Stories to Help Us Understand

(These stories are written in conversational style)

(How the immune system handles an invader)

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General Measles

(How the immune system handles an invader)

Let's suppose you get a measles shot. The brain recognizes that there has been an "invasion" by an enemy. So it tells the immune system to appoint "General Measles" to specifically go after the Enemy.

General Measles builds an assembly line to manufacture "bullets" which are actually special "tags" with a "key" mechanism on them. He makes the "key" to fit exactly and ONLY in the measles molecule. Then he jumps in his Humvee, sticks his head out the window and zooms around the body shooting his "tags" (antibodies) in all the measles germs he finds. The tags mark the measles cells for death. Other body cells see the tags and know to attack and kill the measles germs.

When General Measles can't find any more measles to shoot he turns off his assembly line, but for the rest of his life he stays vigilant, searching ONLY for measles. If he ever finds measles, he flips the switch, gets his assembly line running, and goes back on active duty.

That is how our immune system works. When we test for antibodies we look for the "tags" that General Measles, General Casein, General Mumps, General Gliadin or General Gluteomorphin, etc. use to "mark out" their particular assigned enemy for death. Each antibody is made to fit like a key in a lock ONLY in the specific "enemy" that it was designed to tag.

But somehow this process is going wrong. Sometimes the antibody "keys" stick in "locks" or spaces where they should not fit. (This is called "cross reacting. See more on cross reactions in separate links on this website.) This literally nails "condemned" signs on our tissues and organs. Special killer cells are attracted by the "tags/antibodies" like a demolition crew looking for which house on the street to destroy. When the antibodies stick in the tissues by mistake the killer cells then mistakenly destroy our body tissues instead of just the enemy the were intended to target. This is "autoimmune disease".

Close: General Measles

The Five Branches of the

Armed Forces

(and how they spot their man)

(Explains IgA, IgD, IgE, IgG, IgM)

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The Five Branches of the Armed Forces

(and how they spot their man)

(Explains IgA, IgD, IgE, IgG, IgM)

When our military looks for evidence of action within their ranks, they are more likely to locate the action and enemy if they check all branches of the armed forces (Army, Navy, Air Force, Coast Guard, etc). Similarly, it is wise to check several branches of our immune system/security system to find evidence of immune activity against an enemy.

What is "evidence of immune activity"?

Explain the branches of the immune system please.

Similarly to the above example of the armed forces, when immune reaction to a food or substance is suspected we look for the antibodies, enzymes or other reactions to that substance as proof of immune activity. We are most likely to find these antibodies/enzymes if we check several branches of our immune system. We actually have 2 immune systems, the "innate" and the "adaptive/acquired", and several branches of those 2 systems. There are 5 branches of the "acquired" immune system called immunoglobulins.

IgA - present in mucous membranes - Definition

IgD - a poorly understood immunoglobulin - Definition

IgE - immediate allergic histamine reaction - Definition

IgG - the most common immunoglobulin - Definition

IgM - indicates present exposure - Definition

For example, to test for antigliadin antibodies (AGA) some testing labs check only the IgA branch. Others check IgA and IgG, and others check IgA, IgG, and IgM. Hence the individual tests are labeled, AGA-IgA, AGA - IgG, and AGA-IgM.

Why do labs vary in the tests they run? Opinions vary re the importance of these antibodies mainly because AGA antibodies are often present without visible villi (celiac) damage.

Some specialists insist that villi damage is the only and final proof that of immune response to gluten/gliadin, therefore presence of antibodies is irrelevant if there is no villi damage.

Other researchers argue that damage may not always be to villi, but to other body areas instead, and/or in some patients with genetic villi damage susceptibility. Even then in patients susceptible also to villi damage, the damage may not be advanced enough to be visible upon examination if villi damage appears only in late stages for that patient. These researchers argue that presence of AGA, AGA-tTG, or gluteomorphin antibodies or other reactions by white blood cells (the ALCAT method) is ample proof that the body is "fighting" gluten/wheat or other tested substances. They recommend treatment, i.e., avoidance of the substance such as gluten/gliadin, milk or other tested substances. They also recommend protocols to heal "leaky gut syndrome", a common cause for food intolerances.

Close: Explain the branches of the immune system.

Close: The Five Branches of the Armed Forces

Major Attack in Yemen!

(An immune system on high alert)

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Major Attack in Yemen

(An immune system on high alert)

Remember when the USS Cole was attacked by in the harbor of Yemen? Terrorists loaded a powerboat with explosives and crashed into the side of the ship. This was a serious breach of United States security.

Question?

What happened to every US Marine base around the world the day of the USS Cole attack?

Answer:

Even though the attack was only in Yemen, it was such a severe breach of security that every Marine base around the world went on high alert.

Is is postulated that a similar phenomena may sometimes take place in our bodies. For instance, bacterial or yeast infections or reactions to other foods like milk may be so severe that the entire immune system stays up in arms. When the body is under serious siege somewhere else, General Gliadin or General Casein may be confused and continue to fire antibodies gliadin, casein or other foods are no longer present. Those antibodies may still cross react with tissues and initiate harmful inflammation and damage to the body.

Lesson: In order to calm overactive immune system responses, it is important to find and treat the triggers. There may be several triggers that could include gluten/gliadin, milk, yeast and fungal infections fueled by dietary sugars and starches, other bacterial infections, viruses, molds, other environmental and dietary toxins, and toxic loads of heavy metals.

Therefore removal of gluten, milk or other foods may be large pieces in the puzzle, but not be the only pieces. Other "insults" to the body terrain may create such serious immune response that the entire system runs on high alert creating continued harm and havoc even after offending substances are removed.

Removal of part of the source is like carrying out only half the garbage. The kitchen still stinks! You don't bring back the garbage you removed. You look for the rest of the mess(es) and remove or treat them also.

Unfortunately, once the gut is upset and out of balance, it may no longer to be able to digest many foods efficiently, giving rise to multiple secondary food intolerances hindering the natural ability to digest food such as eggs and (unprocessed) milk that have historically nourished healthy populations for centuries.

Finally, farming methods, food processing, additives, toxic exposures, unhealthy processed fats, emotional stress and increased physical separation from the natural environment are all changes that parallel the rise of digestive/ degenerative/autoimmune disorders?

Close : Major Attack in Yemen!

The Gatekeeper

The Zonulin Story

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The Gatekeeper

The Zonulin Story

The following excerpt is reprinted with permission from

Wheat Free Worry Free: The Art of Happy, Healthy Gluten Free Living

by Danna Korn

Reprinted with permission

Courtesy of Danna Korn

Click to download Adobe version

Wheat and Gluten

May Be in Your Future

(Contributions by Michelle Maria Pietzak, M.D. and Alessio Fasano, M.D.)

“Every oak tree started out as a couple of nuts who decided to stand their ground.”

Anonymous

In the last several years, researchers around the world have focused on potential treatments for wheat sensitive, gluten intolerance, and celiac disease. Specific research on celiac diseases has attempted to understand the mechanism by which gluten causes the presentation of this disease. In the past few years, some exiting new discoveries have been made in this area that may have equally important impacts on other conditions as well, such as diabetes and multiple sclerosis. Recently, scientists at the University of Maryland who were looking for the key to unlock some of the most baffling mysteries about celiac disease shouted a very loud, “Eureka” followed by an equally loud, “Open sesame!”

Zealots for Zonulin

“Zonulin” may sound like a character from a science fiction movie, but it’s actually a protein made by the human body, and may represent an important piece of the puzzle in the development of autoimmune diseases, including celiac disease.

The small intestine contains billions of cells that are packed so tightly together that they act as a barrier against toxins, viruses, bacteria, and other foreign invaders, protecting the body’s tissues. Between these cells are the “tight junctions” (also referred to as the zonula occludens).

Researchers wondered how gluten, a relative large molecule, was getting through the tightly packed cellular barrier and into the immune system where it caused an autoimmune response. The answer, they discovered recently, is that exposing the small intestine of the celiac patient to gluten causes an increase in the production of the protein zonulin. Zonulin decreases the resistance of the small intestinal barrier by opening the tight junctions, which can then open the spaces between cells, allowing some substances to pass through. In other words, zonulin acts as the gatekeeper for the body’s tissues. People with celiac disease and some other disorders have higher levels of zonulin, which, in essence, means that gates are “stuck open,” allowing gluten and other harmful substances to pass through.

An Unexpected Discovery

The story of the discovery of zonulin is an interesting and unique example of how scientists can learn from microorganisms (for example, bacteria). Researchers at the Center for Vaccine Development at the University of Maryland were trying to develop a vaccine for the cholera bacterium (cholera is one of the leading causes of death in children worldwide, and it causes a profuse, watery diarrhea). The researchers discovered that cholera causes diarrhea by secreting a toxin called Zot (zonula occludens toxin), which can open the tight junctions (zonula occludens), thereby contributing to the severe, life-threatening diarrhea. Being keen scientists, they realized that these smart bacteria were likely mimicking a natural process in the human body. Using the latest techniques in molecular biology, they identified zonulin, a human protein that binds to the same receptor as Zot and performs similar actions.

The researchers found that zonulin was elevated in the tissue of subjects with many different diseases, such as celiac disease, type 1 diabetes (insulin-dependent or childhood diabetes, also a autoimmune disorder), and multiple sclerosis. They hypothesized that zonulin opens the tight junctions in these individuals, and allows molecules to pass across the intestinal barrier that normally would not pass through.

In a person with celiac disease, production of zonulin increases in response to eating gluten. This leads to more open tight junctions between the intestinal epithelial cells, allowing the passage of toxic portions of gluten (which are normally too large to pass through). These toxic portions then interact with our friend tTG (tissue transglutaminase; see section on antibody testing for celiac disease), which changes the gluten fraction to a form that can interact with the immune system’s lymphocytes (specialized white blood cells).

These interactions lead to the production of cytokines, chemicals that attract more lymphocytes to the affected area. The lymphocytes then attack the small intestine epithelium, leading to blunted or flat villi. Some lymphocytes will also be stimulated to produce specialized antibodies, the antigliadin, antiendomysial, and anti-tissue transglutaminase antibodies. These antibodies do not damage the intestine, but can be used as markers for celiac disease when they are found in the blood in elevated concentrations.

Zonulin and the Blood-Brain Barrier

Researchers at the University of Maryland were on a roll. Having discovered the importance of zonulin in opening the spaces between the cells that serves as a barrier in the small intestine, they turned their attention to the blood-brain barrier. The blood-brain barrier, like the barrier created by tightly packed cells in the small intestine, is a collection of tightly packed endothelial cells that line the blood vessels of the brain and prevent some substances in the blood from entering, while allowing others to pass through. Until now, scientists knew very little about why some molecules were allowed to pass through and other were not. The researchers hypothesized that zonulin could play a similar role in the blood-brain barrier to the one it play in the intestinal epithelial barrier, by opening the tight junctions or gates between the cells in the blood vessels of the brain.

Their theories have been substantiated; they have now verified that the receptor that binds both zonulin and Zot exists in the brain. This discovery may lead to novel treatments of diseases in which there is blood-brain barrier dysfunction, such as multiple sclerosis, brain tumors, and HIV infection.

The fact that zonulin receptors exist in the brain, and that zonulin is increased in the tissues of patients with celiac disease, may provide an explanation for some of the neurological symptoms of the disease. Also, the possibility that doctors may be able to deliver new types of medications (linked to Zot or zonulin) across the blood-brain barrier could open the doors to a whole new world of treatment options for many neurological diseases.

Technical info here, here, and here

Close: The Gatekeeper

A Life of it's Own

Mousetraps on a Football Field

(Explains cascade reactions)

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Dominoes on a Football Field

(Why does just a small amount matter? and Why no symptoms or only delayed symptoms?)

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The Strong Survive

(A reason why reactions to dietary "mistakes" may be stronger after healing takes place)

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A Garden Hose

and a Power Surge

(Brain Ischemia/Reperfusion Injury)

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(Dr. Thomas O'Bryan)

A Garden Hose and a Power Surge

(Brain Ischemia/Reperfusion Injury)

1: Lijec Vjesn. 2006 Mar-April:128(3-4):87-95
[Pathophysiology of ischaemia-reperfusion injury] [Article in Croatian]

Sirotkovic-Skerlev M, Plestina S, Bilic I, Kovac Z. Katedra za patofiziologiju Medicinskog fakulteta u Zagrebu.

Reperfusion of ischaemic tissue provides oxygen and substrates that are necessary for tissue recovery and concurrently removes toxic metabolites. However, reperfusion may induce various detrimental processes that may cause further tissue damage. Such deterioration of tissue function after reperfusion is defined as ischaemia-reperfusion injury. The consequences of ischemia-reperfusion injury vary from reversible cell dysfunction to local and remote tissue destruction, multiple organ failure and death. The pathogenesis of ischaemia-reperfusion injury is complex and includes excessive production of reactive oxygen species, activation of neutrophils, activation of complement, involvement of cytokines and other inflammatory mediators, vasoactive substances NO and endothelin. This review discusses the pathophysiology of ischaemia-reperfusion injury, the mechanisms of reactive oxygen species production, and the role of other factors in the pathogenesis of such injury. Several approaches and procedures used in pre-clinical and clinical studies in order to limit ischaemia-reperfusion injury are also presented.

PMID: 16808098 [PubMed - in process]

A Power Surge

Ischemia - Reduction of blood flow Definition

Reperfusion - restoration of blood flow Definition

Since the link above is a technical article, it is easier to also illustrate ischemia/reperfusion injury in the following story.

The on/off phenomena of ischemia-reperfusion injury may be compared somewhat to an electrical brownout or blackout. When electrical power is cut off we unplug our sensitive electrical appliances including computers, fax machines, microwaves, etc., and/or provide surge protectors to minimize damage to sensitive circuitry.

Consistent blood flow is vital to every area of the body, but especially to organs and it is crucial for the sensitive brain. (The brain lacks a reserve supply of cell fuel called "organ reserve" that other organs possess to carry them through momentary deprivation. See www.pubmed.gov for over 2000 discussions of brain, ischemia and the phenomena of general ischemia-reperfusion injury).

Medicine is well aware of damage incurred by off/on blood flow to tissue, and attempts to minimize this damage is the subject of extensive study. Other examples of ischemia-reperfusion injury to tissue include on/off blood flow during heart attacks, heart surgery, or hypothermia. Injury occurs when when blood flow returns to deprived tissue. The brain is particularly sensitive to this type of damage.

How does ischemia-reperfusion injury apply to individuals who are immune sensitive to foods such as gluten or milk, yeasts, molds, and/or other environmental substances?

The Garden Hose

A large blood vessel travels up each side of the neck like a garden hose, carrying blood into the brain. Once it reaches the brain it divides into smaller vessels to distribute blood to various parts of the brain, like a sprinkler attachment on a garden hose. In the garden hose example, if the sprinkler is set correctly, every part of the lawn receives an adequate supply of moisture and all is well. However, if the sprinkler is partially clogged, or inappropriately set so parts of the lawn are not adequately watered, then vegetation in those areas fail to thrive or die.

Research was performed of patients known to be gluten sensitive but not yet treated with the gluten free diet. These patients were subjected to SPECT scans (color images) of the brain. Reduction of brain blood flow was noted in an average of 4 areas per patient compared to normal blood flow in healthy controls. SPECT scans were repeated after implementation of a gluten free diet and normalization of blood flow was observed. Reintroduction of gluten in the diet reproduced areas of reduced blood flow.

This mechanism is of grave consequence to patients adhering to the gluten free diet or other diets/treatments designed to remove substances known to induce immune response and its consequent damage and inflammation.

If a sensitive patient adheres to a strict diet or lifestyle which excludes offending substances, research indicates that blood flow is not impaired by the immune induced reactions and inflammation caused by these substances.

Occasional (off and on) ingestion of immune reactive substances such gluten or milk in sensitive individuals may recreate a number of adverse processes including inflammation and temporarily reduced blood flow in various areas of the body. Return to a gluten free diet again normalizes blood flow, but not with risk of the damaging effects of ischemia/reperfusion injury.

This is a difficult state of affairs. Lack of blood flow is not an acceptable state of affairs, but accomplishing return of blood flow through exclusion of inflammatory substances carries it's own inherent risks.

This principle illustrates the rationale behind unwavering recommendations by specialists in the gluten sensitive community to adhere strictly to the gluten free diet. The relationship between ischemia-reperfusion injury and "cheating" on the gluten free diet, such as occasional birthday cake, communion wafer/loaf, an inappropriate brand of gluten containing soy sauce at a restaurant, or the more prolonged gluten challenge for diagnostic purposes is not widely understood in the gluten sensitive community.

Close: Click link at the TOP of story

A metal key in a foam rubber lock?

(Discusses antibody cross reactions and possible relationship to dietary fats)

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Remember the Mousetrap Game? (Explains the need for nutrient dense food)

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Remember the Mousetrap Game?

(Explains the need for nutrient dense food)

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"Mousetrap" is a children's game in which a series of amusing contraptions are linked together to form a "fantasy pathway" which a ball rolls over/ under/through. Each piece added to the pathway allows the ball to activate the next piece until finally the ball disengages a cage that falls and captures a "mouse".

Many adults today remember this childhood game and are aware that even one missing piece in the pathway causes the ball to roll off the course and be lost.

Similarly in our bodies, thousands of chemical reactions take place every second, one after the other. The steps in these pathways need certain "pieces or ingredients" to accomplish each reaction. If those ingredients are not available the reaction and successive reactions may not happen, and digestion, healing and many other processes are hindered.

Homocysteine is an example of this phenomenon. Homocysteine is formed naturally in the body as an amino acid, methionine, is broken down into energy. There are 8 successive steps or reactions needed to metabolize (break down) methionine, and homocysteine is formed during one of these 8 reactions. Several chemicals are needed to take homocysteine to the next step including betain, folic acid and several B vitamins. If these ingredients are not available, homocysteine pools in every body cell, more particularly in some areas and organs than others. This pooled homocysteine is "gas on the fire" when inflammation is present and is known in medical fields to contribute at times to conditions such as sudden death by heart attack and Alzheimer's Disease. When the missing ingredients are provided for the next chemical reaction in the metabolic succession, homocysteine is converted properly and the "bottleneck" is relieved. This is easy, inexpensive and often quickly effective.

Moral of the story

If we consume poor quality over processed "fuel" (food) or toxic substances that lack or actually rob the supplies our body needs for chemical processes, we may no longer feel hungry but our body lacks the pieces it needs to complete chemical reactions required for proper function.

Today much of our soil is depleted and food grown on it may lack the "building blocks" needed to supply these chemical reactions. Additionally nutrients are diminished or chemically altered by food processing. Furthermore, toxins require our bodies to work very hard in it's attempts to remove them. This increases the demands for nutrients normally intended for healthy function.

Close link: Remember the Mousetrap Game?

A Table with 100 Legs

Why so much illness in children and young people??

Why do some people enjoy "reasonable" health even when their diet and lifestyle is poor.

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Last updated Jan. 12, 2011

Look up medical terms here

Tests for The Gluten Syndrome

and other cross reactive food reactivities,

toxins, environmental allergies

and

Explosion 2: Cyrex Labs is open with highly detailed gluten related antibody panels. More info asap.
www.Cyrexlabs.com Tests specifically

focused on diagnosis

of villi damaged

celiac disease

(Thought by some researchers to be a

small subtype of the gluten syndrome.)

~~~

Due to large page size,

the Lab Charts have

moved to a separate page.

The most sensitive and comprehensive tests are discussed on this page

and also here and on the expanded index page.

A black arrow identifies a "show/hide" link.

Click to open and close link.

There are several perspectives of gluten syndrome testing, plus constant new developments. It is unfair to expect any one professional to stay updated perfectly at all times. Patients have more time than their doctors to investigate their condition. This helps them choose or change to qualified, open minded professionals to whom they bring information for evaluation. Humble, open minded professionals pay attention to well conducted research.

Prayer, diligence, courage, and common sense balanced with openness and flexibility are valuable attitudes in the search for guidance.

How does a lay person find information and research?

Readers are encouraged to learn the various types of research articles, and how to find and evaluate them.

Research resource links

www.pubmed.gov

www.pubmed.gov is a free public medical research resource with helpful tutorials.

To search PubMed for a possible connection between a given condition and gluten, type "gluten", "gluten intolerance", "celiac disease", "coeliac disease", "gluten sensitivity" and (name of the disease) in the search bar. Examples: CELIAC DISEASE AND DOWN'S SYNDROME or GLUTEN AND HEADACHES.

Articles are listed with free links to the full text, or a short summary called an abstract, and some have no further information available. Sometimes a local library can obtain articles upon request.

Note: Search engines are not perfect. If a search comes up empty, try using other terms, or combinations. Some words do not come up when they are known to be in the database. Also a search may be empty because a research article is not loaded into this database or research has not yet been performed.

Links to online medical dictionaries:

http://www.nlm.nih.gov/medlineplus/mplusdictionary.html

http://cancerweb.ncl.ac.uk/omd/

Celiac focused research sites are found on the Resources page of this website.

Research articles that cover a wider scope of the gluten syndrome are found at the following websites:

www.enterolab.com

www.immunoscienceslab.com

This website, bottom of Medical Diagrams page and the Lab Charts page under Neuroimmunology Labs.

Understanding your tests - Helpful articles from www.labtestsonline.org

Close: How can a lay person find information and research?

"Testing Viewpoints Checklist"

Note: Due to the high number of expand/collapse links on this page it is recommended that the reader close each link as each section is read to keep the page clean and make it easier to relocate information.

A. A basic tutorial of test processes

A basic tutorial of test processes

1. Is this test credible?

2. How accurately was this sample processed?

3. What is the goal of the test or test panel?

4. What are the best test mediums, and why?

5. What does this test measure or observe?

6. How sensitive, specific, or detailed is this test/test panel?

7. Does the test account for variations such as time of day, diet or other factors?

8. How does this test's results match the experience of the patient community?

9. Do test results fit the individual's experience?

10. What new research is anticipated?

Close link: A. A basic tutorial of test processes

B. Understanding gluten syndrome tests and also the tTG (tissue transglutaminase) test often used to specifically screen for celiac (villi ) damage only.

1. What are the tests looking for?

What are the tests looking for?

Tests look for evidence that that the immune system has manufactured antibodies and/or an enzyme to "tag" various pieces (peptides) of poorly digested gluten.

Please explain peptides and antibodies?

Gluten is a large complex protein molecule found is a number of grains.

During digestion gluten breaks up into pieces called peptides, but it resists breaking up completely, which is not good. The peptides are still too large. If the gut wall is in poor shape, these pieces may slip through the wall before they are properly broken down.

The immune system may misrecognize these large peptides as foreign invaders and manufacture antibodies (like a dunce caps or condemned signs) to tag them for destruction by killer cells that are in the blood stream..

For another easy description or word picture of antibodies, see the "General Measles" story in the opposite column on this page.

Here is a list of peptides that form as gluten breaks up, and the corresponding antibodies the body makes to "tag" them.

Gluteomorphins - pieces of the gluten molecule. - Gluteomorphin Antibody

Gluten - Gluten itself, the whole molecule, is tested by only a few labs.

Gliadin - a piece of only wheat gluten - Antigliadin antibodies (AGA)

Hordein - a piece of only barley gluten - Antihordein antibodies (not tested)

Secalin - a piece of only rye gluten - Antisecalin antibodies (not tested)

Avenin - a piece of only oat gluten - Antiavenin antibodies (not tested)

Example: Below is a fun illustration of the wheat gluten molecule before it starts to break up. Click the title for an explanation.

The Gliadin Mouse in the Gluten House (Click for details)

"The Gliadin Mouse in the Gluten House"

In this illustration, the black wire "cage" represents gluten, a large complex protein molecule. When the bars of the "cage" begin to break apart during digestion, "gluteomorphins" and other glutenins are formed.

The mouse represents "gliadin" and is another "piece" of gluten. (Actually gliadin is "part of the walls" of wheat gluten and is resistant to breaking down during digestion-More technical detail here).

The green and yellow clothespins represent different specific antibodies that the immune system makes to "tag" gluteomorphins, gliadins and other lesser known glutenins as if they were foreign invaders. This marks them for destruction. Each antibody is designed to tag only that particular peptide (piece) but some researchers say they make mistakes and also tag body tissues that look a little bit like that peptide. This attracts killer cells to innocent body tissues and creates inflammation and autoimmune disease.* When the antibodies tag innocent "look alike" tissues or similar foods, this is called "cellular mimicry".

The pink clothespin in the picture represents a normal enzyme called tTG which bids with gliadin and becomes elevated only in reactions that damage the villi specifically (with a few exceptions). Dr. Vojdani (Immunosciences Laboratories) believes elevated tTG is not always present in all gluten related reactions that do not involve villi damage. THIS IS A PROBLEM BECAUSE IT IS NORMAL FOR SPECIALISTS TODAY TO USE THE tTG TEST AS A SCREENER BECAUSE THEY BELIEVE VILLI DAMAGE IS THE ONLY WAY TO DIAGNOSE A GLUTEN REACTION. THEY DO NOT CONSIDER THAT OTHER AREAS OF THE BODY MAY BE DAMAGED INSTEAD OF THE VILLI. DR. VOJDANI AND OTHER RESEARCHERS BELIEVE MANY PATIENTS ARE MISSED BECAUSE THEY HAVE NEGATIVE tTG SCREENERS AND NO SIGNIFICANT VILLI DAMAGE BUT SEVERE AUTOIMMUNE DAMAGE IN OTHER PLACES IN THE BODY.

*Published research observes that due to their structure, antigliadin, gluteomorphin, and casomorphin (milk) antibodies bind or "cross react" with brain and nerve tissue and many other organ and body tissues by cellular mimicry. This means these antibodies are particularly dangerous. See Immunosciences Laboratories on the Lab Charts page for references.

Close: The Gliadin Mouse in the Gluten House

Celiac specialists check very few antibodies but rely mainly on tTG and villi biopsy for dx. Gluten syndrome oriented specialists (there are few of them), test for all the antibodies they can until they get a positive. They do not perform an invasive biopsy unless there are other reasons to examine the gut because they recognize that damage could be to many different locations, and only occasionally the villi (1 in 100).

Most "celiac only" specialists check only the tTG antibody since tTg is usually only elevated if there is villi damage. They rule out many patients due to negative tTg when other gluten syndrome oriented researchers insist that elevated tTG is not present in many gluten syndrome reactions.

A few celiac specialists may check antigliadin (AGA) antibodies, but most do not since they are confused when they get positive gliadin antibodies but negative biopsy. Unfortunately instead of questioning the biopsy as the only possible place of damage, they ignore the positive antibody test, even though antibodies are proof in themselves of an immune reaction.

Gluten Syndrome specialists include gluteomorphin, gluten, wheat, and IgM antibodies in addition to the tTG and gliadin markers used by celiac specialists. When they look for more antibodies, they find many more positive testing patients. (One doctor, Thomas O'Bryan, Chicago, tested all his patients, 350+, over a 3-4 year period and 77% of them were positive for a gluten related antibody!!)

Celiac vs. gluten syndrome specialists vary on their interpretation of antibody tests

Many "celiac only" specialists discontinued antigliadin antibody tests. They believe they are unreliable because often the test finds antibodies but a villi biospy shows no villi damage. They now use the tTG enzyme instead as a marker of villi damage because they believe gluten related damage only happens to villi.

Gluten syndrome specialists believe that any positive gluten related antibody test proves that the body is fighting gluten or wheat. They believe that the villi are not always damaged, but that the damage is often somewhere else in the body. Therefore they use high antibodies, NOT villi biospy as a diagnostic tool. They also pay attention to the patient's symptoms since a few gluten syndrome patients may have antibodies for which there are no tests and therefore may test negatively in even the most complete panels.

Close: What are the tests looking for?

2. List of tests, their abbreviations and descriptions

ANTIBODY TESTS

a. AGA - Antigliadin Antibodies

b. Gluten Antibodies - Why is gluten itself not tested???

c. Gluteomorphins - Immunosciences Laboratories

Gluteomorphins are specific pieces of the large gluten molecule that may form during improper digestion and that are not broken down enough. Sometimes when gluten is removed from the diet, if the patient has gluteomorphins that have cross reacted to brain tissue, they may experience temporary withdrawal symptoms. In some cases this withdrawal may be quite severe and the patient may experience depression or psychiatric symptoms.

There is no abbreviation, hence they are called:

Gluteomorphins - IgA
Gluteomorphins - IgG
Gluteomorphins - IgM

The gluteomorphin test is a blood test available from Immunosciences Laboratories, Los Angeles, CA.

In published research, gluteomorphin antibodies are reported to cross react/bind/or stick to cerebellar (brain) tissue and nerves. Their structure is described on page 191 of this article from the International Journal of Immunology. *(In milk, corresponding peptides are "Casomorphins")

Labs that process gluteomorphin tests find that some patients have gluteomorphin antibodies instead of antigliadin antibodies (AGA) and others have both or other antibodies.

Here is a quote from Dr. Aristo Vojdani of Immunosciences Laboratories which discusses gluteomorphin antibodies.

"Gluteomorphins are very small peptides of gluten the size of 8-80 amino acids. When gluten is broken down by body enzymes to small peptides, some of these peptides bind to receptors on the brain and immune system cells.

Since usually morphins bind to these receptors, and gluten peptides also bind to these receptors, these molecules are then called gluteomorphins, meaning molecules from gluten bind to morphin receptors and act like morphins. That is why patients with gluten sensitivity also have neurological involvements."

Aristo Vojdani, Ph.D, M. T. 8/23/2006

References:

Infections, Toxic Chemicals, and Dietary Peptides Binding to Lymphocyte Receptors and Tissue Enzymes are Major Instigators of Autoimmunity in Autism

Immune Response to Dietary Proteins, Gliadin and Cerebellar Peptides in children with Autism

Heat Shock Protein and Gliadin Peptide Promote Development of Peptidase Antibodies in Children with Autism and Patients with Autoimmune Disease.

Close: Gluteomorphins

d. tTG - Tissue transglutaminase

e. EMA-Antiendomysial Antibodies

f. AGA-tTG antibodies - Antigliadin bound to transglutaminase

g. Cross Reactive Food proteins - Milk (butyrophilins, casein, casomorphins), corn, egg, soy, yeast, and in some cases coffee, sesame and chocolate may cross react with gluten due to similar molecular structure.

Close: ANTIBODY TESTS

Tissue Damage ANTIBODY Tests and biopsies

Pancreas - Glutamic Acid Decarboxylase IgA, IgG, IgM

Brain and Nervous system - Myelin Basic Protein (MBP), Cerebellar and NeurofilNeurofilament Antibodies, all IgA, IgG, IgM

Heat Shock Protein - Involved in temperature related responses

Skin biopsy - biopsy area next to Dermatitis Herpetiformis lesions

Stomach - Parietal Cells - B-12 and Hydrochloric acid function

Thyroid - Thyroglobulin and Thyroid Peroxidase

Villi - biopsy of duodenal villi. Dx used by celiac focused specialists

Many many more tissue tests on the way

Close: Tissue Damage Tests

GENE TESTS

Gluten related gene tests are either blood or cheek swab tests. The tests are run either in 1 or 2 part processes. The 2 part process is more detailed, more sensitive, and more expensive.

There are 3 different opinions regarding gluten reactive genes.

Celiac only researchers recognize HLA DQ 2 or 8. Other non DQ genes are under investigation.

Dr. Ken Fine, MD*, recognizes HLA DQ 1, 2, 3, and 8 for the gluten syndrome. *Gastroenterologist, Dallas, TX

This means, according to Dr. Fine, that most Caucasians carry at least one predisposing gene for gluten reactivity. Enterolab offers a one part gene test that reports the patient's specific HLA DQ alleles. The advantage is that the patient knows his genes and does not need to be retested if in the future they are linked to the gluten syndrome. The one part test is less expensive and in some cases less sensitive than the 2 part test.

Additional genetic information according to Dr. Fine:

Note this is a summary of information on Dr. Fine's website. Below the summary are the actual quotes.

HLA DQ 1 and 3 and subsets of those genes also predispose to gluten reactivity, and are found commonly in patients with Microscopic colitis and rheumatoid arthritis, but not to villi damaged celiac disease.

Possessing 2 copies of gluten reactive genes predisposes the patient to a higher risk of developing gluten reactivity and that the resultant gluten reactivity and disease will be worse.

Each parent possesses 2 HLA genes and passes one HLA DQ gene to the child. Therefore if the parent possesses 2 gluten sensitive genes, one gluten sensitive gene will pass to the child.

31% of the American population carries the HLA DQ 2 gene

12% of the American population carries the HLA DQ 8 gene

38% of the American population carries the HLA DQ 1 gene

HLA DQ 4 is the only DQ gene which does not appear to predispose to gluten reactivity according to Dr. Fine. Therefore a person with 2 copies of HLA DQ 4 (HLA DQ 4,4), a rare combination, is the only combination that does not predispose to gluten reactivity.

Quotes below reprinted with permission from:

https://www.enterolab.com/StaticPages/Faq_Result_Interpretation.htm

https://www.enterolab.com/StaticPages/Frame_TestToOrder.htm#Genetic_testing

Why are gene results so complicated, and which genes predispose to gluten sensitivity/celiac sprue?

Gene tests for gluten sensitivity, and other immune reactions are HLA (human leukocyte antigen), specifically HLA-DQ, and even more specifically, HLA-DQB1. The nomenclature for reporting HLA gene results has evolved over the last two decades as technology has advanced. Even though the latest technology (and the one we employ at EnteroLab for gene testing) involves sophisticated molecular analysis of the DNA itself, the commonly used terminology for these genes in the celiac literature (lay and medical) reflects past, less specific, blood cell-based (serologic) antigenic methodology. Thus, we report this older "serologic" type (represented by the numbers 1-4, e.g., DQ1, DQ2, DQ3, or DQ4), in addition to the integeric subtypes of these oldest integeric types (DQ5 or DQ6 as subtypes of DQ1; and DQ7, DQ8, and DQ9 as subtypes of DQ3). The molecular nomenclature employs 4 or more integers accounting together for a molecular allele indicated by the formula 0yxx, where y is 2 for DQ2, 3 for any subtype of DQ3, 4 for DQ4, 5 for DQ5, or 6 for DQ6. The x's (which commonly are indicated by 2 more numbers but can be subtyped further with more sophisticated DNA employed methods) are other numbers indicating the more specific sub-subtypes of DQ2, DQ3 (beyond 7, 8, and 9), DQ4, DQ5, and DQ6. It should be noted that although the older serologic nomenclature is less specific in the sense of defining fewer different types, in some ways it is the best expression of these genes because it is the protein structure on the cells (as determined by the serologic typing) that determines the gene's biologic action such that genes with the same serologic type function biologically almost identically. Thus, HLA-DQ3 subtype 8 (one of the main celiac genes) acts almost identically in the body as HLA-DQ3 subtype 7, 9, or other DQ3 sub-subtypes. Having said all this, it should be reiterated that gluten sensitivity underlies the development of celiac sprue. In this regard, it seems that in having DQ2 or DQ3 subtype 8 (or simply DQ8) are the two main HLA-DQ genes that account for the villous atrophy accompanying gluten sensitivity (in America, 90% of celiacs have DQ2 [a more Northern European Caucasian gene], and 9% have DQ8 [a more southern European/Mediterranean Caucasian gene], with only 1% or less usually having DQ1 or DQ3). However, it seems for gluten sensitivity to result in celiac sprue (i.e., result in villous atrophy of small intestine), it requires at least 2 other genes also. Thus, not everyone with DQ2 or DQ8 get the villous atrophy of celiac disease. However, my hypothesis is that everyone with these genes will present gluten to the immune system for reaction, i.e., will be gluten sensitive. My and other published research has shown that DQ1 and DQ3 also predispose to gluten sensitivity, and certain gluten-related diseases (microscopic colitis for DQ1,3 in my research and gluten ataxia for DQ1 by another researcher). And according to my more recent research, when DQ1,1 or DQ3,3 are present together, the reactions are even stronger than having one of these genes alone (like DQ2,2, DQ2,8, or DQ8,8 can portend a more severe form of celiac disease).

Is it possible to tell which parent gave me the celiac or gluten sensitivity gene?
Everyone has two copies (or alleles as they are called scientifically) of every gene in the body; one from mother and one from father. The only way to know if a parent definitely has a gluten sensitive or celiac gene without testing them directly, is if a child has two such genes (having received one from mother and one from father). If only one gluten sensitive or celiac allele is present in a child, there is no way to know if it came from mom or dad. One gene is enough, however, to get clinically significant gluten sensitivity or celiac disease, and from published research, two copies yields an even stronger reaction and hence, potentially more severe gluten-related complications.

If I do not have a gluten sensitive or celiac gene, does that mean my parents/siblings/children do not?
Because everyone has two copies (alleles) of every gene, but a parent only gives one of these genes to each of their offspring (distributed randomly between a parent's two alleles), even if a child does not have a gluten sensitive or celiac gene, one or both parents could have one of these predisposing genes as their other allele. Hence, a person without a predisposing gene could still have parents or siblings with these genes. To be sure, each family individual must be tested to know. (The only certainty with respect to genetic testing is that if a person is found to have two predisposing genes, then every one of his/her children and both parents will have at least one copy of these genes, which is enough to get clinically significant gluten sensitivity or even celiac disease.) Because a child gets one allele from each of their parents, even though a particular person does not have a gluten sensitive gene, their children have a good chance of getting one from the other parent since these genes are very common (see next paragraph).

How common are the gluten sensitivity and celiac genes?
DQ2 is present in 31% of the general American population. DQ8 (without DQ2) is present in another 12%. Thus, the main celiac genes are present in 43% of Americans. Include DQ1 (without DQ2 or DQ8), which is present in another 38%, yields the fact that at least 81% of America is genetically predisposed to gluten sensitivity. (Of those with at least one DQ1 allele, 46% have DQ1,7, 42% have DQ1,1, 11% have DQ1,4, and 1% have DQ1,9.) Of the remaining 19%, most have DQ7,7 (an allele almost identical in structure to DQ2,2, the most celiac-predisposing of genetic combinations) which in our laboratory experience is associated with strikingly high antigliadin antibody titers in many such people. Thus, it is really only those with DQ4,4 that have never been shown to have a genetic predisposition to gluten sensitivity, and this gene combination is very rare in America (but not necessarily as rare in Sub-Saharan Africa or Asia where the majority of the inhabitants are not only racially different from Caucasians, but they rarely eat gluten-containing grains, and hence, gluten-induced disease is rare). Thus, based on these data, almost all Americans, especially those descending from Europe (including Mexico and other Latin states because of the Spanish influence), the Middle East, the Near East (including India), and Russia, are genetically predisposed to gluten sensitivity. (That is why we are here doing what we do!) But be aware that if a person of any race has a gluten sensitive gene, and eats gluten, they can become gluten sensitive.

What type of genetic testing does Enterolab offer?

https://www.enterolab.com/StaticPages/Frame_TestToOrder.htm#Genetic_testing

In the genetic assessment for the predisposition to celiac disease (a disease defined as villous atrophy and inflammation of the small intestine resulting from gluten sensitivity - the immune response to dietary gluten), the heterodimer HLA-DQA1*0501 and HLA-DQB1*0201 is one of the main genes required to develop the tissue lesion of celiac disease. However, it appears from research studies that HLA-DQ1, HLA-DQ2, and HLA-DQ3 can all lead to immune reactions to gluten (i.e., gluten sensitivity) even in the absence of intestinal villous atrophy. Non-celiac gluten sensitivity syndromes are no less severe than ones accompanied by villous atrophy, in terms of symptoms they may cause, accompanying autoimmune diseases in other parts of the body, and resultant disability. Thus, it is more important to assess for genetic predisposition to the underlying immune reactivity to gluten itself than just the one clinical form called celiac disease. Furthermore, fecal analysis cannot diagnose celiac disease, therefore EnteroLab makes no such claims of doing so.

In weighing the potential clinical benefit to our clients of adding HLA-DQA1 locus typing (to our current practice of typing only the HLA-DQB1 locus) versus the almost doubling of cost and price, we have found through internal research that the frequency wherein HLA-DQ2 positivity is the celiac-related DQB1*0201 allele verses the non celiac 0202, 0203, 0204, or 0205 alleles is overwhelming in favor of the celiac 0201 (and we now even separate these subtypes). By linkage dysequilibrium, HLA-DQA1*0501 will usually accompany HLA-DQB1*0201. Furthermore, the presence of HLA-DQ2 assessed serologically (functional presence of any DQ2 gene product) has always shown itself to be able to bind gliadin, and therefore predispose to gluten sensitivity (even if someone did not develop celiac disease/villous atrophy). For these three reasons (the overwhelming prevalence of the 0201 allele of DQ2 in our clientele, the linkage dysequilibrium of DQA1*0501 with DQB1*0201, and the greater importance of diagnosing the underlying immune reactivity to gluten, regardless of syndrome caused), we have decided to keep the price down for our clients and limit gene testing to the HLA-DQB1 locus. Finally, the treatment for gluten sensitivity and celiac disease is the same - complete-strict removal of gluten from the diet. The presence of any gene predisposing to immune reactivity to gluten (especially when accompanied by symptoms or an associated clinical syndrome) provides necessary information to the client to make an informed decision about whether or not to adopt a gluten-free diet.

Close: Dr. Ken Fine, MD*, recognizes HLA DQ 1, 2, 3, and 8

Dr. Aristo Vojdani, PhD* believes a gene is unnecessary but if present will predispose for a gluten response. *Immunologist, Los Angeles, CA.

See Medical Diagrams

Dr. Vojdani of Immunosciences Laboratories reports that non celiac (villi damage) gluten intolerance is a serious gluten related reaction that does NOT REQUIRE A PREDISPOSING GENE. This reaction is triggered by exposure particularly to toxins, and also stress and infections. (See Medical Diagrams/Gluten intolerance diagram. Therefore he does not believe that the gene test is worth the expense.

However: It is the opinion of this website that an inexpensive gene test is a valuable test in that it often provides supportive information not only to the patient but to family members. People take genetic information seriously. Example: A seriously symptomatic patient tested negatively to incomplete antibody tests and was temporarily misdirected back to a gluten containing diet with poor results. Later he did an inexpensive gene test and went gluten free based on positive genes. He understood they only indicated a predisposition, but given his obvious reactions to gluten and the gene test he finally "took the step" to go strictly gluten free. In this case the person's entire life changed for the better, physically and particularly mentally and emotionally. Other family members also investigated the issue seriously as a result of his gene test.

Here is Dr. Vojdani'she editorial paper which mentions his opinions on genetics.

The Immunology of Immediate and Delayed Hypersensitivity to Gluten - European Journal of Inflammation Vol 6 No. 1 1-10 (2008) Editorial - A. Vojdani Beverly Hills, CA (now Los Angeles, CA) T. O'Bryan, Warrenville, IL,( now Chicago, Il), G. H. Kellermann Neuroscience, WI, USA Full text here Note: This file contains 2 articles from the journal. Scroll to the top to find the Vojdani article.

Close: Dr. Aristo Vojdani, PhD* believes a gene is unnecessary.

Close: GENE TESTS

CROSS REACTIVE FOODS TESTS
Foods that are known to have a similar molecular structure to gluten and thought by some researchers to cross react in some cases with gluten include:

Milk (casein, casomorphins, butyrophilins) -- IgA, IgG, IgM

Corn - IgA, IgG, IgM

Egg - IgA, IgG, IgM

Soy - IgA, IgG, IgM

Yeast - IgA, IgG, IgM

To some degree also:

Coffee

Sesame

Chocolate

Some gluten free substitute foods including

Millet

Quinoa

Buckwheat

may also cause problems for some people who develop multiple food sensitivities.

Here is a quote from Dr Ken Fine MD, EnteroLab, which discusses these sensitivities.

https://www.enterolab.com/StaticPages/Frame_TestToOrder.htm#What_about_yeast

What about yeast sensitivity?

Although we know less about yeast sensitivity than gluten sensitivty (because the former has been identified and studied for a shorter period of time), we now know that it too can be associated with an immune reaction that damages the intestine and perhaps other tissues in the body. Yeast sensitivity is the only reaction identified to be present in people with a devastating intestinal inflammatory disease called Crohn's disease. Through research, we at EnteroLab have identified coexisting yeast sensitivity in at least three-quarters of those we find to be gluten sensitive. This is not surprising since many gluten containing foods also contain yeast (such as brewer's and baker's yeast). We also find that some people get more symptom relief from a gluten-free diet when it is also yeast-free.

What about milk, egg, and/or soy sensitivity?

Since the 1960's, research has shown that people who are immunologically sensitive to gluten have a higher than average chance of being sensitive to other dietary proteins, especially to those in milk, eggs, and soy. This can be detected by antibodies to these dietary proteins, and our patented stool antibody tests can reveal these to be present before they can be detected in blood. Sensitivity of the immune system to milk, egg, and soy proteins can cause intestinal syndromes and damage mimicking that caused by gluten and celiac sprue. Furthermore, recent research has linked antibodies to milk proteins to the devlopment of eczema, diabetes, multiple sclerosis, autism, and other immunologic syndromes.

To encourage people to get the maximum benefit from their testing and their dietary treatment, for a limited time, EnteroLab is offering the Milk Sensitivity Stool Test Free when you order the Gluten Sensitivity Stool and Gene Panel Complete.

Some labs that offer cross reactive food sensitivities.

www.EnteroLab.com IgA stool testing of multiple foods beyond milk, egg, yeast, soy - coming 2009

www.ImmunosciencesLabs.com - multiple panels of foods IgA, IgG, IgM - Not available at this time

www.OptimumHealthResource.com - multiple food IgG antibody panels

www.ALCAT.com - multiple food panels, cytotoxic test for white cell reaction - A controversial test*

www.ELISAACT.com ELISA/ACT Biotechnologies-food panels-cytotoxic lymphocyte reaction*

-

Note: Cytotoxic testing is controversial - Many professionals believe cytotoxic testing simply identifies foods eaten frequently. Some patients insist these tests helped them pinpoint problem foods.

Close: CROSS REACTIVE FOODS TESTS

Close: 2. List of tests

3. What are the differences between gluten syndrome and celiac tests?

"Celiac only" tests and interpretations are less detailed and target only one type of damage. They look only and very specifically for markers associated with villi damage in the duodenum for a celiac disease diagnosis, and gluten free diet.

They test :

tTG-IgA as a screener for biopsy
optional: AGA-tTG, possibly also AGA-IgG
IgA deficiency if necessary (Some people do not make IgA)
If in doubt, sometimes the HLA DQ2 and 8 genes

If the blood screeners are positive, celiac specialists biopsy the villi only for damage. Villi damage alone (not any other other place in the body) is considered the gold standard diagnostic tool for celiac disease and the gluten free diet.

(Celiac specialists believe that if a patient insists that gluten bothers him but they cannot find the few antibodies they test for, or villi damage, that this reaction is not an immune reaction and is not dangerous. Other specialists strongly disagree with this opinion because they test for more antibodies and find them and for damage in other places and find it.)

Other gluten syndrome specialists now question this viewpoint but villi focused diagnostic criteria remains unchanged. Most practitioners are only aware of celiac disease guidelines only. Furthermore, they only think of this possibility if there are classic gut symptoms. They do not think of celiac disease as a subset of the gluten syndrome.

Gluten Syndrome tests are more detailed. They look for:

More antibodies in more places in the immune system. (Gluten, gliadin. gluteomorphins, tTG, wheat kernel, Total IgA, - all IgA, IgG, IgM)

Tissue damage in many places, not just the villi.

Foods that crossreact with gluten and body tissues.

More genes although some think the gene is not necessary.

More mediums - blood, stool, saliva

See current Immunosciences Labs list on the Lab Charts page. Tests not available at this time. Watch for further announcements on home page of this website.

Gluten Syndrome oriented specialists recommend a gluten free diet when they find gluten related antibodies above normal limits. They consider improvement on the gluten free diet conclusive regardless of the particular underlying gluten related process or area of tissue damage.

Some practitioners use kinesiosiology (muscle testing) or other energy testing for additional clues. Methods and criteria varies widely between practitioners.

Close: 3. What differences are there between gluten reactivity and celiac tests?

4. What test viewpoints exist among today's specialists?

4. What test viewpoints exist among today's specialists?

See Seven Viewpoints Comparison Chart

Celiac specialists -

Celiac specialist focus on villi damage only for diagnosis. They believe a person with gluten damage will always have villi damage. They test blood samples for:

tTG enzymes
optional: antigliadin antibody
IgA deficiency if necessary
If in doubt, the HLA DQ2 and 8 genes, reported positive/negative

If the screener test is positive they biopsy for villi damage and only if the biopsy is positive do they recommend a gluten free diet. Many now question this viewpoint but celiac villi focused diagnostic criteria remains unchanged. Villi damaged celiac prevalence is estimated 1:100 in the healthy population.

Dr. Vojdani, Immunosciences Laboratories

Dr. Vojdani believes there are many more antibodies to test, and that damage may occur in many places in the body but not necessarily always to the villi. Therefore he recommends a complete as possible panel of gluten related and cross reactive food antibody tests. He also recommends a panel testing a number of tissues most susceptible to damage in replace to only one tissue damage test, the invasive villi biopsy.

He tests many antibodies and believes they are proof of immune reaction:

15 antibodies - Gliadin, gluten itself, wheat, tTG, and gluteomorphins, all IgA, IgG, IgM (15 antibodies total at this time more coming)

Crossreactive foods - milk, egg, corn, soy, yeast - all IgA, IgG, IgM

Neurological and organ damage (cerebellar, neurofilaments, mylein basic protein, plus thyroid, pancreas, stomach, and other tissues and functions. He believes gluten and other food antibodies cross react with and damage many organs and tissues in the body.(He tests IgA, IgG, IgM)

See Immunosciences Labs list on the Lab Charts page. Tests not available at this time. Watch home page of this website for further information.

Dr. Vojdani has a 30% gluten related positivity rate in his lab. Dr. Thomas O'Bryan tested all his patients over 4 years with a very complete panel of gluten related antibodies (over 350 sick patients, with a 77% positivity rate.)

Dr. Ken Fine Enterolab

Dr. Fine believes checking stool catches the gluten syndrome earlier than blood. He adjusts his tests for a low level of antibodies usually found in stool.

Dr. Fine checks stool for:

AGA-IgA
Ttg-IGA
Intestinal function (this is his own test)
milk (sometimes free in a combo package)
Optional - corn, egg, soy, yeast (IgA)
Optional - gene test, he reports the patent's actual HLA DQ subtype, 1 step test

A stool test indicates that there are antibodies in stool, not necessarily in blood, although they may be also present in blood or could be present in blood in the future. Dr. Fine considers high stool antibody levels indicative of gluten reactivity. See Enterolab on Lab Charts page or www.enterolab.com

Dr. Fine's test has a high positivity rate as follows compared to 1% celiac test positivity rates.

62-69% positive-common symptoms (autoimmune, fatigue, headache, digestive, etc.)

44% positive for non digestive, non specific symptoms

28% for non symptomatic (silent symptom) patients

Close: 4. What test viewpoints exist among specialists?

Close: B. Understanding gluten reactivity tests and also tests specific to the villi damaged "celiac" subset of the gluten syndrome.

C. How to choose? Should I pay for more than one test if my first test is negative and I question it?

1. Which test or tests are best in my case?

The purpose of the test and the patient's circumstances matter. Example: A patient who has discontinued eating gluten may no longer have detectable antibodies in the blood stream, ruling out a blood antibody test for diagnosis. But if the same patient is already diagnosed and wants to check his diet compliance, a low antibody count indicates a "clean" gluten free diet.

What information are you looking for?

If you currently eat gluten and need a diagnosis:

Gluten Syndrome specialists advise:

Test as many gluten related antibodies as necessary or as possible (15 approximately). If a positive is obtained, remove gluten. If negative, the tests are inconclusive since there are more antibodies than there are tests. (This is uncommon if all known antibodies are run.)

Gluten - IgA, IgG, IgM

Gliadin - IgA, IgG, IgM

Gluteomorphins - IgA, IgG, IgM

Wheat - IgA, IgG, IgM

tTG - IgA, IgG, IgM

Also test and remove other cross reactive foods.

Milk (Butyrophilins, Casein, Casomorphins- IgA, IgG, IgM)

Corn - IgA, IgG, IgM

Egg - IgA, IgG, IgM

Soy - IgA, IgG, IgM

Yeasts, Molds, Fungus - IgA, IgG, IgM

Test and treat damage in susceptible tissues with tissue damage tests or "predictive antibodies" for many tissues (not just villi) These tests replace a villi biopsy unless there are other reasons to biopsy.

Brain, nervous system - Cerebellar, neurofilaments, myelin basic protein

Pancreas - Glutamic Acid Decarboxylase

Heat Shock Protein - Involved in temperature related responses

Skin biopsy - biopsy area next to Dermatitis Herpetiformis lesions

Stomach - Parietal Cells - B-12 and Hydrochloric acid function

Thyroid - Thyroglobulin and Thyroid Peroxidase

Villi - biopsy of duodenal villi. Dx used by celiac focused specialists

Skin - This is a relatively easy biopsy if DH appears to be present.

Many many more tissue tests on the way

Test for nutrient deficiencies, calcium, iron, B 12, vitamin D, etc.

Celiac specialists advise: See Lab Charts page for website links

tTG -IgA screener, if positive biopsy the villi. May run tTG - IgG, or possibly Gliadin IgA, IgG

Villi biopsy - If the biopsy is positive start the gluten free diet. If negative, remain on a gluten diet. Some practitioners also check tTG-IgG, gliadin IgA, IgG and occasionally EMA antibodies. Some practitioners vary in their dietary recommendations depending on the situation.

Gene test (optional) To check for predisposition if there is uncertainty.

Close : If you are currently on a gluten containing diet

If you are not on a gluten containing diet

If you want to check your diet compliance

If you are on a strict gluten free diet with little or no improvement.

Summary descriptions of test options. See Lab Charts.

Common Celiac test panels usually only test tTG and sometimes gliadin (wheat) and are available from several labs. See Lab Charts. They all are blood tests and require that the patient remain on a gluten diet until the test is performed.

The Immunosciences Celiac Neuroautoimmune Panel is the most detailed blood antibody panel available. It requires that a patient be on a diet containing the foods tested, including gluten.

It checks the most gluten related antibodies in the most places.

It checks a number of other cross reactive food protein antibodies.

It checks many susceptible body/organ tissues for damage or predictive antibodies.

Tests not available at this time. Watch home page of this website for further information.

The Enterolab Stool Panels claim to work for a while after the patient has discontinued gluten. It also claims to be more sensitive than blood tests, that is, to detect levels of gluten related antibodies earlier than blood tests.

Optimum Health Resources 96-food IgG panel checks gliadin (wheat) AND gluten and other gluten grains. They all require a gluten containing diet.

The ALCAT panels do not require a gluten containing diet, and are therefore the only blood test option for patients who have not eaten gluten for years. These panels test a large number of foods and other substances. It is a controversial test. Some believe it only shows the foods eaten most frequently.

The ELISA/ACT Biotechnologies test requires a serving of gluten within the past 6 months. It tests lymphocyte (special white cells that make the antibodies) reaction. The gluten or grain is exposed to the lymphocytes and the lymphocytes swell and a halo forms around them just prior to when the antibodies burst out of the cell.

Gene tests determine if a patient is predisposed to a gluten related reaction. They do not indicate the patient currently reacts to gluten. Gene tests can provide helpful information to family groups beyond the individual tested.

They are run in 1 or 2 part processes. The 2 part step is more sensitive for a small number of patients.

Gene tests use either blood or cheek swab.

A gluten diet is not needed for the test.

Prometheus, Kimball and Enterolab run them in a wide price range.

Results are reported 2 different ways depending on the lab. Either the report is "Yes or No" for HLA DQ 2 or 8, or the patient is told which HLA genes he actually possesses regardless of whether they are HLA DQ 2 or 8. (For instance, he may possess HLA 1 and 3, or 3 and 4. Labs that report only 2 and 8 would simply report "negative 2 or 8" for these patients.)

Experts differ on the primary genes involved and more genes in other sections of DNA are under study. Therefore some patients wish to know which actual HLA genes they possess since more HLA genes are already fingered by Dr. Fine and may be more generally recognized in the future.

"Celiac only" specialists only recognize villi damage and the HLA DQ 2 and 8 genes, for predisposition to villi damaged celiac disease (present in 43% of the Caucasian population). Prometheus and Kimball Labs offer 2 part gene tests and report "yes" or "no", positive/negative for the HLA DQ 2 and 8 genes only.

Dr. Ken Fine, Enterolab, runs the 1 step process and reports the patient's actual gene allele for every test.

He recognizes HLA DQ 2 and 8 for celiac villi focused damage and HLA DQ 1 and 3 for non celiac gluten syndrome reaction. Combined, these 4 genes and subtypes are present in 83% of the Caucasian population.

He believes HLA DA 4 is the only non gluten reactive genotype. Therefore he believes only a HLA DQ 4, 4 patient (double copy of DQ 4) is not predisposed to a gluten reaction. His lab has processed very very few positive gluten syndrome tests from patients with DQ 4, 4 genotype.

He believes that if gluten related antigens are presented to the immune system (ie, slip past the gut wall before they are properly digested), a person with a gluten reactive gene will react.

Dr. Vojdani, Immunosciences Laboratories believes the gluten intolerance reaction is autoimmune, (see Medical Diagrams) and DOES NOT REQUIRE A GENE. He believes anyone regardless of genetic predisposition can develop the autoimmune gluten intolerance reaction from exposure to stress, TOXINS, and infections.

Therefore according to Dr. Vojdani, a negative test does NOT rule out serious gluten intolerance reactions. Dr. Vojdani only considered HLA DQ 2 and 8, not 1 and 3 and their subtypes when he formulated this hypothesis. Immunosciences does not run the gene test. No Immunosciences tests are available at this time. Watch the home page of this website for further information.

Many patients find that a positive gene test encourages family members to seriously consider the possibility of the gluten syndrome.

Energy tests - There are various energy related tests including various forms of kinesiology (muscle testing) or electroaccupuncture according to Voll that may not require a gluten diet. Consult alternative practitioners for information.

Close: 1. Which test or tests are best in my case?

2. Are there risks or alternatives particularly if the test is invasive?

Gluten syndrome blood, stool and gene tests themselves are minimally invasive (blood draw). The risk or challenge lies in finding tests that catch the particular antibodies or markers that the patient carries. An inadequate, inaccurate negative test may mislead the patient into a false sense of security. Update Jan 2009, A test panel is proposed to include all available gluten related antibodies performed in a "progressive" manner until a positive result is obtained or all available options are exhausted. A similar complete test panel has already shown to pick up at least one positive in 77% of Dr. Thomas O'Bryan's patients over a 3-4 year period. Watch the home page of this website for further announcement of this proposed panel. (There are known antibodies for which no tests are developed so a negative panel is inconclusive. A false negative is less likely if more antibodies are tested.)

The celiac villi biopsy is invasive and therefore carries a some risk although it is performed routinely today. A known risk is that a negative biopsy may mislead the patient away from a gluten free diet when in fact real damage may be located somewhere else beside the villi. Gluten syndrome researchers believe the villi biopsy is NOT a gold standard for the gluten syndrome, although it is helpful in detecting tumors, or other abnormalities, and diagnosis of the few patients who in fact happen to have villi (celiac) damage.

Some researchers therefore consider that antibody tests are more appropriate alternatives than villi biopsy for diagnosis of gluten reactivity.

IF A PATIENT HAS ALREADY EXPERIENCED IMPROVEMENT ON A GLUTEN FREE DIET MANY PATIENTS AND DOCTORS BELIEVE THAT IS A RELIABLE DIAGNOSIS. PATIENTS OR THEIR FAMILIES TEND TO SECOND GUESS THIS TYPE OF ELIMINATION DIET DIAGNOSIS, WHICH MAY LEAD TO LACK OF FAMILY SUPPORT AND RISKY INCOMPLIANCE ISSUES.

CHEATING IS NOT OK REGARDLESS OF METHOD OF FORMAL DIAGNOSIS OR LACK OF DIAGNOSIS. OVER TIME REPEATED OCCASIONAL GLUTEN EXPOSURE APPEARS TO HAVE LED TO KNOWN SERIOUS NEUROLOGICAL AND PSYCHIATRIC HARM IN SEVERAL CASES. IT IS WELL KNOWN IN THE GLUTEN SYNDROME COMMUNITY THAT A GLUTEN MISTAKE IS USUALLY UNCOMFORTABLE AT BEST. HOWEVER IN SOME CASES SYMPTOMS MAY BE SILENT OR HIDDEN OR SIGNIFICANTLY DELAYED, AND LEAD CHEATERS TO A FALSE SENSE OF SAFETY.

Close: 2. Are there risks or alternatives particularly if the test is invasive?

3. Is the test necessary?

Is the test necessary?

If the patient knows he/she has problems with gluten and improves on a gluten free diet then many patients and doctors believe that is adequate proof that the diet is needed regardless of no test (inadequate) NEGATIVE tests. In this case, the patient must commit to a strict GF diet without test confirmation, knowing that the body's message is it's own confirmation.

Antibody Tests

Celiac specialists use tTG antibodies to screen for those patients who should be scoped for villi damage. Therefore they believe blood tests are a necessary first step in the celiac diagnosis process.

Gluten Syndrome researchers say that a positive gluten related antibody test confirms that the immune system reacts to gluten. A positive helps the patient and family take the condition seriously and strictly comply with the gluten free diet, especially in social situations. This is particularly true for kids who as teens may question their need for the diet if there is no test, or maybe even if there was an initial positive test. HOWEVER THIS IS NOT A REASON TO TRY A GLUTEN CHALLENGE* Late teens and 20's carry a higher risk for symptoms to surface including serious neurological symptoms. A challenge at that age or any age is a grave risk, but symptoms may or may not not show up immediately. Delayed or silent reactions may mislead a teen or anyone into thinking they are OK, or "outgrew" the reaction.

* A gluten challenge means the a patient who is already strictly gluten free decides to resume eating gluten for a period of weeks or months in order to be tested for an immune reaction to gluten.

Villi Biopsy

Celiac researchers believe a villi biopsy is necessary for diagnosis and gluten free recommendation.

Gluten syndrome researchers believe a villi biopsy for recommendation of a gluten free diet is often pointless or misleading since many patients' damage is elsewhere and not necessarily to the villi. They believe a negative biopsy is meaningless since damage could be elsewhere in the body, although a positive biopsy usually does indicate gluten related damage. However, a biopsy may be necessary for other reasons. Gluten syndrome researchers use "predictive antibodies" and other tests to look for tissue damage in many places in the body.

Close: 3. Is the test necessary?

4. Should I test for other food reactivities and cross reactions also?

Should I test for other food reactivities and their cross reactions at the same time?

Many patients react to several food proteins or to yeast. These proteins tend to "look alike" and cross react so some professionals think it makes sense to test for other foods at the same time. It is suspected that if the patient stops eating one food, but still reacts to another, antibodies to the food they discontinue (gluten) may continue to produce, and damage tissue due to the presence of the other reactive foods (egg, milk, soy, corn, yeast and others).

Published research^* indicates that cross reactions between various protein peptides (pieces) occur through cellular mimicry. (Simple explanation: This is illustrated by picturing strings of necklaces with various patterns of bead colors. The necklaces represent peptides, which are partly broken down parts of food proteins or other proteins. The individual beads represent individual amino acids bound in a string. Sometimes a sequence of just a few "colors" (amino acids in the peptide string) match up enough between the two different food proteins to cause antibodies to one peptide to "misrecognize" a similar peptide and bind/cross react inappropriately to it. In other words, if a person reacts to one food, they may also react to another food that "looks like it", meaning it has a slightly similar protein sequence. So all the cross reactive foods may need to be removed before the immune reaction calms down. Many practitioners believe the "leaky gut" or other faulty mucosal barrier needs to be healed to prevent these peptides from slipping through the gut or other body barriers before they are broken down enough.

* Reference: In Celiac Disease, A Subst of Autoantibodies against Transglutaminase Binds Toll-Like Receptor 4 and Induces Activation of Monocytes Published Sept 19, 2006 Click for abstract and full text

Giovanna Zonomi¹, Niccardo Navone², Claudio Lunardi², Giuseppe Tidente¹, Carerina Bason², Simona Sivori³, Buggero Beri² Marzia Dolcino⁴, Enrico Valletta⁵, Roberto Corrocher², Antonio Puccetti^3,4

1. Section of Immunology, Department of Pathology, Universtiy of Verona, Verona, Italy,

2. Section of Internal Medicine, Department of Clinical and Experimental Medicine, University of Verona, Verona, Italy

3. Section of Histology, Departmant of Experimental Medicine, University of Genova, Genova, Italy

4. Immunology Unit, Institute G. Gaslini, Genova, Italy,

5.Department of Pediatrics, University Hospital of Verona, Verona, Italy

Close: 4. Should I test for other food reactivities and cross reactions also?

5. If my test is negative and I question it, should I try another type of test?

5. If my test is negative and I question it, should I try another test?

A properly run positive test indicates an immune reaction, but no one test "covers all the bases" so to speak, so a negative is always inconclusive. To "cover more bases" patients can try more testing of different antibodies, different mediums, or different types of reactions such as lymphocyte or white blood cell reactions. See Testing page to view charts of the following tests and lab information.

Here is a list of characteristics of the following tests.

Standard "celiac only" blood tests check one or two blood markers, tTG and sometimes gliadin. They also do not test for organ damage and other cross reactive food intolerances that can keep gluten antibodies running high even on the gluten free diet. Cost: varies from $76 for a single tTG screener to about $300 for a standard panel.

The ALCAT test exposes white blood cells to various foods and then observes any cell reactions, such as granulation, swelling, etc. These reactions could be for a number of reasons, not just presence of antibodies. They simply indicate that the patient's body does not "like" this substance. ALCAT tests wheat (the whole kernel), gliadin and gluten, in panels that include many other foods and substances. This is a home test and does NOT require a gluten containing diet.

The ELISA/ACT Biotechnologies test requires a serving of gluten or grain tested within the past 6 months. It tests lymphocyte reaction to the gluten related item. Lymphocytes are special white cells inside which the antibodies are made. They burst and spill the antibodies into the blood stream. If the grain or gluten incites a reaction the antibodies produced inside the lymphocyte cause it to swell and a halo forms around the cell prior to bursting. The swelling and halo indicate a positive test.

The Enterolab stool test is a research test that checks gliadin, tTG and intestinal function in stool*, an earlier location than any blood test, which likely accounts for its high percentage of positive results. Enterolab also offers other food tests and a gene test. This test is a home test and usually works for a while after gluten is removed from the diet. *The reference range accounts for an expected number of antibodies that normally occur in stool.

Immunosciences Celiac Panel checks blood levels of gliadin, tTG AND gluteomorphins, gluten, and wheat, all for IgA, IgG, IgM. Tests not available at this time. Watch home page of this website for further information.

Immunosciences Celiac Neuroautoimmune Panel is the most detailed gluten related blood test. It tests gluten, gluteomorphins, gliadin, tTG, wheat, other cross reactive foods, and antibody damage in several susceptible tissues and organs. Most items are tested for IgA, IgG, and IgM. This test requires a gluten containing diet. (January, 2009 - Tests not available at this time. Watch home page of this website for further information.

Optimum Health Resource Laboratories offers a 96-food IgG blood panel that includes both gliadin, gluten (gluteomorphin), and 9 other grains. It is a home test and requires a gluten containing diet. Cost: $379

If the Enterolab test is negative, other listed panels may provide further detail due to a wider variety of antibodies checked. The patient must remain on gluten until all tests are complete.

If the Immunosciences blood tests (not available at this time) and/or Optimum Health Resource blood tests are negative, the Enterolab stool test may catch earlier signs of a gluten reaction. Enterolab tests may be performed for an unspecified length of time (several months, call the lab to ask) after the patient is gluten free.

If a patient has been gluten free for a long time, their only choice is the ALCAT test or a saliva or energy based test offered by alternative practitioners. Opinions vary regarding the reliability of the ALCAT test. The ELISA/ACT Biotechnologies requires one serving of the gluten containing food within 6 months of the test.

Close: 5. Should I try more than one kind of test?

6. I'm considering cutting out gluten without bothering to test.

6. I'm considering cutting out gluten without bothering to test.

In this case, consider the following:

It is uncommon, but possible that if you even test extensively you may never get a positive, and yet you may be very reactive to gluten. The test you need may not be developed yet.

If you have a family that supports your decision and you are convinced to be strict without a test, then you are in a favorable situation to skip testing. However:

Once you have gone gluten free you cannot do a blood test later without doing a long unsafe gluten challenge. (Gluten challenges are often miserable and always risky, particularly neurologically.)

It's easier for the patient, spouse and family to comply with the gluten free diet if the patient has tested positive. This is also particularly true for teens who were put on a gluten free diet as children and do not remember how sick they were before the GF diet. Without test results they may give up the diet just at an age that is high risk to develop problems. (They may do this even with previous positive test results.)

Regardless of tests or the lack of them, if you know you have difficulties with gluten be aware that many wise patients trust their body. Science can catch up later.

In this case, with no test or a negative test that you do not agree with, simply tell your friends that you are gluten free. Period! Don't mention testing. Testing is your business, not theirs. If your family, spouse, parents, give you a hard time, just say "No thanks, I don't do gluten.", and stop talking. No need to defend your decision. The more you say, the more opportunity they have to wear you down. They will accept a firm, quiet but decisive attitude better and quicker in the long run.

Close: 6. I'm considering cutting out gluten without bothering to test.

Close: C. How to choose? Should I pay for more than one test to confirm from several directions?

Testing FAQ's

1. I received my standard antibody/biopsy/gene test results and they are negative. But I get sick when I try to go back to gluten grains. My doctor scolded me and my family thinks I'm silly to avoid gluten because my tests are negative. Help! Why!! I feel deserted.

1. I received my standard antibody/biopsy/gene test results and they are negative. But I get sick when I try to go back to wheat/gluten grains. My doctor scolded me and my family thinks I'm silly to avoid wheat/gluten because my tests are negative. Help! Why!! I feel deserted even by the celiac community.

In this case, it is important to read the information on this website and understand the testing limitations. If patients feel better, they decide to believe their body and be firm with doctor, friends and family. They just say, "no thanks, I don't do gluten!" and stop talking. They find the more they talk the more friends or family can argue. They go to a support group on a regular basis and network with others in their situation for moral support.. They sign up for some of the online forums for daily info and support. Many many people at the support groups and the online forums are negative testers and they know very well they cannot do gluten at all, just like you.

To repeat:

Today's gluten syndrome/celiac testing methods are still very incomplete. Gluten breaks down into a number of pieces for which there actually are tests but few labs run them. It also breaks into known pieces for which there are no tests developed yet. Today's incomplete test panels appear to produce many more false negatives than true positives.

To repeat once more:

It is helpful to remember some reasons your test may have been false negative:

You may have antibodies the test did not check

You may have damage somewhere else beside the villi.

Some researchers say toxins can cause the syndrome without the genes. And some researchers recognize genes that others do not.

Your tests may be been improperly performed.

Close: 1. I received my standard antibody/biopsy/gene test results and they are negative.

2. Who is Dr. Ken Fine and what about his Enterolab stool and gene tests?

2. Who is Dr. Ken Fine and what about his Enterolab stool and gene tests?

In addition to the information on this page, here is the ClanThompson.com review of Dr. Fine's recent announcement conference by Lani K. Thompson titled "News: Celiac Disease, Just the Tip of the Iceberg."

This is a long discussion. As I researched for testing/treatment for our family beginning in 2003 I spent some time investigating this topic. I questioned very experienced people in the celiac support community who know Dr. Fine. Their stories all matched. Dr. Fine's 8 year long research is not officially published but his research announcement, a precursor to publishing, took place March, 2006. Dr. Fine's website explaining his work is www.Enterolab.com. I divided my reply into three topics.

A. Dr. Fine's tests, his professional career and himself.

Dr. Fine's gene test

Dr. Fine's fecal antibody and intestinal malabsorption tests

Dr. Fine's professional and personal history

Dr. Fine's Curriculum Vitae

Dr. Fine is a qualified gastroenterologist/professor who helped design the landmark 5 year Fasano celiac prevalence study. He formerly taught at Baylor University, and while still under the auspices of Baylor he took up the unfinished work of retired English researchers Dr. Michael Marsh and the late Anne Ferguson. (Note: Dr. Marsh originated the Marsh classification system of villi damage, but his main research project was a gluten sensitivity stool test. No one could duplicate his work. He lost his grant and lack of validation left his work unfinished and unusable in many professional's opinions.) Dr. Fine tackled Dr. Marsh's project from a different direction and from his own observations eventually grasped the magnitude of gluten syndrome prevalence in the United States. He left his professorship and research at Baylor, applied for a patent, and set up an independent accredited lab which offered an affordable non scripted gluten syndrome stool panel and gene test directly to the public via internet. Until recently, attempts to duplicate Dr. Fine's work were also unsuccessful but now research on a similar note is published. Some research supports Dr. Fine's work and one study does not. Dr. Fine disagrees with methodology used by the dissenting researchers. Dr. Fine also started a non profit organization, Intestinal Health Institute for educational purposes.

In absence of published validation I inquired about Dr. Fine's character. He is a "maverick" in a nice way. He has 3 apparent interests...his gastroenterology, his music, and helping people. He appreciates spirituality and a simple lifestyle ie., he prefers to sing under the stars with a campfire and backpack and societal norms don't necessarily shape his lifestyle.

Dr. Fine suffers chronic health challenges himself and practices a simple diet that is gluten free. He recommends a healthy lifestyle.

Everyone in the experienced support community whom I questioned, "Is this guy really a good guy, or does he just want me to think so?" says he is sincere,...a good person doing "his thing" to help others and there are high hopes that he is "on to something" with his ideas and testing methods. His recent research announcement and anticipated publishing of his research papers may contribute greatly to the gluten syndrome community.

(By the way, all our doctor heroes are "nice guys" who've sacrificed and taken a beating to bring the gluten syndrome to our attention.)

In my search I was reminded by naysayers that Dr. Fine makes money. To be fair I don't know a good medical pro who does not. They all worked for it. However, in my investigation I communicated with several who knew him from his position at Baylor before he began his current research. It is well known locally that after Dr. Fine chose to operate independently he personally chose an unusually humble lifestyle, preferring to fund his research and bring affordable testing directly to the public. I found his lab in a decent but unostentatious, no frills facility.

Finally, other professionals beside Dr. Fine report a very high prevalence of NON "villi damaged" gluten syndrome reactivity. They observe that non celiac gluten syndrome is as serious or worse than villi damaged celiac disease. Some of those professionals' conclusions are reported elsewhere on this page.

Close: Dr. Fine's professional and personal history

Close: A. Dr. Fine's work, his professional career and himself.

B. Summary of Dr. Fine's announced conclusions

More gluten syndrome genes

Site(s) of gluten syndrome damage are somewhat gene driven.

Villi may be damaged with DQ 2 or 8 AND a couple of other genes.

Negative stool tests usually accompany negative genes.

One gene is enough. Two, particularly certain pairs, are often worse.

One gene equals 50% chance for kids. Two genes, every child will get one.

If gluten is presented to immune system with a gene, it will react.

Other organs, tissues or functions may be damaged INSTEAD of villi.

His stool tests find elevated antibodies before blood tests.

Stool test is usable for a time after a patient is gluten free.

Elevated antibodies are proof of an immune response to gluten.

Villi biopsy identifies villi damage and misses damage elsewhere.

Dr. Fine's lab processes a high percentage of positives.

Dr. Fine also optionally checks cross reactive milk, soy, egg, and yeast.

Close: B. Summary of Dr. Fine's announced conclusions

C. Our family's scary experience - Enterolab was the only accurate test.

C. Our family's testing experience

All 8 members of our symptomatic family have a double copies of DQ 2 and/or 8, or 2 or 8 plus DQ 1 genes. We received negative full celiac panels from a respected lab even though some actually had elevated AGA antibodies. My husband received one positive and one negative tTG-IGA six months apart while on a gluten containing diet. Later our daughter Su, 22, a college student, tried a 6 week gluten challenge after being off wheat for 8.5 years, the last 6 months strictly gluten free. The challenge was miserable, but her blood and biopsy tests at the end were "stone cold negative” from a lab considered reliable. (Her Enterolab test was positive but we did not know how much credibility to give that test.) Even before she returned to a gluten free diet, she began to crash into severe uncontrollable “black pit” depressions which she termed "horrible" and they worsened a few days AFTER SHE RETURNED TO A GLUTEN FREE DIET. This uncharacteristic instability continued for 3.5 months after she resumed a strict gluten free diet EXCEPT for communion bread which she consumed once a week "since her blood and biopsy tests were negative. She thinks she may have had a breakdown and stated at the time that she might not ever be the same person. Eventually upon our request, the church elders kindly permitted us to provide a gluten free loaf for communion. Several weeks after the loaf change, Su was able to describe to us how much better she felt. She attributed this to the total elimination of gluten grains from her diet. Over the next months, she continued to stabilize, paced her workload, and was very careful with her diet. However, four months after the communion loaf change, she baked cookies with wheat flour and, although she did not eat the cookies, she crashed again. Her "black pit depression" reaction lasted about 2 weeks. Five months after the baking incident, she had another “gluten grain mistake” and although she experienced severe abdominal pain for days, she did not crash psychiatrically. Thankfully she was able to graduate college with honors and degrees in both nursing and Spanish.

Our family history on all 4 sides, genes, symptoms and good diet response strongly indicate some type of reactivity to gluten grains. My husband’s aunt is a diagnosed celiac. My husband, Su’s father, has been sick for 35 years. Most of our children had symptoms as babies and children, and our sons also are redeveloping symptoms in their early twenties. Su appears to have had the gluten syndrome from babyhood. She carries a double copy of the DQ 2 gene and the Enterolab test was positive. Her standard blood tests and biopsy were negative. We now understand that the blood panels are very incomplete. Likely Su had other antibodies than the ones they tested and neurological damage, not villi damage.

In our family's experience, Su's body and Dr. Fine’s more sensitive tests told us the truth. We wish we'd trusted that when an accredited lab finds antibodies they are real, they can hurt us, and we should pay attention!! Validated science can catch up later in this case and we hope that will be soon.

Update: May 2007

Su works as a nurse and still is doing well on a very very strict gluten and dairy free diet. However, she has suffered an emergency appendectomy, back problems, a fractured sternum, and for a short time a grumbling gall bladder. Her emotional state is good, but still not quite as good as the six months she was strictly gluten free just before her gluten challenge. The gluten challenge was dangerous and unnecessary.

Her Enterolab test matched her case. Likely a more detailed blood test such as the Immunosciences Laboratories panel would have revealed antibodies that the shorter celiac panel did not include.

Update January 2009

Su is doing very well. She married a fine young man, also a nurse, last year and recently left her hospital nursing job of over 3 years to do home health nursing. She is very strict with her diet and her husband joins her in her diet in order to support her. They go out of their way to make healthy lifestyle choices.

Close: B. Our family's testing experience

Close: 2. Who is Dr. Ken Fine and what is the situation regarding his Enterolab stool and gene tests?

3. Why are the panels recommended by Immunosciences Labs so much more detailed when other labs/celiac centers discontinued the antigliadin antibody test?

3. Why are the panels recommended by Immunosciences Labs so detailed when other labs/celiac centers discontinued even the AGA antigliadin antibody test? Tests not available at this time. Watch home page of this website for further information.

Why have many specialists have discontinued the AGA test?

Many specialists discontinued the AGA test because AGA antibodies often are elevated but there is no villi damage. Conservative doctors insist that villi damage is the ONLY definitive marker of immune response to gluten so they discount the presence of antibodies if there is no villi damage (ie they believe the gliadin antigen is often false positive). They now test for elevated tTG instead, which is usually directly connected to villi damage.

Dr Vojdani believes that properly run gliadin antibodies are accurate, reliably prove immune response, and are dangerous.

Dr. Vojdani checks IgA, IgG and IgM antibodies.

Dr. Vojdani checks more types of antibodies, including gluten itself.

Patients do not all have the same antibodies.

Glutamic Acid Decarboxylase and gluten and diabetes

Cellular (Molecular) Mimicry - Predictive Antibodies

Immunosciences Labs and other labs test for cross reactive foods that look similar to gluten, such as corn, egg, milk, yeast and soy.

Close link: Why are the Immunosciences Labs testing panels more detailed.

4. I've never heard of the ALCAT and ELISA/ACT Biotechnologies tests. What do they test? How are they different from each other and other tests?

The ALCAT test is a separate type of test compared to other tests on this page. In this method, white blood cells are exposed to various foods and other substances such as additives separately and the reaction of the cells is observed. This lab includes gliadin and gluten testing in their panels.

A simple analogy is that traditional tests of IgM, IgG and IgA antibodies are similar to "calling up" the Army, Navy and Air Force to find a criminal. (See "Stories to Help Us Understand" above). The ALCAT method is likened to "calling in" the National Guard. It's another way to look for adverse response in the immune system. Opinions vary regarding the reliability of this test.

More information about this method is found at www.alcat.com

A prescription is not mandatory and arrangements can be made for a nurse/phlebotomist to perform the blood draw at home. Post test counsel is included in the test package. Note: this test is controversial. Some professionals believe it mainly reacts to foods eaten frequently. Some patients say it helped them pinpoint their problem substances.

The ELISA/ACT Biotechnologies is a similar test to ALCATin that it tests specific white blood cells called lymphocytes for a specific reaction to gluten related items. Lymphocytes are the cells inside which antibodies are made. They burst and spill the antibodies into the blood stream. If the grain or gluten incites a reaction the antibodies produced inside the lymphocyte cause it to swell and a halo forms around the cell prior to bursting. The swelling and halo indicate a positive test. This test requires a serving of gluten or grain tested within the past 6 months. It is offered in panels of multiple foods including gluten and non gluten grains, molds, chemicals, food additives, etc. Gliadin, gluten, wheat, and a number of other gluten and gluten substitute grains are included in the panels.

Close link: 4. I've never heard of the ALCAT test. What does it test and how is it different from other tests?

5. Help!! No one knows how to read my gene test!! Gene chart coming

6. What about saliva tests?

7. What about finger stick blood tests that check for IgG antibodies?

8. What about Electroaccupuncture according to Voll?

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