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Long-time lurker, finally signed up to ask something, as I couldn't find any similar questions!

I visited the doctor for a general health check-up, and after the subject of diet and eating habits arose, I told her that I feel bloated, get stomachaches, and am lethargic after eating anything with gluten. This is a self-diagnosis; I suspect I have an intolerance/sensitivity issue at most, nowhere near coeliac, thankfully. However, she ordered me a blood test, and asked me to start eating gluten at least a week before the test - I quote "a couple of slices of bread a day", so that it shows up in the test. Now, she mentioned that intolerance is unlikely to show up on the test, so I'm not sure whether I should go ahead with it. Cost isn't an issue (I'm in the UK, using the NHS), but it seems a waste of time and resources on both sides if the test won't show anything. My family is pressurising me to take it, as they do not follow a paleo lifestyle and tend to get very annoyed when I opt out of the grains and bread at mealtimes. But that's a story for another time.

Another factor to consider is that I am trying to get into ketosis (for weightloss), and anything with gluten also tends to be high-carb, so that would throw me off a little. I am already doing 16 hr IF 3+ times a week, intense calesthenics for 15 mins x 5 per week. (Any tips here would be welcome, too!)

However, should I go ahead with the blood test, what is the minimal amount of gluten I can get away with eating, and for how long?

Thanks!

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4 Answers

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Interesting article about celiac and non-celiac wheat sensitivity.

http://www.nature.com/ajg/journal/vaop/ncurrent/full/ajg2012236a.html

Biopsy will show the intestinal cellular damage but the changes seen in the small intestines in celiac disease are very similar to changes seen in SIBO, chronic malnutrition and hypersensitivity reactions. So, if your serological studies suggest celiac it is much easier to correlate the biopsy. Most bxs are reported with a comment that says "clinical correlation and serological studies may be further contributory"

So...if you want to do it right

get the serological tests and the bx.

If you don't care about the dx and you feel better not eating gluten...don't eat gluten.

Having said that celiac patients do have an increased incidence of T-cell lymphoma so you may want to know.

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 oh, and eat the gluten if you want the tests. The biopsy analysis will look at the # of lymphocytes in the intestinal epithelium. There are not usually that many lymphocytes in the epithelium...they need to be "invited". If you are celiac, the gluten will stimulate the changes to "invite" the lymphocytes. No gluten, no lymphs...colon prep and biopsy for nothing. If you are going to do it, do it right. – juju Aug 14 at 20:41
I'm not sure I'll be able to get the biopsy, but I'll certainly ask the doctor when I go for the blood test. Thank you for your help! – Laulet Aug 15 at 23:14
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To be get a good result, you need to eat 2-4 slices of bread per day for 4-6 weeks. This is the standard advice from medical advisers to Coeliac Australia who are leading researchers in the field. Agree with the response from juju, need blood test results and biopsy to correlate. Another thing to consider. Can you request the Coeliac gene test where you live? - it is not a firm diagnosis, but if you don't have a relevant gene, you can rule it out. Coeliac Victoria and Tasmania Inc. Australia

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The 4 week window was what the doctor recommended at first, before she shortened it to a week when I showed reluctance. I am going to request the gene test if possible, although I'm of East Asian background - this site seems to find most non-Caucasians less prone to inheriting coeliac. Still, I would like to find out whether my intolerance is real or not, which is the problem with the test - it won't show up. I certainly get stomach aches and bloating, I'm lucky to have reactions, but the family believe it's a psychosomatic reaction. – Laulet Aug 16 at 5:44
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I would forgo the blood test completely and get an intestinal biopsy. If you have celiac disease, the intestinal biopsy is definitive (blood test is not, many people have false results). I don't think you have to eat gluten at all if you get the biopsy, because if you have celiac disease, the damage will still be there. It takes about a year of zero gluten to heal.

If you have digestive problems with gluten that are not celiac disease, the blood test won't help you either.

Either way it sounds like gluten is not good for you. Knowing if you have celiac disease is important because it greatly restricts your dining options due to cross contamination. If you don't have celiac, you can be more at ease with eating stuff that simply doesn't contain gluten in the ingredients.

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But in many celiacs damage is already patchy and if you're not eating gluten for even a few weeks, healing starts in most patients. If the Drs don't hit the exact right spots andor don't take enough samples, it would be too easy to get a false negative biopsy too. If the OP has been cheating regularly though - say, at least once or twice a week - a few weeks of gluten every day might be enough. Four to six weeks is the usual direction I see. – arugula Aug 15 at 12:49
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I was gonna get the test and biposy. read that it was 2-4 servings a day for 4 weeks. I had been mostly gluten free for 3 months after discovering paleo. I did 3 servings my first day. I spent the entire night and most of the next day on the bathroom floor writhing in pain. I decided that was proof enough for me. 23andme DNA test later came back with 4/5 celiac genes present.

TL;DR: elimination chalenge may be enough/reintroduction may not be worth it.

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I did the Celiac test without having had any gluten for over two weeks, and when I had gluten, it was only three small pancakes. I tested positive too with 4/5 as well. – DemingRN Aug 15 at 3:42
Eating gluten does not affect the gene test. So whether you ate pancakes or not you would have had the same genetic results. – arugula Aug 15 at 12:50

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