It seems like there should be one single test you can take that would definitively determine whether you have gluten sensitivity, celiac disease, or none of the above. But alas, it’s not that simple.
For one thing, there are different types of tests: blood, stool, saliva, and intestinal biopsy. In most cases, one type of test may determine whether you have celiac disease or gluten sensitivity – but most tests don’t discern between the two or test for both. In other words, one test looks for gluten sensitivity but not celiac disease; another looks for celiac disease but not gluten sensitivity. And most people only get one (maybe two) of those tests, so they’re rarely tested for both conditions.
So which test is best? Sounds like a simple question, but there’s no simple answer. The gold standard for testing for celiac disease is a blood test followed by an intestinal biopsy. If both tests are positive, you’re deemed to be confirmed as having celiac disease.
What can be said for certain – or close to it – is that if you test positive for celiac disease, you have celiac disease. That’s because the tests for celiac disease are very specific, highly sensitive, and extremely reliable – especially when they indicate a positive outcome (diagnosis of celiac disease).
However, if the test is negative and your symptoms go away on a gluten-free diet, then you probably have some form of gluten sensitivity.
Unfortunately, there are false negatives and occasional false positives. Some people test negative yet find that they don’t feel right when they eat gluten. Perhaps it was a false negative – or maybe gluten just doesn’t sit right with you.
Sadly, because the protocol for defining and diagnosing gluten sensitivity isn’t well established and there’s some disagreement about definitions of gluten sensitivity in the medical community, patients are often told to ignore inconclusive or confusing test results and to go back to eating their bagels and pizza. If you aren’t sure you can trust your test results, you may want to be tested again at a later time.
You may be tempted to skip the testing and jump right into a gluten-free diet. If, for instance, you highly suspect you have celiac disease or gluten sensitivity, it makes sense – going gluten-free can help you start healing the minute you start the diet. Most people begin feeling better right away, some take months to improve, but in the long run, you can look forward to improved health – sometimes dramatically improved.
If you don’t eat gluten, or haven’t eaten it for long enough, your body may not produce enough antibodies to show up on the tests, and the results will come back negative for gluten sensitivity or celiac disease – even if you do have the condition.
In other words, the gluten-free diet will “heal” you. Your body will no longer think it has celiac disease or gluten sensitivity. It will stop producing antibodies, and your intestines will heal – so the tests that determine whether you have the conditions will tell you that you don’t, even if you do.
No one knows for sure exactly how much gluten you need to eat to be properly tested, but if you eat the equivalent of one or two pieces of gluten-containing bread a day for at least three months, you should have enough gluten in your system to provide a measurable response.
Keep in mind, though, that you may be causing damage to your body by continuing to eat gluten! It’s a conundrum, for sure!
Realizing the Consequences of Cheating
If you actually have gluten sensitivity and not celiac disease, you may be able to get away with eating gluten from time to time. Just make sure you remember those pesky false negatives and misdiagnoses, and make sure you don’t have celiac disease if you’re going to indulge.
Some people are told they’re gluten sensitive when they really do have celiac disease. If that scenario applies to you and you continue to eat gluten, even if it’s just every once in a while, you could do some serious unseen damage, not to mention you may continue to suffer unpleasant symptoms.
On the other hand, if you do have celiac disease and you want to improve your health by following a gluten-free diet, you’re going to have to do it 100 percent. A “gluten-free lite” diet won’t get rid of your symptoms, and it will continue to damage your body. The next few sections explain why.
If you have gluten sensitivity or celiac disease and you continue to eat gluten, you are compromising your health, even if you don’t feel any symptoms. Even the tiniest amount of gluten will cause you problems because you’re still setting off autoimmune responses and your body is being robbed of important nutrients that it needs to function properly and stay strong.
When you have celiac disease, every bit of gluten you eat affects your intestinal tract adversely and keeps you from making healthy progress. That means you’ll need to be extremely careful about reading labels, choosing ingredients, and avoiding contamination while cooking.
Certain conditions are associated with celiac disease. It’s usually tough to tell which one developed first, but because awareness of other conditions is higher than that of celiac disease, people are usually diagnosed with the other one first.
It’s important to understand the association between conditions for a few reasons:
✔ Someone who has one condition is more likely to have the other.
✔ If you don’t give up gluten, your chances of developing an associated condition may increase.
✔ An associated condition is a red flag that you may also have gluten sensitivity or celiac disease. If you have one of these conditions, you should be tested for gluten sensitivity or celiac disease.
✔ If people in your family have an associated condition, you may want to consider urging them to be tested – and being tested yourself.
Several autoimmune diseases are associated with celiac disease, including
✔ Addison’s disease (hypoadrenocorticism)
✔ Autoimmune chronic active hepatitis
✔ Crohn’s disease
✔ Insulin-dependent diabetes mellitus (type 1 diabetes)
✔ Myasthenia gravis
✔ Raynaud’s phenomenon
✔ Scleroderma
✔ Sjögren’s syndrome
✔ Systemic lupus erythematosus
✔ Thyroid disease (Graves’ disease and Hashimoto’s disease)
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