Should I Avoid Gluten? 2 Best Tests for Gluten Sensitivity.
DECEMBER 28, 2016 by DR. HEATHER MODAY, MD
Not sure if you should avoid gluten? The Moday Center, which offers gluten sensitivity testing in Philadelphia, weighs in with the two best ways to find out. You can do one of these tests for gluten sensitivity at home – though we recommend consulting a nutrition professional.
So, you’ve seen the doctor because you’re starting to suspect you have a gluten sensitivity. Every time you eat some pizza or spaghetti, you don’t feel great the next day. Maybe you get gassy and bloated, or your joints feel swollen and stiff. Perhaps that morning bagel is making you tired and foggy, or your skin keeps breaking out.
Still, it can be hard to tell if you do have a gluten sensitivity, since it can pop up out of the blue as an adult and manifest in all sorts of unexpected symptoms. Plus, gluten may not affect you until hours after you eat it.
But when you saw the doctor, he or she told you that you don’t have a wheat allergy and you don’t have celiac disease — that it’s all in your head. As I explained in my last blog about having non-celiac gluten sensitivity, tests not turning up gluten sensitivity is too common and completely wrong.
Non-celiac gluten sensitivity is quite common. Whereas celiac disease affects about 1 % people in the US, Dr. Alesio Fasano of the Center for Celiac Research and Treatment in Massachusetts, says about 5-6 % of Americans, or about 18 million people, have some sort of gluten sensitivity, and the incidence is growing.
So, where can you turn once you have been given the pink slip from your doctor?
Test for Gluten Intolerance – 2 Main Ways
One is to run an experiment in the best laboratory possible… your body! The other is to get testing for antibodies against other parts of the wheat molecule and to look for intestinal permeability (aka leaky gut markers)
Let’s talk about them both:
#1 – Self Experimentation or the Elimination Diet:
- Pros: It’s free and quite accurate if done right — your body is your best teacher! It’s completely safe.
- Cons: You don’t get an actual lab number (for those that need written proof), and it takes a few weeks of denying yourself certain foods to get a clear answer.
I love elimination diets as a tool, and I use them to clear the decks whenever someone has GI complaints. In the case of gluten sensitivity issues, you must take out all sources of gluten, including those grains which may cross react with gluten. In fact, I prefer a “Paleo” approach and remove all grains and rice, even those that are labeled “gluten free.”
You must be very strict, removing grain-based liquor as well. Keep them out for 28-30 days. You may notice improvements over those days, which can also be related to improvements in blood sugar, mood, concentration or weight loss that naturally occur with the removal of flours and grain-based foods. After the 30 days, you can start returning these things to your diet, but you must do it the right way!
Although there is no actual gold-standard way to do this, I recommend adding back the non-gluten grains first, and only one type every 48 hours. If there are any symptoms that occur during the re-introduction, you must stop adding back foods until you feel better. Symptoms can be headaches, changes in mood, GI issues etc.
If you are able to add back non-gluten grains without a problem, then you can start with gluten-containing grains like wheat or spelt. Add back a small amount at breakfast, lunch and dinner for the next 2 days and see you how you feel. Within 72 hours, you will usually know whether gluten bothers you or not.
One thing to note is that some people with NCGS also are sensitive to proteins in milk, soy and corn, which may confound things. If your symptoms seem to be better without gluten but not totally gone, I would also remove these foods for a trial period of 30 days.
#2 – IgG Antibody Testing
- Pros: Fast, and it gives you a straight answer.
- Cons: Some issues with reliability, especially when you avoid gluten. It can be expensive and require a blood draw.
So you have tried elimination diets and are still confused, or perhaps you really want cold hard data before giving up that chocolate croissant.
There are several labs that specialize in advanced gluten testing and intestinal permeability. IgG is a class of antibody that forms when our immune system reacts to a foreign protein such as that in a bacteria virus or food. IgG antibodies are fairly long-lived and can circulate in our blood stream for months to years.
These tests can pick up antibodies that form against the 2 major components of gluten: gliadinand glutenin, as well as other proteins called gluteomorphins (which can cross the blood brain barrier and cause neurologic issues), in addition to wheat germ agglutinins found in “healthy” sprouted bread. There are many other antibodies that can form against components of wheat that are associated with human disease, from skin issues to autoimmune disease.
These tests also measure a molecule called Zonulin. Zonulin may sound like a planet right out of Star Trek, but it’s actually something that gets released from our own intestinal cells when exposed to bacteria or to the gliadin portion of gluten. Zonulin then dissolves the glue holding the tight junctions of our intestinal cells together, directly causing “leaky gut.” This allows many more bacteria, viruses and undigested protein to cross the intestinal wall and cause chronic inflammation, and even set us up for potential autoimmune disease.
Some lab companies also offer testing to look for antibodies to other cross reactive foods, such as non-gluten grains, soy corn and dairy.
Regardless, if you think you may be suffering from symptoms related to gluten sensitivity, doing a proper elimination diet with a nutrition professional and/or having advanced testing done/interpreted is an absolute must for optimal health.