Ask the Doc: Can a little gluten affect my blood test?

Posted on August 14th, 2011 by Alison | Posted in Ask the Doc, Gluten Intolerance | ADD A COMMENT »

questionmarkgreen1.jpg Q. Can one or two recent “glutenings” create a positive TTG test even if I’ve been really compliant for 4 years?

A. It depends on how intense were your “glutenings”! A few crumbs here and there, or a huge serving of pasta, with several slices of bread, or a piece of cake, can make the difference between a positive anti-tTG and a negative test. The truth is no one really knows for sure. In certain research protocols, 7 grams of gluten are used in challenges to bring a normal intestinal biopsy in a proven celiac patient who has been gluten-free to an abnormal one, but I am unaware of any data about tTG levels. Besides, each individual may respond differently to the same amount of gluten; if your test has turned positive after only a little gluten intake, then you know that you are more sensitive and vulnerable.

Health and happiness,
Dr. Aron

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Ask the Doc: Positive biopsy but negative blood tests

Posted on September 29th, 2010 by Alison | Posted in Ask the Doc, Celiac Disease, Gluten Intolerance | ADD A COMMENT »

questionmarkgreen1.jpg Q. I suffered my whole entire life with intestinal issues (I am 46). I have been gluten free for over 3 years now, I went in for an upper GI (for gerd) and I had him test me for celiac disease, it came back positive (I had blunted villi). I then went for blood work and all came back negative, on the HLA genetic testing, it came back DR1/DQ5. But listen to this…I lost 3 pregnancies, first one at 8 months gestation, the second and third at 5 months (I had to labor and deliver them all) and they were never able to “officially” tell me why. After I lost my second one (1991) they did blood work and told me I had anticardiolipin antibody syndrome. Two years ago at the age of 44 I was diagnosed with osteopenia (a little on the young side!). Last year I saw a hematologist (for a cosmetic procedure I’m going thru) I gave him my complete history including being gluten-free. He told me that some people who have anticardiolipin antibody syndrome and are then diagnosed with celiac disease, once they go gluten-free, it clears up the anticardiolipin syndrome. He tested all my numbers, and they were indeed negative (first time in 20 some odd years!!). I’m so confused as to what to think about all this! Can you provide any feedback?

A. You are not the first one to have blunted villi and negative celiac serologies. There are many other genes involved in gluten sensitivity and we are not clear on exactly what they are doing.  If you have really been completely gluten-free for the past three years, and your villi are still blunted, you probably have had advanced disease for years, given your infertility and osteopenia. It may take longer for your villi to return to normal, but you must be perfectly gluten-free. If you have been, then you may have refractory celiac disease, and there are other therapeutic options to explore. You should see a gastroenterologist to discuss this further.

Health and happiness,
Dr. Aron

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Ask the Doc: Are there different levels of celiac disease?

Posted on August 5th, 2010 by Alison | Posted in Ask the Doc, Celiac Disease | Read 1 Comment - Add Your Own »

questionmarkgreen1.jpg Q. I was just recently diagnosed with celiac disease after a positive biopsy last week.  I don’t get real sick, other than bloating and gassy.  Those were my only symptoms.  My question is, are there different levels of celiac disease?  If I go to a restaurant and ask for gluten free foods, but they happen to get cross contaminated with something containing wheat, rye or barley, am I at that serious of a risk by dining there since I don’t get the diarrhea and vomiting, etc.?  It’s been real hard on my family and me trying to dine out at a restaurant who has a true understanding of celiac sprue.

A. Ask your doctor to obtain the Marsh classification of your biopsy. The higher the class, the longer it will take to heal on a gluten-free diet. Symptoms often do not correlate with the level of biopsy abnormality.  Those who have been diagnosed with celiac and have their biopsies return to normal — Marsh 0 — will develop damage after being exposed to 7 grams of gluten, or about the amount in a slice of bread. I hope this helps.

Health and happiness,
Dr. Aron

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Ask the Doc: Why does celiac disease cause infertility?

Posted on May 5th, 2010 by Alison | Posted in Ask the Doc | ADD A COMMENT »

questionmarkgreen1.jpg Q. In one of your previous responses you mention that polycystic ovarian syndrome (PCOS) and celiac are related. I was diagnosed with PCOS for over 20 years and treated with BCPs and then Metformin. Meanwhile I’d suffered terrible bloating, chronically, for years, encompassing both lower and upper abdomen. I began to learn gluten may cause the bloating and PCOS symptoms, so I went off gluten and the meds simultaneously (without any clinical testing). I have had periods like clockwork since, and the bloating is greatly improved.

My questions are:

  1. Without the classic celiac symptoms and diagnosis, is this most likely celiac or gluten intolerance (or do you think they are always one and the same)?
  2. Why do people suggest that celiac be considered for “unexplained infertility,” as opposed to for all women experiencing infertility and other symptoms of reproductive hormone imbalance? (Similarly, now UWisconsin health clinics test all women with osteoporosis for celiac, not just those with “unexplained” osteoporosis.) So many doctors will just say, “oh, that’s PCOS,” therefore “explaining” it without really understanding it as gluten for so many of us. They have their “explanation,” ergo, no need to test for gluten! Talk about a “tip of the iceberg”? One practitioner states that over 80% of her patients with PCOS test positive for gluten issues. Is this a percentage you would expect to find in a well-designed formal study? If so, wouldn’t that be roughly 5% of women having gluten issues just from that symptom complex alone?

Thank you for any time you may find to address my questions. Unfortunately there appears
to be scant clinically sound information or studies concerning this.

A. To answer your questions:

  1. Textbook celiac disease only accounts for about half of all those who cannot tolerate gluten. There are a number of genes beside the HLA genes that are associated with gluten intolerance.  Unfortunately, we do not know precisely their contribution to gluten intolerance. Thus, they are not one in the same as we cannot trace all gluten intolerance to the consequences of untreated celiac disease.
  2. The second question can be answered by understanding that CD4 cells activated at the gut level by gluten can travel through the bloodstream to the brain where they can influence the secretion of hypothalmic releasing factors that influence pituitary trophic hormones and lead to infertility.  In addition, these activated CD4 cells also home to the endometrium, and can create local inflammation that can interfere with the implantation of a fertilized ovum.

Hope this helps.

Health and happiness,
Dr. Aron

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Ask the Doc: Are follow-up tests needed after being gluten-free?

Posted on March 17th, 2010 by Alison | Posted in Ask the Doc | Read 1 Comment - Add Your Own »

questionmarkgreen1.jpg Q. What needs to be done or watched for once living gluten free, 4 years in my case, with nothing more than an occasionally accidental ingestion of some gluten?  Are there any tests that we should have, assuming everything else appears to be fine?

A. If you are well, then an occasional accidental gluten exposure is safe. Each individual has an unique reaction to gluten depending upon their genetics, the bacterial and viral environment of their gut,and many other factors.  To check for inadvertent gluten exposure, get an IgA anti tTG test.

Health and happiness,
Dr. Aron

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Ask the Doc: Can mouth symptoms be caused by gluten?

Posted on February 20th, 2010 by Alison | Posted in Ask the Doc, Celiac Disease, Gluten Intolerance, Symptoms | Read 1 Comment - Add Your Own »

questionmarkgreen1.jpg Q. Could symptoms labeled as Burning Mouth Syndrome be caused by gluten intolerance?  These symptoms have been constant for 5 2/3 years and include pain in roof of mouth, tongue, cheeks and under the tongue at all times except when eating. Additionally during the night I have pain above the roof of the mouth and into one ear and down the throat.

I have had nightly GERD for 8 years that doesn’t respond to any medications,  thyroiditis and nodules and increased vascularity in the thyroid, sometimes a fine tremor in my hands, and involuntary movement of my tongue and extremities. I also have had post nasal drip and phlegm for 25+ years which doesn’t respond to any medication nor was it improved by surgery to correct a deviated septum (which my doctor said left me with “perfect sinuses”.)

I know the thyroid symptoms may improve if gluten-free but are any of the other symptoms likely to be improved?

A. Sores or aphthous ulcers and taste disorders are common in celiac disease, as is reflux esophagitis, and thyroiditis.  You must get tested for celiac disease, and you must have a thorough investigation into your reflux, with endoscopy biopsy and manometry studies.You may contact my office at www.gut-check.com.

Health and happiness,
Dr. Aron

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Ask the Doc: Can I have celiac disease if I don’t have the celiac genes?

Posted on January 2nd, 2010 by Alison | Posted in Ask the Doc | Read 2 Comments - Add Your Own »

questionmarkgreen1.jpg Q. I just had a blood test to test for genetic predisposition to celiac because my mother is a celiac and I have a lot of the same symptoms. It came back negative and I am just wondering if it is possible to still have it. My doctor has completely ruled it out based on the test. Have you any idea what percentage of celiacs have no genetic markers?

A. The genetic tests for HLA DQ2 and HLA DQ8 account for 95% of celiacs. Celiac disease itself by the classical definition (positive anti tTG and EMA antibodies and a Marsh III biopsy) only accounts for half of all patients who are sensitive to gluten. There are a number of genes that are not currently tested for in clinical practice that have been associated with gluten sensitivity.  We currently are ignorant of their precise actions. You probably would benefit from a gluten-free diet.

Health and happiness,
Dr. Aron

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Ask the Doc: Is working in a bakery bad for celiac?

Posted on November 7th, 2009 by Alison | Posted in Ask the Doc | Read 1 Comment - Add Your Own »

questionmarkgreen1.jpg Q. I am a bakery manager. Last month I tested positive on the celiac blood tests. My father has been diagnosed with celiac, has both genes associated with the disease, as well as lactose and soy allergies now. I have had diarrhea for about a year and a half. My CBC didn’t show much to worry about but I was a little low on vitamin D, not dangerously so, just none stored up.

In my bakery I don’t actually work with the flour, but the bakery is an open environment. We also have  a cake decorating area and a coffee bar, where I generally work, about 30-90 feet away from the dough prep area. Is it possible that I will still be able to continue working in the facility as long as I wash my hands frequently, wear a mask when I am within 5 feet of dough prep area?

I am very concerned because I have been in the bakery industry my entire adult life, it is what I know. I started when I was 18 am now 39. The first 16 years were spent in a bakery that worked with frozen dough the one I currently manage is a full scale mostly scratch bakery. My plan was to see how an exclusive gluten free diet worked and if that did not change my symptoms and reduce my numbers then I would HAVE to consider a career change. However the more I read the more fearful I become that it is inevitable that I will have to change my job.

Do you have any advice or similar case examples you may be willing to share?

A. You need to get a biopsy, to assess the extent of your celiac disease: the more advanced the biopsy, the greater need to protect yourself. Gloves and a mask are a good idea.  There is some data on how much gluten will injure a celiac patient, but that data was generated in stable celiacs who have a normal biopsy, and may not apply to your case. I have had two patients who had minimal , and I mean MINIMAL gluten exposure and became symptomatic.  One was a waitress who was exposed to serving bread, buns, toast, pancakes, etc. She even could tell if someone switched the scoop from wheat to her grain bins at Whole Foods. Another patient would get sick just walking near a bakery!!!!

Health and happiness,
Dr. Aron

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Ask the Doc: Was my celiac blood test wrong?

Posted on July 9th, 2009 by Alison | Posted in Ask the Doc, Celiac Disease, Gluten Intolerance | ADD A COMMENT »

questionmarkgreen1.jpg Q. Last year I had a test to see if I had Celiac Disease. The test came back negative. When I eat things like bread and chicken nuggets or cereal etc. I end up with nausea and headache and feel really bad. Could the test have been wrong or am I just sensitive to gluten? Eating has become a real problem!

A. Many of the commercial lab tests for celiac disease are only about 40% sensitive. Ask your doctor to order a Celia-Plus test from Prometheus labs. If those are negative (they include genetic testing) you could still be sensitive to gluten: celiac disease only accounts for about 50% of those sensitive to gluten.  We know of at least 6 other genes that are involved in gluten sensitivity, but we don’t know how they are involved. The bottom line is: if gluten bothers you, see a dietician, and go on a gluten-free diet. It’s healthy and harmless, and is getting easier to follow every day.

Health and happiness,
Dr. Aron

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Ask the Doc: Celiac triggered by abdominal surgery?

Posted on March 21st, 2009 by Alison | Posted in Ask the Doc, Symptoms | Read 3 Comments - Add Your Own »

questionmarkgreen1.jpg Q. I noticed your answer to a question about celiac disease that its onset could be caused by abdominal surgery. How is this possible? How often does it happen? I have just recently started seeing a homeopathic MD and one of the tests showed a borderline gluten allergy and thyroid imbalance. All of my symptoms have worsened through 2 pregnancies that resulted in post partum induced thyroidism and an ectopic that ruptured requiring surgery. Your comment about surgery causing celiac disease is interesting. Thank you for any info you can share.

A. Many with latent celiac disease will have activation of the disease after any abdominal surgical procedure; the mechanism is obscure, but is thought to be a result of an intense inflammatory response to the operation.  Non-celiac mimicking conditions such as the Irritable Bowel Syndrome are similarly activated.

Health and happiness,
Dr. Aron

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