Gluten Related Disorders, Coeliac/Celiac and Non-Coeliac Gluten Sensitivity Testing

Resources:

TrulyGlutenFree

Coeliac Disease/Gluten Related Disorders (GRD) Factsheet

Please click on the test links given below to see more detail, collection instructions, sample reports etc...

Overview:

This medical field is evolving so fast it is sometimes hard to keep up! What we do know now is that there is a whole spectrum of gluten illnesses, not just coeliac disease (CD). CD is the most studied and is related to an autoimmune reaction in the gut, on the villi specifically, triggered by gliadin, one of the peptides in gluten grains. So far, so good.

We know that many people are mis or undiagnosed coeliacs, but we also now know that you can have other gluten related disorders (GRDs). In fact, gluten or gliadin IgE allergy, IgG delayed intolerance and non-coeliac gluten-sensitivity, which affects the neurological systems more than the gut, are probably much more prevalent.

Testing these disorders is also evolving, but we do now have a strategy for finding most of the hidden coeliacs and GRD sufferers previously told they had no problem with gluten and it was all in their heads!

Coeliac Testing

First, before giving up gluten, you need to test for coeliac disease to rule it in or out. This is often negative because mainstream tends to look for gliadin 33-mer and transglutaminase antibodies linked to villi autoimmunity only. We know of plenty of others now and it seems daft to only look for the well-known ones.

I recommend you do Cyrex 3x testing as a minimum now to look for as many of the peptides and transglutaminases as you can. This is not perfect but this is so much better than what we've had up to now. The best way to start with testing, I think, is the Cyrex 2,3x and 4 bundle which saves you £100 - and most people end up doing them!

You can view all of the Cyrex tests here and the Cyrex FAQ here and a sample report here - they all look like this one but with the different analytes tested. Note: equivocal is taken as a weaker positive, not borderline.

I can do a standard 33-mer gliadin and transglutaminase test if you wish, but I find myself constantly saying: 'yes, but now test Cyrex 3 before you believe a negative!'

The Cyrex tests are ordered via the UK lab and drop-shipped for you to the US. The samples need centrifuging - pls see the FAQ for more on how to do this. Please also note: you must write your date of birth in full on the vials ie. 12th May 1976 so Cyrex don't get confused between UK and US DOB forms! Please also note that the lab now emails you a postage charge before they send the test kit. This is £9, which covers the cost of posting the test kit to you and, importantly, the return of samples to the UK and onward to the US. MUCH cheaper than doing it yourself.

If you've given up gluten already...

You can still do Cyrex 3 if you've not been off long. See the FAQ below for specific timings etc. I do NOT recommend reintroducing gluten for testing - and neither do most of the experts I speak to - because of the potential for causing more damage.

Instead, use the Gluten Gene Test. I was the first person in the UK to do this for people, and it is now available again in the UK. It is a simple cheek swab and the only test that measures for all known genes linked to gluten sensitivity (HLA-DQ1/HLA-DQ3) and coeliac disease (HLA-DQ2/HLA-DQ8). Other labs only measure for genes linked to coeliac disease, which is why many people are sadly misdiagnosed. Once ordered, I will post the kit out to you (inc in cost). You then pay to return your samples in a standard envelope to the US, containing the cheek swabs and requisition forms. The swabs are viable for a long time so there is no need to send them back with priority mail.

The pattern of the genes found in the results help us work out your risk of coeliac disease or if it is more likely to be NCGS (non coeliac gluten sensitivity). When I did it, for example, I had a double DQ1 and a single DQ8. If these genes are triggered (which mine have been), then you are likely to develop a gluten illness. In my case the DQ1 is more likely to be skin issues (inc leaky gut!!) of NCGS but I have a low risk of coeliac disease. NCGS can be every bit as serious as coeliac disease, by the way, so don't get lulled into a false sense of security! Check my TrulyGlutenFree section on the website for more on this.

You can see a sample report here. The report gives you some idea of what's going on, but I can also explain more if you need me (see Support options here). The different DQs relate to different conditions and you can find that and loads more about gluten testing and treatment in the Gluten Plan if yours comes up positive. Please allow up to 4-5 weeks for results for this one - do prod me to chase as they can be a bit tardy!

Gluten Free Diet Testing

It is now believed by some, including me from personal and clinical experience, that many coeliacs and indeed GRDs generally, are not healing because they are reacting to other foods that cross-react with gluten/gliadin so the body gets confused and reacts in the same as it would to the gluten. Dairy and other grains are the most common.

Cyrex 4 has been designed specifically to help you find if you have antibodies to the cross-reactive foods and, usefully, also to some of the most common GF diet substitute foods. I would then follow that up with Cyrex 10, a much larger food panel; the best I have seen in a long time. See the leaflet here on this. There is also a useful video here.

You can also now do:

Cyrex 10C, which includes Arrays 3, 4 and 10. This has a good saving on doing the tests separately for you. This is the best value test by a long run if you're going to have 3, 4 and 10 done anyway at some point.

See also the Allergy Tests section for my thoughts on how to test effectively for food reactions. For antibody tests, you need to be eating the foods, remember so an ALCAT is better if you aren't.

In general, I would combine Cyrex 4 and/or 10 with an ALCAT test for non-antibody reactions for the best chance of finding your healing diet. The absolute ideal would be to do Cyrex 10C plus an ALCAT - sadly, out of reach for most people.

One thing to remember is that, if you suspect your immune antibody production is low ie. your IgA or SIgA has been low at some point or you have immune issues such as chronic infections, frequent colds, autoimmunity, chronic fatigue or multiple sensitivity, it can often be a good idea to do a Total Immunoglobulins test before any antibody test like Cyrex. If you are not producing much, you could get false negative results. This wouldn't affect the ALCAT test as that doesn't measure antibodies.

Gluten Treatment Testing

Mucosal Immune Test: Array 14

This is a salivary SIgA test which is looking for triggers and causes of loss of tolerance to foods, autoimmune triggers etc. It's a fab test. You might find you want to start with this one first. See my post on SIgA testing and the Array 14 here.

Leaky Gut or Blood-Brain Barrier

Next, you need an idea of what your specific GRD is up to in the body so you can devise a way to combat it. In essence, you can check the damage gluten has done to your gut with Cyrex 2. Gluten is known to affect the functioning of the tight junctions in the gut wall, which makes you 'hyper-permeable' or leaky in common parlance.

I think if you have sensitivities to other stuff as well as gluten, you can possibly assume and treat this without testing, although it can give some useful targetting info on whether the leakiness is more about food or bacterial infection. It also gives you a progress marker you can monitor.

Similarly, you can test now for a leaky blood-brain barrier using Cyrex 20. We know that most GRDS are actually affecting the brain and nervous system (think: brain fog, movement disorders, migraine, anxiety, ataxia, depression etc). Sometimes, seeing this leakyness on paper answers a lot of questions. Again, it can act as a progress monitor.

You can also now check for evidence of leaky gut and SIBO in the small intestine. Cyrex 22. This is very different to the breath test in that it is looking for antibodies to bacterial cytotoxins released in SIBO rather than the gases we produce. It also looks for evidence to see if the cytotoxins have caused a leaky gut. You can see more info on this sheet here.

Autoimmunity

We know that gluten is the only common denominator found so far in autoimmune disorders, which is really exciting info! Coeliac disease is an autoimmunity attack on the absorptive villi in the gut, hence the problems that come with CD illness. But that is what we know and have studied. Other people have autoimmune thyroid or adrenal issues, ovarian attack (infertility is common in GRDs), skin diseases, reactive arthritis, psoriasis etc etc. The list goes on.

First, check if autoimmune disease markers are present. Use Cyrex 5 for a really comprehensive autoimmune screen (you can see an interpretation table of what each antibody means etc here), 7X for the neurological autoimmunity screen and Cyrex 20 for blood-brain.

Pathogens and other triggers

Next, consider if pathogens are causing your issues. Cyrex 12 assesses IgG immune reactivity to pathogens that are documented triggers or exacerbators of autoimmunity and chronic disease. The test looks for IgG antibodies to various pathogens including oral pathogens, gastrointestinal parasites, bacterial and stealth pathogens, environmental moulds (molds), viral pathogens and tick-borne pathogens - you can see all of them here. If an IgG antibody is present, it doesn't show a current infection, but it suggests there is a hidden or latent pathogenic problem that may well be causing you problems or acting as a trigger.

It can also be a good idea to consider levels of known toxic chemicals in your system. Could you have a high levels of something like glyphosate (Round Up) in your system that is triggering cross-reactivity to organs and tissues maybe or messing about with your gut flora, hormones etc? To check that, see the Glyphosate and GPLTOX tests here and maybe also check Cyrex 11 for any clues that you are immunologically reacting to any of the most common ones. In other words, you can now check for presence and immune reaction to them.

For much more on this whole complex field, do read the TGF site in Resources above, and download the Gluten Plan for full testing and treatment protocols. You can read much more about the Gluten Plan here.

Testing Hints & Tips:

Q: Do the Cyrex samples need centrifuging?

A: Yes. Please see the FAQ for more details on having blood taken locally. With the Cyrex kits only, I asked Regenerus if they would centrifuge the samples for us. They said yes:

Yes we can, the only catch is that it does have to get to us within 24 hours. Our UPS shipping can do that as long as the patient can get it picked up the same day as the blood draw. So if that can be guaranteed, then your patients can send the whole blood sample to us for centrifuging. We include a UPS shipping label in with the test kit which patients will pay for if they use it. So, you would need to arrange to have your blood sample taken first thing and have arranged for UPS to collect it/you drop it off to UPS that same day, preferably in the morning, and pop a VERY CLEAR note in and/or have arranged beforehand for Regenerus to centrifuge the sample for you.

Q: If I have one Cyrex test done, can I have another one done on the same blood sample?

A: Yes, you can. You can add on multiple tests within the first 21 days. They then freeze your blood sample for 90 days, so between 21 and 90 days you can add on other tests once only and they will be done once the sample has thawed. This is most commonly done, for example, if you have done Cyrex 3, found a problem and then want to test the cross-reactive foods with Cyrex 4 and/or the predictive autoimmune antibodies Cyrex 5. We just ask them to use the same sample. I wish all the labs would do this!

Q: Can I do the Cyrex tests if I am off gluten?

A: It depends. If you have been off it for less than a couple of weeks, you can still test reliably. The advice is: if you have been off it for fewer than 10 days and you were eating it regularly before, wait 25 days after your last ingestion and then do Cyrex 3.

If you have been off it for more than a few months or even years, doing the test can actually show you if you are still producing antibodies and therefore if you diet is good enough to heal. If you find something, it means you are likely still consuming some gluten hidden somewhere or a cross-reactive food. That is crucial knowledge for healing.

Q: Can I do the Cross-Reactive Foods test, Array 4, or the Food Screen, Array 10, if I am off some of the foods?

A: Yes, this is the same as above. For antibody tests, you need to be eating the food or have done recently. Follow the same guidelines if you wish to reintroduce a food to test.

Q: Can I continue or go back onto the foods safely if the antibody tests are negative?

A: For gluten, you need more tests to know whether that is safe. The most common reaction is an antibody one but there is a possibility that you have a different mechanism. If all antibodies for gluten are negative, that's a great sign, but do an elimination diet check and the gluten gene test as a double check before you introduce it.

For the cross-reactive foods, you may not yet be as far as producing an antibody, so I advise an elimination diet as a double-check to be certain.

Q: Can children do Cyrex tests?

A: Yes, it is fine for under 16s. For small children, the lab says: "No restriction on age. If they are old enough to be eating gluten, they can be tested. The difficulty is generally taking the blood."

Q: I have got saliva and blood vials in my test kit. Is that right?

A: Yes, there is one test kit for all the tests so just use the one you need and discard the other, or keep it for later in case you need a blood test further on.

Q: I have gone wrong with my saliva test as I ate something before it. Can I rinse it out?

A: No, you need a new vial. Please contact me or Regenerus direct to request one.

Q: Will I need follow-up tests?

A: The best way of finding out your progress is to repeat your test so you know you are on the right diet, protocol and path to heal.

Q: Is there any logic to sequential testing with the Arrays? Do the results of one test provide direction for the other tests?

A: Yes. There are logical sequences to testing. Ideally we recommend ordering Arrays 2, 3, 4 and 5. Another option is to start with Arrays 2 and 3 and depending on your results, add Array 4 and 5 if necessary. The lab will freeze your blood and you can order additional test(s) within 90 days. I have added a combination test of the most frequent food screen now - arrays, 3, 4 and 10.

Q: Are there any medications, foods, conditions, or other factors that could interfere with the results of a Cyrex test?

A: Yes. While Cyrex is unable to provide an exhaustive answer to this question due to the interactive complexities and varieties of medications and patient circumstances, the following has been noted:

• Immunosuppressant and corticosteroid drugs can reduce antibody production and cause false negative results. Inhalers specifically can affect the results of Cyrex’s oral fluid testing (Array 1). Wait two weeks after completion of inhalant dosages before collecting the specimen. If you are on steroid treatment, it doesn't necessarily mean you can't have the Cyrex tests, but you need to bear in mind that any scores might be lower than they would be without the steroids so that could mean they look OK or low level when they are not. If in doubt, talk with your health professional and/or Cyrex for advice.
• Limited assessments on the effects of aspirin, acetaminophen, and antipsychotics on Arrays 2-4 have been performed. No noticeable effects were observed.
• Unknown cross-reactive epitopes from foods and microorganisms may stimulate the antibody production in the absence of a true antigen. Cyrex has already developed Array 4 in order to recognize the most common antigens in this regard.
• A gluten-free diet can cause false negative results on gluten protein/peptide tests.
• Certain conditions, such as ileal pouch surgery, may cause a false positive celiac serology.

Q: How soon after finishing steroids can a patient do Cyrex testing?

A: 60 days. It takes this period of time for the medication to clear the system and allow the normalized production of antibodies, required for immune testing, to resume.

Q: What is the difference between the Lactulose/Mannitol test and Cyrex’s Intestinal Antigenic Permeability Screen™ (Array 2)?

A: The Lactulose/Mannitol test is an assessment of nutrient absorption. It looks for the passive absorption of micromolecules (mannitol) and relative permeability to lactulose. For the test to be effective, intestinal dysregulation must be present. Cyrex’s Intestinal Antigenic Permeability Screen™ assesses gut barrier damage by measuring antibodies to barrier proteins. It can therefore detect barrier damage long before there is dysregulation in absorptive function. This makes Cyrex’s Intestinal Antigenic Permeability Screen™ preferential for early detection and preventative care.

Q: How long does it take to see reductions in the antibodies to the lipopolysaccharides, actomyosin, or occludin/zonulin after the gut barrier is restored?

A: Antibody levels decrease on a curve and not in a line. Based on patient populations, initial significant decreases—after no exposure—can be seen in two weeks for IgA, four weeks for IgM, and six weeks for IgG. Lower levels can remain longer after this initial reduction. IgG can be found in some patients up to one year after exposure.

Q: If someone recently had an infectious gastroenteritis, would this temporarily cause a leaky gut and give a positive result to the Array 2?

A: In a person with infectious gastroenteritis, you may detect leaky gut. It is recommended to wait at least four weeks after completion of treatment before ordering Array 2.