As discussed in the previous article: celiac disease, food allergies, and gluten sensitivities are three very different beasts. Each requires a separate screening process and a different level of treatment.
To recap: If you have a gluten allergy, it’s mediated by an IgE immune cell which will cause itching and sometimes difficulty breathing (like a peanut allergy) almost immediately after eating wheat. If you have a gluten sensitivity, it’s mediated by an IgG immune cell, which may take up to 72 hours for more insidious symptoms like headaches, aches and pains, and neurological symptoms (including mood disorders) to show up, making the root cause harder to diagnose if you’re not looking for this connection.
And then there is Celiac Disease, an autoimmune condition triggered by gluten exposure. This means that due to a genetic variant, some people’s immune systems are triggered by gluten to attack their own cells. This causes damage to the small intestine. When left untreated, individuals are at serious risk of developing other autoimmune diseases (such as Hashimoto’s thyroiditis, type 1 diabetes, and multiple sclerosis), anemia, cardiovascular disease, osteoporosis, neurological conditions (including epilepsy), and intestinal cancers.
Fortunately, Celiac Disease is very easy to treat with appropriate laboratory screening, gluten removal, and protocols which heal the small intestine and decrease inflammation throughout the body. Unfortunately, most doctors aren’t trained to properly screen for or treat Celiac Disease. Further, many people go gluten-free without getting tested for Celiac Disease, feel better, and decide to stay off gluten for good; and once you’re on a gluten-free diet you can’t screen for Celiac Disease anymore, because your body won’t produce the antibodies that are measured in the blood test.
There are some very practical reasons to differentiate between gluten sensitivity and Celiac Disease. If you have Celiac Disease you will need to operate a 100% gluten free home and be very careful about gluten contamination at restaurants and where you shop. Recent studies have shown that even one gluten exposure can elevate antibodies for up to 3 months, which means that your immune system is attacking your small intestine. Additionally if you are diagnosed with Celiac Disease your insurance plan will be more likely to cover the medical costs related to your condition and you can claim extra costs incurred on a gluten free diet as a medical expense on your income tax return.
The screening lab work for Celiac Disease is a simple panel of blood tests that can be done at any lab. These tests are most accurate if you’ve been eating the equivalent of 1 piece of wheat bread per day or more for 30 days. Otherwise, you risk a false negative result.
If you’re interested in getting screened for Celiac Disease ask your doctor about ordering a Celiac Screening Panel which includes the following tests:
Deamidated Gliadin Peptide IgA
Deamidated Gliadin Peptide IgG
Tissue Transglutaminase IgA
Tissue Transglutaminase IgG
If the Celiac Screening Panel is positive your doctor will refer you to a gastroenterologist who will confirm the diagnosis by intestinal biopsy. This is done during a colonoscopy and is the only way to inspect your intestinal cells to confirm the diagnosis of Celiac Disease and assess the damage.
You can also test whether you have the genetic variant associated with Celiac Disease by ordering HLA Genetic Typing for Celiac Disease (HLA-DQB2 and HLA-DQB8). Please note that 30% of people have the gene for Celiac Disease, but only 1% go on to develop Celiac Disease. However, if you don’t have the gene it’s not impossible, but highly unlikely that you would develop Celiac Disease.
So, what if your genetic tests and screening celiac panel are negative? Does that mean that gluten is a healthy food for you?
At this point you have a little detective work to do. If you’ve ruled out Celiac Disease with these blood tests, now it’s time to test for gluten sensitivity. There are IgG antibody panels that you can run to screen for food sensitivities including gluten, but I prefer to do an elimination and reintroduction diet for 30 days.
Elimination and reintroduction is the gold standard of testing and while food sensitivity lab work can be interesting, we still don’t know how accurate it is. I’ve seen the results change when folks were eating a lot of a certain food (like during raspberry season) or after completing a gut healing protocol. For those reasons I recommend the elimination and reintroduction diet first, and conduct food sensitivity testing only when it’s absolutely necessary.
The elimination and reintroduction diet is exactly what it sounds like. First you remove inflammatory foods from your diet for 30 days, giving your immune system time to reset. Then you reintroduce foods you want to test, one by one, 72 hours apart from each other, observing your system’s reaction during each 3-day span.
This is a very effective way to heal and identify the cause of your food sensitivity symptoms. I often use a protocol similar to the Whole30, especially because it’s important to eliminate all grains and sugar to achieve the level of digestive healing during the elimination phase. Then you can test gluten, rice, and corn separately and know which grains work for you and which ones don’t.
In addition to removing foods that are causing inflammation from your diet, it’s important to add foods that are healing to your digestive system and provide your body with all the nutrition needed to set yourself up for maximum energy, comfort, and enjoyment. We’ll talk about healing foods and gut healing helpers in the next article.
Dr. DeFrancesco partners with patients seeking a smarter & sustainable approach to health by doing the detective work to uncover root cause(s) and design a personalized and comprehensive plan that includes nutrition, lifestyle, functional medicine, and root cause therapies.
This approach benefits people who are seeking help with chronic inflammatory conditions, autoimmunity, thyroid conditions, digestive problems, brain health, and health optimization.