Recently a Hashimoto’s patient called to tell me they were feeling very poorly on the protocol I had recommended. They had taken a sudden turn for the worse. When I looked at their blood test the only thing changed was a severe increase in inflammation and immune markers. I feared for the worse and questioned the patient. After many questions they informed me they had sought evaluation from a Celiac Disease (CD) specialist. On the internet, gluten and celiac are synonymous but gluten and thyroid are not. Because part of the protocol was to be gluten free, they had decided they must have CD. Based upon my recommendation, they were gluten free for eighteen months and were doing much better. Until the CD Doctor required them to eat gluten daily for three months before they would do an evaluation.
The CD specialist knew that anti-gliadin antibodies would be low and to fulfill the Interlaken criteria required the patient to be eating gluten to provoke a reaction. This in my opinion is similar to the TH-1/TH-2 challenge used by some Functional Medicine doctors. You don’t light a match to check for a gas leak. I don’t think provoking a potentially damaging situation is in the patient’s best interest. I use a step approach to determining a patient’s condition.
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First I ask simple questions, i.e. how do feel eating gluten? How do you feel drinking coffee (a TH-2 stimulator)? Next I look at antibody tests. Doing this I also take into account how long gluten antibodies will be seen in the different tests.
The immune system considers gluten a foreign protein causing a reaction that may damage the intestine and other tissues of the body. Anti-gliadin antibodies are a screening of the reaction of the immune system to gluten in the diet.
WHAT IS THE PREVALENCE?
In the general U.S. population, blood gliadin antibodies are found elevated in 12% of those tested. Stool antibodies can be detected in as many as 35% of the general U.S. population. General population refers to otherwise normal people, not Celiac Disease subjects
HOW LONG AFTER GLUTEN IS ELIMINATED WILL ANTIBODIES BE FOUND
Serum Antigliadin Antibodies IgA, IgM, IgG
- Must be extreme and progressed response.
- Become negative after 3-6 month on a gluten free diet.
Saliva Antigliadin Antibodies IgA
- More sensitive than serum but less sensitive than stool.
- More indicative of upper gastrointestinal & respiratory sensitivity.
- Become negative after 30-60 days on a gluten free diet, must be compared to total sIgA levels.
Fecal IgA Antigliadin Antibodies IgA
- Detect sensitivity 1-2 years after gluten is removed and longer if there is hidden exposure to gluten.
Tissue Transglutaminase Fecal anti-tissue transglutaminase IgA antibody
- Reaction of the immune system to the tissue transglutaminase enzyme produced by the body when gluten is ingested.
- Immune system considers tissue transglutaminase a foreign substance causing an autoimmune reaction that may damage the intestine and other tissues (myelin – covering of nerves).
Endomysial Antibody IgA (EmA)
- EmA has shown to have high specificity and sensitivity for celiac disease.
On a gluten free diet, these antibody levels become normal, or negative. They reappear very quickly (1-2 weeks) on a gluten diet.[i]
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[i] Gluten Sensitivity and Mild Enteropathy, Gastroenterology, 1996. 111(3):608-16