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 | Comments Off on Ask the Doc: Can a little gluten affect my blood test?

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 | Comments Off on Ask the Doc: Positive biopsy but negative blood tests

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 3 Comments - 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 | Comments Off on Ask the Doc: Why does celiac disease cause infertility?

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,

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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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