Historically, gluten intolerance testing has missed the mark. A common issue patients face is when they know that they have a problem with wheat, but their doctors run the standard blood profile and one of two things happens:
1. IgA anti-transglutaminase or anti-endomysial antibodies come back negative. (In other words, the test did not find antibodies for gluten intolerance.)
2. IgA anti-transglutaminase or anti-endomysial antibodies come back negative, and anti-gliadin, or anti-deamidated gliadin antibodies, come back positive, with the doctor telling the patient that “it’s OK to eat wheat because the tissue antibodies are negative.” (One test is confirming you have a gluten intolerance, but the other test does not support it.)
Understandably, the patient may be left in a state of confusion. After all, they don’t WANT to give up wheat. They believe it’s a part of a staple diet in life, and who wants to be denied of anything?
When your doctor says it’s OK to eat something but you know you don’t feel as well when you eat it, go with what your body is telling you.
Do you feel better off gluten than on it? It turns out that up to 75% of patients with persistent symptoms will improve when put on a ‘‘no detectable gluten’’ diet. This entails a strict adherence to the elimination of gluten from your diet.
Many people will try to rationalize these symptoms by saying “Oh well, it must be the stress of my life making me feel bad” and then proceed to order their bagel. That’s the dilemma. Where’s the problem? The problem is the test.
The tests are negative, yet the person feels better when they do not eat gluten. Many studies have validated the sensitivity and specificity using anti-endomysial and/or anti-transglutaminase antibody testing to identify celiac disease. Since the science says these tests for gluten intolerance are very, very accurate, there shouldn’t be an issue. Right?
In reality, it’s a different situation. The definition of celiac disease requires total villous atrophy – not partial villous atrophy, not increased inflammation without any visible atrophy yet. Therefore, when researchers look at populations who have celiac disease confirmed by biopsy and investigate how accurate the blood tests are, they come up with percentages above 95% because they’re only including people who have total villous atrophy in their study group.
What is villous atrophy, exactly? ‘Villous’ refers to that ‘shag carpeting’ on the inside of your small intestines. Villi are little tentacles that stick up, just like a rug. Each little villus provides even more surface area to absorb nutrients. Now, imagine a worn down carpet that no longer pops back up after you vacuum. This is what is called atrophy, in which those cells start degenerating. As a result, they are unable to fully absorb the nutrients you are eating. Just like trying to vacuum shag carpeting that is forever pressed down, you can’t get in between those carpet fibers. And neither can the nutrients get in to be properly absorbed. Thus, before you get the official diagnosis of celiac disease, you have to already have destroyed the villi.
If we were to expand the definition of celiac disease to include those with partial villous atrophy, or include those whom as of yet just show the mechanism that wears down the villi (increased intraepithelial lymphocytes), then the sensitivity and specificity of anti-endomysial or anti-transglutaminase goes down, in some studies to as low as 27-32%. But what if I told you that for every gluten-sensitive patient with the symptoms of enteropathy, there are 8 with no GI symptoms?
Tests Need To Broaden Their Focus For Gluten Intolerance.
Enteropathy is just a sophisticated word for a disease of the intestines. For every person who is gluten intolerant that has symptoms of enteropathy, EIGHT do not have symptoms in that area.
Strangely, before you can confirm someone has a diagnosis of celiac, the precursors leading up to it are ignored. The diagnosis is looked at in black and white – you either have it, or you don’t. Meanwhile, damage is continually being incurred until it reaches the level of diagnosis. Is it just me, or does this seem illogical? Do we want to base our health guidance and decisions on blood tests that are limited to identifying celiac disease at its end stage of intestinal deterioration? Or do we want to include gluten intolerance testing, which has a much bigger picture in mind and looks to identify gluten sensitivity inside and outside the intestines at earlier stages?
The vast majority of research on a reaction or a sensitivity to wheat has only been looking at celiac disease. So many doctors, because of the training they underwent 10 or 20 years ago, still believe that if you don’t have celiac disease, you don’t have a problem with wheat.
In Italy, they have 34 centers that are designated as gluten-related disorder centers by the government. If you get a diagnosis of a gluten-related disorder, or any wheat-related disorder, then your food bills are a tax deduction. People will even go to one of these 34 centers to see if they have a problem with wheat because of tax benefits associated with a diagnosis. What they report is that of all of the 15,000 people they looked at in their study, only 7% of them have celiac disease; 93% of them have non-celiac wheat sensitivity.
Non-celiac wheat sensitivity is as dangerous or even more dangerous than celiac. Antibodies to your own tissue (called autoimmune antibodies) from a wheat allergy are more prevalent in non-celiac wheat sensitivity than in celiac disease – that means they may be in your brain, in your lungs, or in your heart.
So the initial training that doctors receive taught them that if you don’t have celiac disease, you don’t have a problem. Of course, we now know that’s not true.
If we recognize the now well-known fact that gluten sensitivity may manifest as celiac disease, or it may manifest outside of the intestines, one of the ways of expanding our diagnostic range is to focus on whether or not our immune system is saying that gluten is a problem. We might know where the problem is manifesting, or we might not. But if our immune system is saying “We’ve got a problem here”, it is likely worth listening to.
Better Testing Exists To Determine Gluten Intolerance
Mortality in celiac patients is highest (6x higher) in those not adherent to a gluten-free diet. This makes early identification a potentially life-threatening situation.
While your neighborhood doctor may not be up to speed with the latest in testing for gluten intolerance, it does exist. You just need to know what to ask for:
- Cyrex Array 2 and 3 – Cyrex is available internationally. Array 2 is the intestinal permeability, systemic dysbiosis panel, while Array 3 is the gluten-wheat sensitivity panel. We recommend combining these. Before you do the Cyrex Array 2 or 3, ask your physician to order a total immunoglobulin IgA, IgG, IgM panel to make sure that you are producing optimal immunoglobulins or optimal antibodies. Cyrex Array 2 measures intestinal permeability (AKA leaky gut) and identifies the damaging route through the intestinal barrier.
Cyrex labs also offers the Array 3, which expands its focus to 12 different peptides of gluten – not just gliadin. Now, another diagnostic tool has been added to your doctor’s repertoire assisting in accurately identifying gluten sensitivity with or without the serious end-stage of tissue destruction – total villous atrophy. Print the information and take this to your healthcare practitioner.
- Vibrant Wheat Zoomer – If you are in the US, Vibrant Wheat Zoomer is the test to get for gluten intolerance. It’s a combination of six tests in one. It covers the markers that would be tested in conventional medicine for celiac disease, as well as markers for intestinal permeability, dysbiosis, gluten sensitivity, wheat sensitivity, and true wheat allergy. Total IgA and total IgG is also included on the Wheat Zoomer test. The Wheat Zoomer has been validated at 99% specificity and sensitivity. If your gluten-free lifestyle has been successful, a test for antibodies to peptides of gluten should come back negative. However, we have found that 90% of people on a gluten-free diet still will have antibodies to peptides of gluten or wheat or a marker of intestinal permeability on the Wheat Zoomer. This critical information could tell you that your gluten-free lifestyle and gut healing protocols have not been completely successful.
Many people are surprised to learn that while they believe they are gluten-free, they may in fact be exposing themselves to gluten through daily hidden dangers like medications or lipstick.
A 60-minute consultation with our Clinical Services team is included with the purchase of a Zoomer test to help you interpret and understand test results that you can also share with your local doctor.
- Find a CGP near you. – CGPs are Certified Gluten-Free Practitioners with a variety of backgrounds. The program was designed to train all types of wellness professionals (both licensed and unlicensed), including MDs, NDs, RDs, RNs, Chiropractors, Health Coaches, Nutritionists, Acupuncturists, and more. I am proud to say that we offer the most comprehensive education available for gluten, wheat-related disorders and autoimmunity through this program.
We educate practitioners by providing them with knowledge to better identify, support, and educate patients/clients about how to properly test for gluten intolerance, wheat-related disorders, and autoimmunity. They learn intervention protocols that work to arrest, or in many cases, reverse the degenerative process autoimmunity brings by combining current medical and nutritional research science with decades of clinical expertise.
If you suspect you have gluten sensitivity, you can locate a Certified Gluten-Free Practitioner (CGP) near you on our website at www.theDr.com. If you do not have a practitioner to order this gluten intolerance test, contact your nearby CGP or see https://thedr.com/products-page-2/clinical-services/lab-tests/ for more information.
- Consult with our Clinical Services team. Our Clinical Services team has extensive training in functional medicine, nutrition, and my 4 Pillars of Health methodology (Structure, Biochemistry, Emotion, and Electromagnetic Fields). We believe this holistic approach allows for true healing. Your diagnosis is a symptom. We pride ourselves in addressing the whole person rather than the disease and in creating authentic partnerships between the client and practitioner.
Taking a gluten intolerance test may be one piece of your treatment plan. Each person’s health history is looked at in its entirety – your body tells a story unique to you! As you learn how to read the tale your body has been telling, you can begin to fill in those gaps and better understand your own personal health mystery.
It is my personal prayer that as a result of this expanded gluten intolerance test, we will no longer miss those with earlier stages of celiac disease and gluten sensitivity.