Which Test To Order

If you think you may be gluten sensitive or that you may have intestinal damage due to gluten (i.e., have celiac sprue), the best test providing the most accurate set of information is the Gluten/Antigenic Food Sensitivity Stool/Gene Panel with Fat Malabsorption Stool Test added. The tests in this panel and test are complementary: the gluten sensitivity stool test looks for the antibodies produced by your body against gluten, and the malabsorption test assesses whether your intestine is malabsorbing dietary nutrients because of damage, even slightly so, by gluten (or perhaps other factors), and the gene test assesses your risk based on your genetic predisposition. It is even possible that possessing the gene, per se, may be enough to predict that you will experience better health and feel better by eliminating gluten from your diet.

If you simply cannot afford to include the gene test (because it is a highly technical assay it is an expensive test for us to run), the next best test would be the Gluten Sensitivity Stool Panel. And if you are deciding between this stool panel and the gene test alone, the stool panel better determines whether you are actively reacting to gluten while the gene assesses the probability that you are reacting or will react to gluten.

Since the 1960’s, research has shown that people who are immunologically sensitive to gluten have a higher than average chance of being sensitive to other dietary proteins, especially to those in other immune-stimulating (antigenic) foods such as milk, eggs, soy, other grains, meats, nuts, and nightshades (potatoes, tomatoes, peppers, and eggplant). Furthermore, with the irresponsibly common corporate agricultural practice of over-hybridizing and genetically modifying our plant foods (mainly wheat, corn, and soy), combined with overuse of stomach acid-inhibiting drugs that reduce digestion of proteins in the gut, food sensitivity is now commonplace and on the epidemic rise. Immunological sensitivity to non-gluten food antigens can be detected by the same procedure of detecting in stool antibodies to these dietary proteins, and our patented stool antibody tests can reveal these to be present before they can be detected in blood. Sensitivity of the immune system to milk, egg, soy, and rice proteins has been reported to cause intestinal syndromes and damage mimicking that caused by gluten and celiac sprue. The other food antigens can cause symptoms, and possibly syndromes as well, contributing to irritable bowel syndrome, and probably aggravating rheumatoid arthritis and other arthritides, for example. Furthermore, recent research has linked antibodies to milk proteins to the development of eczema, diabetes, multiple sclerosis, autism, and other immunologic syndromes.

To encourage people to get the maximum benefit from their testing and their dietary elimination treatment, EnteroLab is now offering testing for the main food antigens (gluten, milk, egg, and soy) in economical panels that accompany gluten sensitivity testing, or as an economical testing panel for an array of foods beyond the main four food antigens.

Although we know less about yeast sensitivity than gluten sensitivty (because the former has been identified and studied for a shorter period of time), we now know that it too can be associated with an immune reaction that damages the intestine and perhaps other tissues in the body. Antibodies against Saccharomyces cerevisiae yeast is the only reaction identified to be present in and diagnositic of people with a devastating intestinal inflammatory disease called Crohn’s disease. Through research, we at EnteroLab frequently find coexisting yeast in those we find to be gluten sensitive. Furthermore, Crohn’s disease is 7 times more common in celiacs than in the normal population, further evidence that gluten and dietary yeast sensitivity not uncommonly coexist. This is not surprising since many gluten containing foods also contain yeast (such as brewer’s and baker’s yeast). We also find that some people get more symptom relief from a gluten-free diet when it is also free of foods and bevarages containing added or high concentrations of Saccharomyces cerevisiae yeast.

Having microscopic colitis and other autoimmune diseases is a strong risk factor for being gluten sensitive. It is even probable based on research studies that all such people are gluten sensitive. Thus, it is imperative that you be tested for gluten sensitivity and if found to be positive go on a gluten-free diet. New research studies (including my own) are showing that a gluten-free diet can help these associated immune syndromes remit or improve.

The same guidelines would be followed for those listed in the previous paragraph. The Gluten/Antigenic Food Sensitivity Stool/Gene Panel with Fat Malabsorption Stool Test added provides the most and best information, followed by the Gluten/Antigenic Food Sensitivity Stool Panel Limited or Gluten Sensitivity Stool Panel.

Family members of celiac patients or people diagnosed as having gluten sensitivity are at a higher risk for being gluten sensitive themselves because of the sharing of genes. The same guidelines would be followed for those listed in the previous paragraphs. The Gluten/Antigenic Food Sensitivity Stool/Gene Panel with Fat Malabsorption Stool Test added provides the most and best information, followed by the Gluten/Antigenic Food Sensitivity Stool Panel Limited or Gluten Sensitivity Stool Panel.

If you have recently been diagnosed as a celiac, we recommend our Gluten Sensitivity Stool Panel to establish baseline levels for your gliadin antibodies in stool and to determine the severity of intestinal damage. (You do not have to and should not return to eating gluten if you have already started your gluten-free diet.) Both of these values serve as an important baseline for comparison 12-24 months after going gluten-free. This is especially important if you do not improve or improve fully on a gluten-free diet. The stool test would be repeated at that time and depending on the result, treatment could be better prescribed accordingly. At the least, the Stool Test for Intestinal Malabsorption/Damage should be ordered for this purpose.

If you desire to assess the risk of your parents, siblings, and children based on your diagnosis, adding the gene test can assess this risk. Furthermore, although one of your genes has led you to get celiac or gluten sensitivity, if it is discovered from the gene test that you have two copies of the genes, you would be at a greater risk still for complications of gluten sensitivity (and therefore you would want to be especially strict with your diet), and you would know that all of your siblings, children, and parents would have at least one copy of the gene putting them at risk for gluten sensitivity.

Previously diagnosed celiacs can benefit from testing in three ways. First, even if you are feeling good, the Gluten Sensitivity Stool Panel can give you peace of mind that any past damage of your intestine has healed and that there is not an ongoing antibody reaction to gluten that may be hiding in your diet. (You do not have to and should not return to eating gluten if you are on a gluten-free diet.)

Second, if you are having any symptoms that might be related to gluten (or other food) sensitivity or celiac sprue, the Gluten/Antigenic Food Sensitivity Stool Panel Limited or Gluten Sensitivity Stool Panel must be done to determine if these symptoms are indeed from gluten potentially hiding in your diet or something else. (You should not return to eating gluten if you are on a gluten-free diet.) These results could then be used by a doctor to determine most safely and quickly what is causing your symptoms. The malabsorption test can also help determine if you may be having malabsorption from a lack of production of digestive enzymes by the pancreas which affects celiacs with greater frequency than non-celiac individuals. This latter problem can be assessed by our fecal elastase test.

And third, a Gluten Sensitivity Gene Test can determine which gene has caused your celiac sprue or gluten sensitivity and thus help assess which gene in family members may put them at risk. This is especially helpful when the celiac-predisposing gene is one of the “alternate” genes more recently identified.

In the genetic assessment for the predisposition to celiac disease (a disease defined as villous atrophy and inflammation of the small intestine resulting from gluten sensitivity – the immune response to dietary gluten), the heterodimer HLA-DQA1*0501 and HLA-DQB1*0201 is one of the main genes required to develop the tissue lesion of celiac disease. However, it appears from research studies that HLA-DQ1, HLA-DQ2, and HLA-DQ3 can all lead to immune reactions to gluten (i.e., gluten sensitivity) even in the absence of intestinal villous atrophy. Non-celiac gluten sensitivity syndromes are no less severe than ones accompanied by villous atrophy, in terms of symptoms they may cause, accompanying autoimmune diseases in other parts of the body, and resultant disability. Thus, it is more important to assess for genetic predisposition to the underlying immune reactivity to gluten itself than just the one clinical form called celiac disease. Furthermore, fecal analysis cannot diagnose celiac disease, therefore EnteroLab makes no such claims of doing so.

In weighing the potential clinical benefit to our clients of adding HLA-DQA1 locus typing (to our current practice of typing only the HLA-DQB1 locus) versus the almost doubling of cost and price, we have found through internal research that the frequency wherein HLA-DQ2 positivity is the celiac-related DQB1*0201 allele verses the non celiac 0202, 0203, 0204, or 0205 alleles is overwhelming in favor of the celiac 0201 (and we now even separate these subtypes). By linkage dysequilibrium, HLA-DQA1*0501 will usually accompany HLA-DQB1*0201. Furthermore, HLA-DQB1*0202 can cause celiac as well. The presence of HLA-DQ2 assessed serologically (functional presence of any DQ2 gene product) has always shown itself to be able to bind gliadin, and therefore predispose to gluten sensitivity (even if someone did not develop celiac disease/villous atrophy). For these three reasons (the overwhelming prevalence of the 0201 allele of DQ2 in our clientele, the linkage dysequilibrium of DQA1*0501 with DQB1*0201, and the greater importance of diagnosing the underlying immune reactivity to gluten, regardless of syndrome caused), we have decided to keep the price down for our clients and limit gene testing to the HLA-DQB1 locus. Finally, the treatment for gluten sensitivity and celiac disease is the same – complete-strict removal of gluten from the diet. The presence of any gene predisposing to immune reactivity to gluten (especially when accompanied by symptoms or an associated clinical syndrome) provides necessary information to the client to make an informed decision about whether or not to adopt a gluten-free diet.