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How do I get tested and how do I eliminate the symptoms?
How do you know if you should go gluten-free? (Making the decision to go gluten-free)
Going gluten-free is not really an easy decision. Anyone who reduces the amount of wheat, bread and pasta that they eat may become healthier but changing to a gluten-free diet is a major dietary shift. A gluten-free diet is a lifestyle change and is not a quick way to lose weight or a fad diet. Because gluten-free foods have become much more popular in recent years, more manufacturers are making processed foods that do not contain gluten, but that does not mean they are devoid of sugar or fat. Often, manufacturers will add more sugar or fat to make up for the change in texture that results from removing the gluten.
Deciding to go gluten-free will affect your daily life, your family’s life and will affect your social life for years to come. On the other hand, it is not normal to feel sick for no reason. If you need to start a gluten-free diet, you will start to feel better. Because it is such a big decision, it should be done for the right reasons, but the question is… where do I start?
If you have looked at the possible signs and symptoms of gluten intolerance, then the first step is to seek the help of a healthcare professional experienced in gluten issues, such as Dr. Bryan D. Royer at Harmony Chiropractic Center, Inc. It would also be appropriate to see a gastroenterologist, which is a medical doctor that specializes in disorders of the digestive system. A thorough evaluation will involve a complete history and examination. If it is appropriate, blood testing would be the next step in finding a diagnosis.
A typical allergy test, such as a scratch test, is commonly used to find allergies to things like peanuts, shellfish and hay fever. It would be appropriate to use a scratch test to see if a person is has an immediate-onset allergy to wheat, rye or barley. These allergies can present as hives, swelling or even anaphylactic shock. This test will not determine if a person is reacting to gluten though.
Blood tests are used to find sensitivities to gluten. Anti-gliadin antibody (AGA) tests for different types of antibodies (IgG and IgA) to gliadin, one of the proteins that make up gluten. If this test is positive, a second test is run on the blood for the presence of tissue transglutaminase antibodies (tTGA). Tissue transglutaminase is present in the cells of the small intestine that compose the villi and the presence of antibodies to tTG means that there may be damage to the villi. If the tTGA antibody test is positive, then the person is scheduled for a biopsy to look for damage to the villi. Any person with a positive tTGA test and damage to the villi on biopsy is considered to have celiac disease. If a person tests positive for anti-gliadin antibody (AGA), then they should start a trial gluten-free diet to help them figure out if they are gluten intolerant. A person would start a trial gluten-free diet regardless of whether they were positive for tTGA or not.
One of the difficulties with going to a gastroenterologist is that some do not recognize non-celiac gluten sensitivity as a condition. Because of this they may only test for tTGA. These doctors believe you either have celiac disease or you don’t have a problem with gluten. The problem with the tTGA test is that it is very good at finding people with celiac disease, but most people who are gluten intolerant will test negative for tTGA. A study in 2003 showed that people who were gluten sensitive that had a “normal biopsy” where shown to have submicroscopic damage to the microvilli upon closer examination.1 Normal biopsies use a light microscope that magnify the sample by 400x where the microvilli are still not visible. To view the microvilli, a scanning electron microscope or transmission electron microscope is needed to be able to magnify to approximately 4000x. A medical pathologist would not see any abnormalities if the microvilli were damaged and the villi were intact.
There are currently no medications or surgeries that can reduce symptoms for those with gluten intolerance. The only treatment for celiac disease or non-celiac gluten sensitivity is avoidance of gluten in the diet. The reduction in the severity of symptoms after the elimination of gluten from the diet is also a method of confirming that a person is gluten intolerant. For those with a positive test for AGA, confirming with a gluten free diet is necessary.
One side effect of the gluten-free diet is developing an increased sensitivity to gluten. In many gluten sensitive individuals, the reaction to gluten is more severe the longer they have been gluten-free. People can develop symptoms when preparation or cooking areas have not been properly cleaned.
Sbarbati A, Valletta E, Bertini M, Cipolli M, Morroni M, Pinelli L, Tatò L.“Glutensensitivity and 'Normal' Histology: Is The Intestinal Mucosa Really Normal?” Dig Liver Dis. 2003 Nov; 35 (11): 768-73.