Gluten Blood Tests Are Not Reliable for Diagnosis
Majid Ali, M.D.
The symptom-complexes of gluten sensitivity and celiac disease are primarily rooted in altered bowel ecology, overgrowth of fermenting microbes, gut fermentation and its inflammatory consequences. Nearly all my patients who benefit from an initial period of gluten-free diet can eat gluten foods without symptoms if consumed once weekly or so after satisfactory control of gut fermentation.
The available blood tests for diagnosing are not specific for gluten sensitivity, gluten enteropathy, or celiac disease. These tests are also positive with high frequency in nearly all chronic immune-inflammatory disorders.
These antibodies are produced in response to exposure to several proteins collectively called gliadin family. Not surprisingly then the antibodies produced in response to them also vary in their structures and function.
The second issue of interest is that antigliadin proteins belong to the following three different classes of IG antibodies and have different roles and effects:
1. Anti-gliadin IgA
2. Anti-gliadin IgG
3. Anti-gliadin IgE
Diagnostic Tests for Celiac Disease
Blood antibody testing (also called serological testing) and genetic tests for celiac disease include the following tests:
1. IgA anti-tissue transglutaminase antibodies
2. Anti-endomysial antibodies
3. HLA-DQ2, HLA-DQ8, and HLA-DQ7.5 tests
4. Intestinal biopsy
In the prevailing thought, patients with celiac disease require a lifelong strict gluten-free diet as the only effective treatment. By this criteria, celiac disease is a very uncommon disorder because, as pointed out above, nearly all my patients who do not tolerate gluten foods initially can eat gluten foods once weekly or so after satisfactory control of gut fermentation.