Traditional diagnostic testing has focused on blood antibody tests and or intestinal biopsies. Unfortunately traditional tests for gluten sensitivity are often incorrect!

In the digestive process, if you are gluten sensitive, your body produces antibodies to gluten. The gold standard for confirming a diagnosis of celiac disease is a positive blood test for antigliadin IgA antibodies, anti-tissue transglutaminase, and anti-endomysial antibodies. Blood tests are inadequate to detect gluten sensitivity for several reasons: They only measure a fraction of how a person’s immune system can react to gluten. Blood tests only measure the gluten found in wheat (gliadin). The other problem is that people react to gluten in different ways. In addition, partial atrophy is ignored. You can only be guaranteed to test positive if total villous atrophy has occurred, meaning the villi are completely flattened. If you have partial or infiltrating villous atrophy, you may not test positive. The atrophy and inflammation of the villi may not be severe enough to allow all these antibodies to easily pass through the intestinal barrier. Unfortunately, by the time that total villous atrophy occurs, you are pretty sick with many symptoms. Blood tests are also incomplete because they do not identify all the antibodies in the blood. The most common antibody that a gluten-sensitive produces is antigliadin. The agent labs use for this antibody is wheat mixed into a water solution. The problem is gliadin does not dissolve in water. As a result, more than 30 gliadin peptides are not evaluated by this test. Your body may be reacting to gliadin peptides that are not picked up by these blood tests. Some people have immune reactions, intestinal problems, migraine headaches, psoriasis, osteoporosis, fibromyalgia, chronic fatigue, multiple sclerosis… The list goes on.

Some doctors are not satisfied with blood test. If blood tests come back negative but you still have symptoms, they do a biopsy. Unless significant structural damage has occurred to the villi of the small intestine, physicians rule out celiac disease and gluten sensitivity. Without total villous atrophy, doctors consider a biopsy negative even if early inflammatory changes are seen. Research has shown that the brunt of the immune reaction to gluten can affect the functions of the intestines and cause symptoms without structural damage.

Gluten sensitivity and celiac disease can be evaluated with genetic testing. Genetic testing is done by swabbing the inside of your mouth. If the mucosa tests positive, there is a high probability that you have a gluten sensitivity and may develop celiac disease. In addition, stool and salivary testing is more conclusive, however, if your total secretory IgA is suppressed, you can get a false negative.

There is usually a 30-50 year gap in medical research and its application in actual practice. Therefore, don’t expect your gastroenterologist or other specialist to start discussing gluten with you. If you have any questions on testing for gluten sensitivity or testing cross-reactive foods associated with gluten, please contact me for a free phone consultation.


The Gluten Connection: How gluten sensitivity may be sabotaging your health. Shari Lieberman, PhD, CNS, FACN.

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