If there are any celebrities left who aren’t on a gluten-free diet, then we haven’t met them! And if you haven’t been living under a stone for the last few years you will probably know that avoiding gluten is a BIG thing. But how do you know whether it is right for you? If you don’t feel well when eating gluten, then find out the lowdown on gluten sensitivity laboratory testing options in the UK for coeliac and non-coeliac gluten issues.
More and more people are choosing to adopt a gluten-free diet. Supermarket shelves are now brimming with gluten-free bread, pasta, biscuits and cakes. Many models, actors and sports professionals are very publicly turning to gluten-free diets and some have published their own gluten-free recipe books.
Despite the huge rise in available gluten-free foods and the evidence that going gluten-free can help a lot of people, the diet is tricky to follow, especially when catering for large families, eating out or travelling. It can also be expensive.
A good way to start is to try it for 6 weeks to 3 months to see if you have any gains in your health. However even that can seem like a huge mountain to climb for people who want more evidence before taking the plunge. Others would like to cut back on gluten but are not sure how far they need to go and whether they do need to go down the route of 100% avoidance or not. Many people therefore ask me whether they can test to see whether they or their child should adopt a gluten-free diet.
So here is what you need to know on the tests currently available in the UK.
Coeliac Disease Testing
Historically a gluten-free diet has only been for those with a diagnosis of Coeliac disease. This is an auto-immune disease which is triggered by consuming gluten. It affects the gut and can flatten the villi of the small intestine known as villous atrophy. Villous atrophy was first described by a British doctor John W. Paulley in 1954. Coeliac disease was once seen a very rare but it now affects 1% of the population.
This can be tested through your GP and you need to ask for a Tissue Transglutaminase Coeliac test. If your GP does not offer it, then a full Coeliac Panel blood test can be arranged through The Doctors Laboratory. If a positive test is reported, then it is advisable to get a referral to a gastro-enterologist who will carry out a biopsy on the small intestine.
Gluten Sensitivity Research
The Sheffield Institute of Gluten-Related Disorders (SIGReD), headed by Professors Marios Hadjivassiliou and Dave Sanders, is currently researching how the diagnosis of Coeliac disease could be improved through increased recognition of the symptoms that are not always connected to the gut, as well as those patients who have non-Coeliac gluten sensitivity. Dr Hadjivassiliou, reported in The Lancet, said that gluten sensitivity can actually be at times exclusively a neurological disease. That means people can be showing symptoms of gluten sensitivity by having issues with brain function without any gastrointestinal problems. Gluten can inflame the brain and it deposits a type of plaque that interferes with proper communication between cells. SIGReD has suggested that 20% of the population may be significantly affected by ingestion of gluten. Dr David Perlmutter’s book Grain Brain also demonstrates how gluten is very detrimental to brain cells.
Cyrex Antibody Testing for Auto-Immune Conditions
In addition to SIGReD, the UK now has a cutting-edge gluten antibody test available from Cyrex Laboratories. This test is a very accurate way of identifying people with non-coeliac gluten-related health disorders. Cyrex Array 3: Wheat/Gluten Proteome Reactivity & Autoimmunity tests for 12 separate IgG and 12 IgA antibodies to wheat and other gluten grains.
This gluten sensitivity laboratory testing has completely revolutionised our ability to identify whether someone needs to be 100% gluten free and whether gluten is triggering an auto-immune response.
Other gluten sensitivity laboratory testing that you can do if you get a negative coeliac result, but still react to gluten is a blood test for HLA-DQ class two alleles (AKA genes). 95% of patients with coeliac disease hold the HLA DQ2 gene and about 5% have HLADQ 8. This is a good test to do if you have members of the family with coeliac disease or a strong family auto-immune picture. So even if you do not have coeliac disease (yet!) but you do hold this gene, then you may be more susceptible to developing coeliac disease or an auto-immune condition. Therefore a precautionary gluten-free diet may be a good idea. HLA SNPs are also highlighted in the 23andMe genetic panel that is becoming increasingly popular in the UK.
If you feel drunk, woozy or have brain fog, having ingested gluten, then peptides may be an issue. Children with gluten peptide issues often seem somewhat in their own world, may be the type of child who never feels pain, and may have speech and auditory integration issues. Commonly, they fixate on only eating certain foods: dry cereal for breakfast, sandwich for lunch and pasta for supper, day after day is a typical presentation.
Urinary peptides are incompletely broken-down pieces of protein. The peptides from gluten and casein can react with opiate receptors in the brain, thus mimicking the effects of opiate drugs like heroin and morphine. These compounds, called neuropeptides, have been shown to react with areas of the brain’s temporal lobes that are involved in speech and auditory integration. Neuropeptides also decrease the ability to feel pain and affect cognitive function. Urinary peptides can be tested through Cyrex Array 3 or through the Great Plains Gluten/Casein Peptide Test.
Pure Wheat Allergy?
Many people are allergic to wheat and therefore need to be wheat-free rather than fully gluten-free. Wheat is now one of the top eight allergens, and affects millions of people globally. This can be tested through an allergy specialist or through The Doctors Laboratory.
Food Intolerance Testing
Some people do not react to eating gluten immediately after ingestion. It can take up to 72 hours to experience the unwanted effects of gluten. IgG testing is available to those with more niggly low-grade reactions to gluten and other foods. These are less dramatic than an allergy and can often be overcome more easily than a pure IgE allergy or auto-immune response. I often see positive IgG response in the kids with sore tummies, wheezing, itchy skin and/or mild learning difficulties or processing issues.
The glutamate content in gluten is very detrimental to brain cells and is well documented in Dr Russell Blaylock’s book Excitotoxins: The Taste That Kills. Glutamate is an excito-toxin, which means it overexcites brain cells, either damaging or killing them. Glutamate’s home in the brain is called the NMDA (N-methyl-D-aspartate) receptor. Excessive excitation of this receptor has been linked to many psychiatric disorders.
Testing for excessive glutamate may be done either in conjunction with a broader panel such as the Optimal Nutrition Evaluation by Genova Diagnostics (which also looks at other excito-toxin markers) or as a part of a neurotransmitter panel through Labrix laboratories.
Toby, a teenage boy diagnosed with type 1 diabetes had also suffered from extreme gut problems since the age of 7. For 3 or 4 years he had missed a great deal of school due to fatigue and brain fog associated with these gut problems. He had repeatedly tested negative for Coeliac disease. When we carried out the Cyrex Array 3, he showed four raised antibodies to gluten and wheat including Transglutaminase-2 IgG which attacks the gut in a similar way to Coeliac disease.
Within a month or so of adopting a strict gluten-free diet, his gut, energy and brain fog symptoms disappeared. He did try one week back on gluten and suffered for three weeks afterwards so is now convinced he does need to remain in this diet.
The neurologic significance of celiac disease biomarkers.
McKeon A1, Lennon VA2, Pittock SJ2, Kryzer TJ2, Murray J2
Pathophysiology of celiac disease
Consensus Paper: Neuroimmune Mechanisms of Cerebellar Ataxias
Mitoma H1, Adhikari K, Aeschlimann D, Chattopadhyay P, Hadjivassiliou M, Hampe CS, Honnorat J, Joubert B, Kakei S, Lee J, Manto M, Matsunaga A, Mizusawa H, Nanri K, Shanmugarajah P, Yoneda M, Yuki N.
Coeliac disease: noncoeliac gluten sensitivity–food for thought
Aziz I1, Hadjivassiliou M2.
Diagnosis and management of adult coeliac disease: guidelines from the British Society of Gastroenterology
Ludvigsson JF1, Bai JC2, Biagi F3, Card TR4, Ciacci C5, Ciclitira PJ6, Green PH7, Hadjivassiliou M8, Holdoway A9, van Heel DA10, Kaukinen K11, Leffler DA12, Leonard JN13, Lundin KE14, McGough N15, Davidson M16, Murray JA17, Swift GL18, Walker MM19, Zingone F5, Sanders DS20; BSG Coeliac Disease Guidelines Development Group; British Society of Gastroenterology.
Editorial: Noncoeliac gluten sensitivity–a disease of the mind or gut?
Aziz I1, Hadjivassiliou M, Sanders DS.
Anti-transglutaminase 6 antibodies in children and young adults with cerebral palsy
Stenberg R1, Hadjivassiliou M2, Aeschlimann P3, Hoggard N2, Aeschlimann D3.
For confidentiality purposes, we routinely change names in examples, case studies and testimonials.
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