Is the test process itself based on "cutting edge" good science?  Is it validated as duplicatable and is it peer-reviewed?  If not why not?  Who funded the research?

If the test is invalidated,

Why is it invalidated?  Sometimes there are explainable reasons.

Who developed the test? 

What motivators influenced the work?

What track record/reputation does this test maintain?  Does it match patient experience when test results and clinical results are compared?

The gluten syndrome community has a home stool test available at www.enterolab.com, for which the research is not published or validated at this time. However public confidence has grown considerably in the test over the past 8 years. It produces a high number of positives and in most cases, the results match patient experience. More on this test on this page.

Was it performed correctly?

Were quality materials used to process the test.?  Sometimes this is a problem.

Was it read correctly?  Processing employees may be inexperienced.

Did the doctor interpret the results in an accurate context or paradigm? (ex. celiac only or the wider gluten syndrome perspective.)

Contrasted examples of test goals include:

Blood antibody test panels - Does the test check for IMMUNE RESPONSE (antibodies) to gluten-related substances?  (Ie., is the body fighting gluten?).  Why is this important?  Some researchers believe the presence of antibodies alone is proof that gluten should be avoided.  They believe the antibodies can damage many tissues of the body. Some of them may be difficult to find.  But the antibodies prove an immune reaction is present.

Villi biopsy - This test checks for damage to one specific body tissue only, the villi.  Why is this important? Celiac specialists use villi damage only to confirm immune reaction to gluten and prescribe a gluten-free diet. If gluten antibodies are present but there is no villi damage they ignore the antibodies.  They do not count the very presence of antibodies as proof that the immune system reacts to gluten nor the possibility that in many cases damage may occur to other areas of the body and NOT the villi.

Blood, saliva, white blood cells, stool, skin or villi biopsy, and energy-based testing are mediums used for testing gluten reactions.   

Celiac specialists use blood tests, and villi or skin biopsy only. They use blood antibodies because they show a reaction circulating in the bloodstream.

Gluten syndrome specialists use blood, stool*, and saliva.  (Some alternative practitioners use energy-based testing such as bioenergetic testing.) They believe elevated antibodies in any medium are conclusive proof of a reaction to gluten and they may show up in stool or saliva earlier than in blood. *Since it is normal to have a few antibodies in stool to most foods we eat, the reference ranges are adjusted to account for these normal levels.

Specific villi or skin damage is considered proof by both celiac and gluten syndrome specialists to be caused by gluten (sometimes milk in the case of villi damage)  However gluten syndrome specialists believe villi damage is only one of many places gluten may target for damage.  They also say that if other tissues but NOT the villi are damaged, a villi biopsy is useless.  Skin biopsy is only performed if there is visible damage (dermatitis herpetiformis).

As more literature is published on saliva tests,  more patients now turn to these tests due to low cost, and easy collection.  If their saliva tests are negative they may move on to more detailed antibody tests or other mediums such as blood to check out more possibilities.  Since there are antibodies for which there are no tests, any negative test must necessarily be inconclusive for diagnosis of the gluten syndrome.

Standard gluten-related tests measure antibodies, the tTG enzymes, and villi or skin damage.  However, 2 labs test the function of other organs or tissues www.enterolab.com and Immunoscienceslab.com), looking for possible gluten-related damage.   Other labs, ALCAT and ELISA/ACT Biotechnologies, each measure different white cell reactions to gluten-related substances.  The ALCAT test is controversial.

Sensitivity - Some tests are sure to find a substance when it is present.  Other tests may miss the item sometimes. This trait is called "sensitivity".  If a test runs 100 samples that all are actually positive, and it finds the substance in 75 of the samples (positive) then it is 75% sensitive.

Specificity - Some tests identify a "specific substance" very well.  The test may not always find the item when it is present, but when it does find it, it only finds that item without confusing it with something else.  If a test runs 100 samples that are all positive and correctly identifies the tested substance in 75 samples without confusing it with something else in the sample, then it is 75% specific.

Limitations - Some tests ( blood or saliva antibody tests) are only accurate when the patient has eaten gluten for a period of weeks or months before the test.    The www.enterolab.com stool test can be used for several months after the patient goes GF because they claim the antibodies hang around in the gut longer than the bloodstream.  The ALCAT test does not require a gluten-containing diet. the ELISA/ACT Biotechnologies test requires one serving of gluten within the past 6 months.

 Examples: 

Is only one test/collection accurate, or do levels rise and fall at different times of the day, necessitating a series of tests/collections repeated at intervals in order to reflect these variations?  Answer?  Good question!!!

Should gluten be consumed before the test is performed?

Blood and saliva tests - Yes a gluten diet is required for weeks or months prior to the test.   NOTE:  If the patient is already completely off gluten for a number of weeks depending on the person, experience indicates that many patients are miserable if they go back in order to be tested, and it has been downright harmful, even psychiatrically, for some. 

Stool testing (www.enterolab.com) claims that the test works for weeks or months after the gluten-free diet is begun because the antibodies hang around in the gut that long.  Call the lab to ask.

Stay in touch with other patients including online forums and local and regional support groups.  Investigate other's patient's experiences with the test in question.

The patient's own body often is a reliable judge.  However, in the case of gluten, there are some confounding factors to consider as a reaction or lack of it is evaluated.  These can be confusing at first.

1.  Some serious gluten-related reactions/conditions may be SYMPTOMLESS for long periods of time sometimes due to delayed reactions or damaged silenced nerves.

2.  The patient may have uncomfortable healing Herxheimer's or retracing reactions in which symptoms actually regress temporarily as healing takes place, or other food intolerances and imbalances are still untreated, or retracing (copies) of old health and emotional events occur.  (Retracing is a homeopathic concept.) 

3.  Sometimes a withdrawal effect may be experienced.  Gluteomorphins may exert an opiate-like effect on the brain and removal of them may produce temporary withdrawal.

Taking the above variations into account, what might the patient's own body tell him regardless of test results?  This may be highly significant.  Many patients and their doctors tend to believe negative tests even when the patient's body clearly says that gluten is not OK.  Others realize negative tests are inconclusive and take their body's message very seriously.  They recognize that this field with its testing methods, is still in its infancy.

What future options may become available as patients evaluate today's choices?

A gluten-related test protocol is proposed that runs the most common gluten antibodies first and progresses through the list of available known antibodies until a positive is reached or all have been tested.  This progressive test panel conserves total cost and the patient need only submit specimens once.  Watch the home page of this website for further information.  This website has no financial interest in any product or service mentioned here.

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 in 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 dunce caps or condemned signs) to tag them for destruction by killer cells that are in the bloodstream.

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)

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 a 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 in 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 biopsy 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 biopsy 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.

 "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 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, 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 remain 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 are 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 the current Immunosciences Labs list on the Lab Charts page.  Tests are not available at this time.  Watch for further announcements on the 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 an improvement in the gluten-free diet conclusive regardless of the particular underlying gluten-related process or area of tissue damage.

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

See Seven Viewpoints Comparison Chart

Celiac  specialists -

Celiac specialists 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 remain unchanged.  Villi-damaged celiac prevalence is estimated at 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 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 of 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, myelin 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 the Immunosciences Labs list on the Lab Charts page.  Tests are not available at this time.  Watch the 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 the 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 the 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 nondigestive, nonspecific symptoms

28% for nonsymptomatic (silent symptom) patients

Example:  A patient who has discontinued eating gluten may no longer have detectable antibodies in the bloodstream, 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. 

 "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 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, 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 remain 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 are 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 the current Immunosciences Labs list on the Lab Charts page.  Tests are not available at this time.  Watch for further announcements on the 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 an improvement in the gluten-free diet conclusive regardless of the particular underlying gluten-related process or area of tissue damage.

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