Dr. Fasano was introduced to me by a colleague as the expert on celiac and after reading many of his publications I agree whole-heartedly.
One of the early comments on his recent post, Celiac Disease Insights: Clues to Solving Autoimmunity, was, “why is the medical professional community not mandating the re-education of medical practitioners and the testing of patients to find those who might have been overlooked?”
However, Integrative and Functional Medical doctors are very aware of celiac disease and every integrative medicine conference I’ve been to in the last three years talks about celiac or gluten sensitivity. A gluten sensitive person feels symptoms after eating gluten and the symptoms go away when they stop eating gluten. Gluten does not typically destroy the lining of his/her GI tract however and will not create high antibodies, like it does in celiac disease.
Even if your doctor doesn’t recommend you get a celiac test, you, as an educated patient can request your doctor run the test for you. Sometimes patients have to teach doctors what is important.
If anyone in your family has autoimmune disease, you might want to test for celiac. The “gold standard” is a tissue biopsy, but who wants to do that? The accepted blood test for celiac disease measures total immunoglobulin A (IgA), IgA anti-gliadin antibody, and IgA tissue transglutaminase antibody in your serum. This type of test may be covered by your insurance plan, depending on your diagnosis.
However, I think there are some other non-invasive tests that can be useful to detect gluten sensitivity, even when the serum celiac tests are normal. Saliva anti-gliadin antibody has some evidence that it is a screening tool for celiac (much easier than a blood draw).
Also, some laboratories test for anti-gliadin antibody in stool.
I haven’t read many papers supporting a correlation with this marker and the markers in serum, but I’ve seen many people that were very sick, had a positive anti-gliadin antibody in stool, came off gluten, and their symptoms resolved.
There are other antibody tests and genetic tests as well. The bottom line is, having a normal serum celiac test does not tell you definitively that you are free from celiac or gluten sensitivity.
If you don’t want to pay for a test, you can save money by simply doing an elimination and challenge. Eliminate gluten completely from your diet for one month or more, then eat 10-20 grams of gluten-containing foods for a couple of days in a row and watch your body for any symptom that was previously bothering you. If gluten is a problem, you should notice it pretty quickly. Other doctors do variations on this protocol.
Find out more at the links below:
IgA: The I Stands for Interesting!
Gluten Intolerance Group of North America: http://www.gluten.net/
National Foundation for Celiac Awareness: http://www.celiaccentral.org/
Celiac Disease Foundation: http://www.celiac.org/
Celiac disease white paper: http://www.metametrix.com/PDFs/Celiac-disease.pdf
