Sense and Sensitivity
By Melissa Diane Smith
If you're confused about gluten-sensitivity testing, here's the latest on the subject from three top experts.

Walk into your doctor’s office to try to find out if you’re gluten sensitive and you’ll almost always have trouble getting an answer. For one thing, doctors may not want to run blood tests to test for the condition. If they do, they will probably pay attention only to tests that screen for tissue damage in the gut, a likely indicator of celiac disease. If the tests for tissue damage are negative, it’s common for a physician to ignore the test results that indicate an immune reaction (IgA and IgG gliadin antibody levels) even if those immune reaction tests come back positive. Many doctors simply tell their patients that they don’t have celiac disease and should keep eating a diet that contains gluten.

New tests to screen for gluten sensitivity may be developed in the future. In the meantime, doctors who are knowledgeable about gluten sensitivity and about how many people aren’t being diagnosed with the condition are using slightly different ways to look for it.

Alessio Fasano, MD, medical director of the Center for Celiac Research in Baltimore, recommends that patients get blood tests for celiac disease. If those tests are negative, he recommends getting tested for a traditional IgE-mediated allergy to wheat. If that test is negative, Fasano asks his patients to try a gluten-free diet to see if their symptoms abate. Fasano considers that the best test of gluten sensitivity right now.

Stephen Wangen, ND, author of Healthier without Wheat and founder of the Center for Food Allergies in Seattle, goes further in his testing. He has a laboratory analyze patient blood samples for IgA, IgG, and IgE antibody levels to gluten and also to wheat and the other gluten grains. This panel of tests is a more comprehensive way to identify not just gluten sensitivity (also called gluten intolerance), but also an allergy to gluten or an allergy to grain components other than gluten. The latter two reactions exist, but are less common than gluten sensitivity, Wangen says. Unfortunately, few doctors will run this spectrum of tests. That’s why more and more people are taking matters into their own hands and eliminating gluten from their diets on a trial basis to see if their symptoms improve or go away.

Rodney Ford, MD, a New Zealand—based specialist in gluten illness, says instead of people having a “belief” in gluten sensitivity, there needs to be more widespread knowledge about the condition so it is acknowledged and diagnosed and people don’t needlessly suffer. Many practitioners may look for celiac disease, but most simply are not looking for gluten sensitivity and therefore miss it.

Intestinal biopsy and celiac blood tests that detect tissue damage—the main tests used today—don’t identify gluten sensitivity. The IgG gliadin antibody test, which is used, but commonly overlooked, is the best blood test to identify gluten sensitivity. The best clinical test is to try a gluten-free diet for three months, Ford says.

The focus with gluten-related illness shouldn’t be gut damage, nutritional deficiency, or intestinal biopsy results. The focus should be treating symptoms that develop from eating gluten and that go away when gluten is removed, says Ford.

These three top experts agree that gluten sensitivity affects far more people than celiac disease, and that a gluten elimination diet trial provides valuable information and sometimes the only information that is needed to detect gluten sensitivity.

One caution: if you happen to have silent celiac disease—a condition in which there is damage to the gut but few or no clear-cut symptoms—you might not notice a difference in how you feel by going gluten free. Therefore, if you have a condition that is a common complication of celiac disease, such as iron-deficiency anemia, osteoporosis, infertility, or an autoimmune disease, act from a place of knowledge and be sure to get the blood tests to screen for celiac disease first before eliminating gluten from your diet.

This article was adapted from information in Gluten Free Throughout the Year by Melissa Diane Smith.




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