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Old 11-25-2009, 09:57 PM
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Default Testing for gluten intolerance

I have been reading "Healthier without Wheat" by Dr. Stephen Wangen, which I picked up from the library. In it, he says that the blood test for gliadin antibodies is a good test for gluten intolerance. I've tested negative for this more than once, so wonder if this means it is a lot less likely that I have gluten intolerance (his phrase, not sure if this is different than gluten insensitivity)

Thanks and Happy Thanksgiving

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Old 11-26-2009, 04:59 AM
Razzle0 Razzle0 is offline
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As far as I know, the specific blood test for "gluten sensitivity" is anti-gliadin IgG. Celiac disease usually requires an elevated anti-gliadin IgA and/or IgG along with an elevated anti-tissue transglutaminase (however, there are cases where these numbers are normal and yet the small bowel biopsy says Celiac; there are also cases of Celiac in which the biopsies are negative initially but as the person continues to eat gluten, they get sicker, and upon retest, they are positive on biopsy).

It is generally thought that Celiac is a subset of Gluten Sensitivity in which there is an autoimmune reaction against the small intestine in response to ingested gluten. In Non-Celiac Gluten Sensitivity, there may or may not be an autoimmune response, but the immune system is still involved in symptoms.

Take care,

-Razzle
Gluten Sensitivity, dx via EnteroLab 7/05
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Old 11-26-2009, 02:06 PM
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Thanks,

So you can test negative for the anti-gliadin antibodies yet still have gluten sensitivity? The book I mentioned doesn't address this specific situation, i.e. possible meaning of a negative test.

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Old 11-27-2009, 04:51 PM
jcc jcc is offline
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Yes, you can test negative for antigliadin antibodies and still have gluten sensitivity. Even in cases of biopsy proven celiac disease, 10-20% of all biopsy confirmed patients are seronegative according to several different published studies... so blood tests are not perfect. Sometimes the lack of antibodies is due to IgA deficiency, but not always.

I've known many who were negative on blood tests, negative on biopsy, but greatly improved on a gluten free diet. Some of these people who tested negative negative on blood tests, tested positive on the stool test through Enterolab. Others just tried the diet despite negative blood testing.

The bottom line is that no test is perfect... and although I feel the testing is worth doing to see if you can score positive for celiac disease.... even when there are negative results, a gluten free diet trial is worthwhile for those who are symptomatic. Sometimes the best test of all is one's response to the diet.
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Last edited by jcc; 11-29-2009 at 02:44 AM.
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Old 11-28-2009, 11:29 PM
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Thanks Cara,

How long do you think an adequate gf test would have to last?

Did you ever find anything further about gluten leading to tongue atrophy, as occurs in ALS? I wonder if gluten sensitivity has ever clearly been linked to ALS in a person.

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Old 11-29-2009, 02:47 AM
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No, I never had a chance to look for more on tongue atrophy. Thanksgiving and a houseful of company for a week distracted me.

I'd say a gluten free trial should be a minimum of 3-6 months. In the case of some neurological problems, it could take as long as a year to see improvement... but often people will notice improvements on some level in the 3-6 months range... enough to stick with it longer.
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Old 11-29-2009, 12:55 PM
jcc jcc is offline
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I'm still not sure I fully understand what your tongue atrophy is, but a quick google search this morning turned up these. I tried looking up tongue atrophy in ALS, and it appears there can be both surface and muscle atrophy. So, I'm not sure what exactly you mean, but either way it looks like it could be attributable to gluten sensitivity, too.

Quote:
A 33-year-old man presented at our clinic with a 4-month history of an erythematous, atrophic area on the dorsum of the tongue, accompanied by a painful burning sensation.

The glossitis resolved within 1 month after the initiation of a gluten-free diet.

The tongue was the most frequently affected site in a series of 128 patients with celiac disease who were examined for oral mucosal lesions and symptoms, with 29.6% of the patients describing soreness or a burning sensation and 8.6% having erythema or atrophy.3 Robust evidence in support of routine screening for celiac disease in patients with atrophic lesions of the tongue is lacking. Nevertheless, the National Institutes of Health consensus statement on celiac disease states that "the single most important step in diagnosing celiac disease is to first consider the disorder by recognizing its myriad clinical features."4 Our report should alert physicians and dental practitioners to consider celiac disease in managing cases of idiopathic atrophic glossitis.

http://content.nejm.org/cgi/content/full/356/24/2547
http://nejm.highwire.org/cgi/reprint/356/24/2547.pdf

Quote:
Cracking at the mouth corners, burning lips and mouth, and magenta tongue (with hypertrophy or atrophy of papillae) result from riboflavin deficiency. A pale, sore, and swollen tongue results from iron deficiency, while niacin deficiency causes a scarlet, swollen tongue with burning of the mouth. A beefy red, smooth tongue with burning results from vitamin B12 deficiency.
http://www.todaysdietitian.com/newar...60109p50.shtml
Quote:
The smooth tongue has a deep red glossy appearance and is usually quite painful and may be noted in patients complaining of glossodynia (Figure 4). This condition is due to atrophy of the papillae and is often attributable to an underlying nutritional deficiency or malabsorption syndrome. Disorders such as pernicious anemia [B12 deficiency] or gluten-sensitive enteropathy should be actively sought and corrected.
http://www.medscape.com/viewarticle/464476
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I wonder if gluten sensitivity has ever clearly been linked to ALS in a person.
... have you read this thread? ah... you did... as you posted to it.
http://brain.hastypastry.net/forums/...ad.php?t=45899


I think whether gluten sensitivity is a factor in ALS or in some cases of ALS or whether some cases of ALS have been misdiagnsed and are really B12 deficiency and/or gluten sensitivity... isn't fully known. It is still so early in time when it comes to understanding gluten sensitivity and neurological disease. Because there is really no down side to a gluten free diet (except perhaps a little extra cost if you want to buy specialty products, or a little inconvenience now and then when eating away from home)... it seems like a gamble worth taking.... although how long of a trial is disputable. I feel at LEAST 3-6 months, preferably as long as a year... before deciding it hasn't helped.

Have you tried poking around Wrong Diagnosis forums? If you enter ALS gluten B12 .... you might find some personal testimonials.
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Last edited by jcc; 11-29-2009 at 03:31 PM.
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Old 11-29-2009, 02:02 PM
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Quote:
Originally Posted by jcc View Post
No, I never had a chance to look for more on tongue atrophy. Thanksgiving and a houseful of company for a week distracted me.

I'd say a gluten free trial should be a minimum of 3-6 months. In the case of some neurological problems, it could take as long as a year to see improvement... but often people will notice improvements on some level in the 3-6 months range... enough to stick with it longer.
Cara,

Thanks for looking this up and hope you had a nice Thanksgiving. I did re-read that interesting thread from last year after you posted the link (had forgotten about it). When you advocated testing for gluten sensitivity in that thread, did you mean the test for anti-gliadin antibodies? I know that some cases of ALS have been linked to Celiac; just wasn't aware if any such link had been made to non-celiac gluten sensitivity.

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Old 11-29-2009, 03:46 PM
jcc jcc is offline
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I haven't reread the thread again, but when I advocate testing for gluten sensitivity/celiac... I usually mean anti-tTG and antigliadin IgA, IgG (and total IgA). I think it is worth running all of the bloodtests, but I put special emphasis on antigliadin antibodies because that test is often skipped, and isolated positive results are often disregarded.

I think antigliadin antibodies should bear more weight than they do in mainstream medicine, but certainly docs like Hadjivassiliou, Fine, and a growing number of others place proper emphasis on antigliadin antibodies, knowing that sometimes they are the only indicator for gluten sensitivity.

I think that the terms gluten sensitivity and celiac disease can be used almost interchangeably when it comes to associated conditions and symptoms; everything except villous atrophy which, by definition, is the cornerstone for a celiac disease dx.

I think gluten sensitivity (with no sign of villous atrophy or anti-tTG) is associated with other autoimmune disease, and can cause widespread neurological disease by immunological means or nutritional deficiency. Seizures, ataxia, and peripheral neuropathy are the most widely studied, but gluten sensitivity may cause other neurological disease... some of which remains to be studied.

And, I think, people can be gluten sensitive without any antibodies showing up on the blood tests. This is the whole reason why Dr. Fine developed the stool test and Enterolab. If you haven't spent much time reading his website... you might want to read through some of the education material and personal testimonials.
http://jccglutenfree.googlepages.com...ndstooltesting
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