Patients with autoimmune diseases many times have an association between food intake and their disease severity. This is usually due to intestinal permeability or “leaky gut”. Food antibody testing measures reactions to specific foods, which can cause inflammatory reactions at various sites in the body, including the large and small intestines, kidneys, skin, sinuses, head, joints, and lungs. Delayed food sensitivities can take from one hour to three days to appear. This type of reaction is IgG and IgA mediated and is much different from the immediate IgE (RAST) testing traditional allergists perform. Since these are a delayed response, it is almost impossible to associate a particular food and the patient’s symptoms.

Gluten sensitivity/intolerance is a major cause and contributor to autoimmune diseases. Most doctors dismiss gluten as a problem unless a person develops celiac disease. Because of this, millions suffer needlessly with a multitude of health problems.

Rheumatoid Arthritis has been shown to improve, and occasionally remit entirely, with gluten removal.1 In a recent study of this immunological link between gut immunity and RA, food IgG, IgA and IgM antibodies were measured. In the intestinal fluid of many RA patients, all three immunoglobulin classes showed increased food specific activities, including gliadin antibodies.

Traditional diagnostic testing has focused on blood antibody tests and or intestinal biopsies. Unfortunately traditional tests for gluten sensitivity are often incorrect. There tends to be a lot of false negatives.

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. Furthermore, 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 is often not 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 extremely 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.2 The best lab I found for testing many gluten proteins in the blood is Cyrex labs. They are two arrays that are great to test these proteins as well as many cross-reactive foods with gluten. Personally, I just have every patient with an autoimmune condition avoid gluten. If they don’t, I do not get the results I want.

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. This is done by using the Marsh classification. 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, you may have a gluten sensitivity or develop celiac disease. The problem with this test is 80% of the population has a gene for gluten sensitivity and you get many false positives. Just because someone has a particular gene, does not mean that it is being expressed. In addition, stool and salivary testing is more conclusive, however, if your total secretory IgA is suppressed, you can get a false negative.3

The take home message is there is a very strong correlation between gluten sensitivity and many autoimmune conditions. There are many tests out there for gluten sensitivity of which are not very accurate. Therefore, if you have an autoimmune condition, save your money on testing and completely eliminate from your diet.

1Hafstrom I, Ringertz B, Spangberg A et al. A vegan diet free of gluten improves the signs and symptoms of rheumatoid arthritis: the effects on arthritis correlate with a reduction in antibodies to food antigens. Rheumatology (Oxford) 2001 Oct; 40(10):1175-9.

2 The Gluten Connection: How gluten sensitivity may be sabotaging your health. Shari Lieberman, PhD, CNS, FACN. p. 94-101.

3Lord R, Bralley J. Alexander. Laboratory Evaluations for Integrative and Functional Medicine. 2nd Edition. Chapter 6: Organic Acids. p. 324.

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