauces and even meat products. It is important to thoroughly check labels for ingredients. Foods to avoid if you experience symptoms of gluten intolerance include:
- Wheat
- Couscous
- Rye
Genetic Testing For Celiac Disease
The most established genetic test is specific to celiac disease and not necessarily for a wheat allergy, a non-celiac gluten sensitivity or a broader intolerance. But it can help either verify the presence of celiac disease or identify people who may be predisposed to developing celiac disease. Because it can be done in a non-invasive manner , this celiac disease genetic test is often done for at-risk children.
The test looks for the HLA-DQ2 and HLA-DQ8 genes. If one or both genes are present and the patient has a family history of digestive concerns, the individual is at a greater risk of developing celiac disease at some point in his or her life.
Please note, however, that it is still possible to have these genes and not develop celiac disease. In fact, around 35% of the general population has these genes while around 1% of the population has celiac disease. That means millions of people have the so-called celiac gene but do not have celiac disease.
So this test is usually either to take preliminary steps in identifying and helping at-risk individuals or to help confirm a diagnosis begun with some of the tests listed earlier in this lesson.
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Are There Any Dangers To A False Diagnosis Of Non
The below response comes from Daniel Leffler, MD, MS, Director of Clinical Research, The Celiac Center at BIDMC, Director of Quality Assurance, Division of Gastroenterology, Beth Israel Deaconess Medical Center following the December 2012 webinar, You Ask, We Answer: 60 Minutes with Top Celiac Disease Researchers.
Since the only treatment for non-celiac gluten sensitivity is a gluten-free diet, as long as you receive proper nutritional counseling and keep a healthy balanced diet, there is no danger to this treatment. However, it is important to recognize that many gastrointestinal diseases present with similar symptoms, so the real danger is that in assuming a person has non-celiac gluten sensitivity, they are not evaluated appropriately and a more serious illness is missed and allowed to progress untreated.
What Are The Signs & Symptoms Of Celiac Disease
Common symptoms of celiac disease are diarrhea, decreased appetite, stomachache and bloating, poor growth, and weight loss. Many kids are diagnosed with it when theyre between 6 months and 2 years old, which is when most kids get their first taste of gluten in foods.
For some people, the problems start slowly and the symptoms may be terrible one week and not as bad the next. Because of this, some people arent diagnosed with celiac disease until theyre older. The problem is chronic, which means that although symptoms may come and go, people who have celiac disease will always have it.
Someone with celiac disease may feel tired and could be irritable. Some also have skin rashes and mouth sores. The problem is sometimes mistaken for other digestiveproblems called inflammatory bowel disease or lactose intolerance. And in some cases, a kid wont have any symptoms and then will all of a sudden start having problems during a time of stress, such as after an injury.
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With the gluten-free diet gaining popularity year over year including gluten-free options getting major traction on menus and store shelves many people are reaching for gluten-free choices. In fact, 30% of adults are interested in avoiding or cutting down on gluten in their diets, according to a recent study conducted by the NPD Group, a consumer research firm. But sometimes people opt for gluten-free foods without really understanding the difference between celiac, gluten sensitivity or other reasons for going gluten-free.
How Many Forms Of Gluten Intolerance Exist
This surprises some people , but there is more to gluten intolerance than celiac disease. While it is still considered the most serious medical condition among them, celiac disease is only one of several significant medical conditions triggered by the consumption of this troublesome protein composite.
- Celiac Disease
- Dermatitis Herpetiformis
- Gluten Ataxia
Along with gluten ataxia, a growing number of gluten-sensitive idiopathic neuropathies are being diagnosed. Collectively medical researchers now refer to these conditions as gluten-related disorders.
Unfortunately, each of these conditions require a different means for diagnosis and with two of them, NCGS and gluten ataxia, doctors and researchers havent yet agreed upon a consistent and accurate way to perform diagnosis.
In addition, one form of gluten intolerance, dermatitis herpetiformis, requires a skin biopsy, not blood work. Also, doctors and researchers havent yet agreed on how to identify a non-celiac gluten sensitivity in a consistent and accurate manner, other than to rely on a diagnosis by deduction.
In other words, if a gluten challenge reveals a problem with gluten but the patient tests negative for both celiac disease and a wheat allergy, then the patient will be diagnosed as non-celiac gluten sensitive .
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Gluten And Your Brain
Gluten has particular reactivity to our nervous system and is no longer considered to be a gut issue. Our brain and nervous system governs our perception, mood and quality of life. When our nervous system deteriorates, our life deteriorates.
Research has correlated gluten sensitivity to seizures, neuropathies, ADHD, Alzheimers, MS, migraines and even EEG anomalies .
One study concluded, Gluten sensitivity can be primarily, and at times exclusively, a neurological disease.
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:
- Amenorrhea
- 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.
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