The Quick Gluten Testing Route!
Welcome. If you have landed here and just need a quick reminder of what order to do main tests in, here it is for you:
For the rest of you, here is the introduction and full testing route explained in more detail…
Testing for Gluten Allergy, Coeliac Disease and Non-Coeliac Gluten Sensitivity
This can be pretty complex and I have tried to simplify it down for you into what I see as the ideal testing route. Note that is the ideal testing route: no-one is expecting you to do every test but, I have to say, the more info you have the better you will heal and prevent issues in future.
Review the quick testing route above if you need to and stick to that as it will cover most of the really important bases for you. I have included others as people are at loads of different stages and need to find out different things. All in all, if your body tells you it doesn’t like gluten, that’s enough for me. The rest is confirmatory, if you see what I mean. If you can establish your right diet and address your permeability and inflammation, you are way down the right track.
Note: There is a much more detailed look at testing in the Gluten Plan; this page would have been huge if I put everything! Also, note I have started a Cyrex Tests FAQ and will build this as I get your questions in, no doubt!
OK, let’s get to it. Hope it helps …
Step 1: Finding Your Type of Gluten Related Disorder
If you are eating gluten …
1. First, aim for a mainstream diagnosis of coeliac disease. Ask your GP for a coeliac test and/or do the more extensive Genova Coeliac Profile, which is the best currently available that looks for mainstream blood markers and includes DGP, the most predictive marker. If positive, you have your diagnosis of coeliac disease.
2. Also, rule an IgE classical allergy out: ask your doctor who should be able to do an IgE test for wheat and gluten/gliadin or do Genova IgE Gluten Test.
3. If your main problem is bloating with gluten, consider gluten maldigestion or wheat-only sensitivity.
4. If these are negative, look for more peptides and transglutaminases as some people don’t have antibodies to the usual coeliac markers. Do Cyrex Array 3 or, if you think it could be very early stages, start with Cyrex Array 1 as saliva markers can show much earlier than blood.
One important thing to note is the issue that if your body blood levels of IgA are low, this could give you false negatives on any IgA antibody result. My advice is to do a Total IgA test either via your GP or me too so you can rule that out and be sure that negatives are really negatives.
A note on gluten withdrawal: Array 3 can also be useful to do before you come off gluten because it looks for the gluteomorphines. If you have antibodies to this, you are likely to be one of those people who have withdrawal symptoms when you come off gluten, much like you might a drug. If you know this, you can offset it by using specific enzymes.
5. If negative, do an elimination diet check as your body doesn’t lie and do the gluten gene test to look for genes related to any type of gluten illness. Doctors normally look for DQ2 and DQ8 genes and will take note of any DQ2 as it confers higher risk. However, other genes are related to NCGS including DQ1 and DQ3. Do this gluten gene test, which looks at both A and B locations, so is the best available. This can show you the predisposition to a particular type of gluten disorder and put together with your symptom pattern, you can usually put two and two together and you have something on paper.
If you are not eating gluten …
1. NEVER re-start eating gluten for a challenge; the risk of damage is not worth it. If you reacted to it, there was some form of gluten illness going on, full stop.
2. If you have been off gluten for less than a couple of weeks, you can still rely on the Cyrex tests if you were eating it regularly before. The advice is to wait 25 days after your last ingestion and then do Cyrex 1 or 3.
3. You can do the Cyrex Tests 1 or 3 if you have been off gluten for several months/years. About 60% of people on a gluten free diet show antibodies even after this time. If you get nothing positive back, then it doesn’t really tell you categorically that you are or were gluten sensitive and you need to do a different test. However, if you get something positive back, it confirms the problem was there all along, but ALSO confirms you are still consuming something somewhere that is hidden or cross-reactive, otherwise you wouldn’t have any antibodies.
4. If you are in the US or able to send a stool sample back within 2 days to the US, the Enterolab tests are said to be accurate for up to a year off gluten.
5. Do the gluten gene test to check if you have the correct genes to match your symptoms ie. DQ2 for coeliac, DQ1/3 for NCGS. This doesn’t show you have the disease but shows your genetic weakness. If you put that with your symptom picture, the issue is usually obvious. You can see a sample gluten gene test report here.
Step 2: Determining Your Diet
1. If any of your tests are positive, next you need to work out what diet you need to heal: Do Cyrex Array 4 Cross-Reactive and Common Foods.
2. If positive, avoid those foods, using an appropriate diet to help you.
If cross reactive foods antibodies are positive, you need to avoid for life in the same way as gluten.
If common food antibodies are positive, avoid for several months until your Array 2 permeability results (below) are negative.
If any antibodies are negative, that’s a great sign, but do an elimination dietto double-check; your body doesn’t lie and you may not yet be as far on as producing an antibody reaction.
3. If you have already stopped eating one of the common foods and wish to check it, you can do Array 4 and check antibody levels, then eat the food for a month, wait 25 days to allow antibody production enough time and repeat the test. If the antibody to a food has risen, that food is not a good one for you. I wouldn’t recommend doing that with a cross-reactive food though because of the potential for triggering more damage.
4. If you suspect other foods, do the elimination process to identify them, extended antibody testing (Alletess) and non-antibody cellular testing (Genova’s FACT or ALCAT) to try and find them if you need to. You might find the free Allergy 101 Factsheet useful to help with this.
Step 3: Establishing Your Healing Protocol
Now you know the diet you need, the next thing is to suss out the best supplemental treatment to heal yourself with. The vast majority of coeliacs, according to statistics, do not heal on a gluten free diet. That’s because, with both CD and NCGS, the inflammation, malabsorption and autoimmunity (if triggered) continue for a long time and need to be addressed. The days of just treating with a gluten free diet are over. Getting gluten free ‘enough’ is nigh on impossible as we now know that such a tiny amount can trigger a damaging process that lasts a couple of months. So, the emphasis needs to be on healing the barriers to stop anything getting through to the bloodstream in the first place, and calming the inflammation down that is already going on.
1. First, we need an idea what damage has been done so far so you can address some specific issues. Check your hyper-permeability levels: if you are too leaky, you will allow food sensitivities, inflammation and autoimmunity to run riot in the future, despite your diet. Do Array 2 (gut) and/or Array 20 (blood-brain barrier), the latter especially if your symptoms are neurological eg. migraine, mood, MS etc. The Arrays 2/20 will act as a starting point and progress marker later for your diet to expand. If anything is positive, treat for barrier healing.
2. Most gluten sensitives are malabsorbing in some way whether because of villi flattening (coeliac disease), inflammation (NCGS’s) or autommmune processes (eg parietal cells in the stomach) so you need to address your nutrient needs and boost them. Take a good gluten free multivitamin/mineral and some fatty acids as a base. Do any nutrient checks needed, especially red blood cell minerals, Vitamin D, anaemiaand bone markers and add anything required.
Gut Status and Inflammation
3. Next, check the state of your gut environment (eg bacteria, candida, parasites etc) to make sure you are not harbouring chronic infections that would scupper healing. Do the Doctor’s Data Stool Test, which will also give an indication of digestive ability and gut inflammation. It is also a good idea to check whole body levels of inflammation, so ask your doctor to test your ESR and CRP levels, or do this Inflammation Test. If anything is positive do an appropriate Gut Detox or Candida Plan and use a natural anti-inflammatory.
4. Finally, but possibly most importantly for your future health, you need to look for any autoimmunity processes going on: do Array 5 to look for predictive antibodies to several organs and glands including thyroid, adrenals, intrinsic factor, parietal cells etc. If anything positive is found, treat for auto-immunity.
Phew, lot to take in there, but hope it helps!