Why I Don’t Recommend The Magazine Gluten Free Living

Here is a copy of the letter I wrote to “Gluten Free Living”.

March 25, 2011

Dear Editor:

I no longer recommend your magazine to my gluten sensitive patients. I have two reasons for this.

The primary reason is the narrowness of focus. Gluten sensitivity has been linked to about 100 disorders. You continue to talk only about celiac disease and light microscope intestinal biopsy related damage and maybe a casual reference to skin or other problems. My wife, for example went gluten free based on a positive genetic test (one celiac and one gluten sensitive gene), marginally elevated anti-gliadin antibodies in a stool test but several clinical conditions known to be associated with gluten such as early onset osteoporosis (about age 50), atrial fibrillation, Hashimoto’s thyroiditis, tinnitus and some chronic skin lesions. I am happy to say that after 13 months of a gluten-free diet, her bone density has improved about 30 percent and she is solidly out of the osteoporosis range and now shows mid range osteopenia. We expect that improve further over the next couple of years. The atrial fibrillation has been reduced dramatically, her thyroid panel has improved and the skin lesions have disappeared.

On the topic of intestinal biopsy, a couple of excellent published articles compared intestinal biopsies with light Vs scanning electron microscope techniques. The researchers in both studies I read found that light microscope techniques failed to detect damage in over half the subjects. The damage was readily detected by SEM analysis. We can conclude that many people with celiac or related disorders will not test positive with some current technologies. SEM technology is prohibitively expensive both for research and clinical budgets. A clinician must be aware of the limitations of testing.

The other issue is the insistence that oats and corn are gluten free. I have to remind my patients that in my reading and clinical observation, about half of gluten sensitive people also react negatively to oats and/or corn. The Textbook of Natural Medicine has a nice table that shows the gliadin content of common grains including wheat, oats and corn. Corn and oat proteins have significant gliadin percentages. Some new research indicates that even though the oats and corn gluten fragments are not identical to the wheat, rye and barley varieties, they can still activate some of the receptors that stimulate an antibody cascade.

We consult with clients around the country. When they talk of chronic problems and say they are gluten free we then ask about oats and corn. Invariably they are still eating these grains. Once they are removed from their diet, most begin to notice the improvements they are looking for.

Although this isn’t a perfect test, I tell people to go off the oats and corn for two to three months and then add it back in and pay attention to their body’s response (mental energy, intestinal reaction, skin problems etc) over the next 24 hours or so. Often the peak reaction doesn’t occur for about 18 hours. Of course this doesn’t address the myriad of other problems that could be gluten related but at least gives some idea.

We just received word from a close friend who woke up one day about three months ago with severe global joint pains. Only with great difficulty could she get out of bed. We recommended she get a basic medical workup and was diagnosed with rheumatoid arthritis and placed on a couple of standard RA meds. After much discussion we convinced her to do some reading on gluten and autoimmune disorders. I told her I didn’t know if a gluten-free diet would reverse her symptoms but I knew it wouldn’t hurt her. After just about two months doing her gluten-free diet (including elimination of oats and corn), she reports that she off her meds and is pain free.

The point is that I see commonly see this type of response because I recognize that gluten sensitivity has a broad range of effects. Focusing on celiac disease based on narrow parameters is not appropriate based on the published research of the last decade. I have to explain this to patients who are reading your magazine and tell them that your approach is dated and over the last year I do not see change in that direction.

So I will not be recommending your magazine to my celiac or non-celiac gluten sensitive patients.

Regards

Daniel Schlenger, DC, DACNB

Gluten-Free Diet, No Celiac Diagnosis

As you research a gluten-free diet (GFD), you will no doubt run across opinions from celiac “experts” that will emphatically state that you shouldn’t start your GFD until you have a confirmed celiac diagnosis by blood testing and/or intestinal biopsy.

This is wrong and dangerous advice for several reasons that I will explain here.

#1  NOBODY needs wheat, rye or barley to live. A GFD is not dangerous in any context. On the contrary,ample evidence exists that shows that wheat and similar grains have negative health consequences for just about everyone. There is good anthropologic evidence that joint degeneration (arthritis), degenerative heart problems and tooth and gum decay follow as wheat became a staple and agriculture societies replaced hunting and gathering. Modern day cultures that rely on little or no wheat to this day have less of these degenerative problems. Also we see as wheat is introduced into cultures that typically used little or no wheat for centuries that they encounter many new health issues as a result.

#2 The celiac “experts” imply with their recommendation that if you don’t have full-blown celiac disease that you aren’t gluten sensitive and that you won’t benefit from a GFD. I have to wonder how much time these “experts” have spent in the research literature keeping up on the hundreds of studies published in the last decade that show otherwise. Dietary gluten has been linked to over 60 health disorders, many of which are life threatening such as juvenile onset diabetes, adult onset diabetes, cancer, rheumatoid arthritis, dementia, autism, cerebellar ataxia, thyroid problems, liver problems, osteoporosis, gastric reflux and many others. If any other substance in our culture had been scientifically proven to be associated with so many serious health problems it would have been banned by now. Recommending that person stay on wheat and similar grains except for very specific and narrow diagnositic criteria is irresponsible and dangerous. These “experts” are either sincere but badly mistaken or have a serious conflict of interest with their ties with the wheat industry at some level.

#3 A good study was completed about 2002 that showed that the incidence of celiac disease as proven by blood testing (tissue transglutaminase antibodies) and/or biopsy in the North American population is about 1:133 as reported by Fasano et al. It is estimated that the diagnosis detection rate is currently pathetic at about 3%. Also only about 12 of each 100 with celiac disease will have relatively obvious intestinal signs meaning that 88 of each 100 will have either mild or no intestinal signs that they mention to their doctor. With less than obvious intestinal signs most doctors will not even bother to look for celiac disease and won’t correlate their other signs and symptoms with a gluten cause. Therefore most patients who truly have CD are on their own. As mentioned, medical doctors are picking up about 3 of every 100 people with true celiac disease leaving 97 to fend for themselves.

Therefore saying that a person should get a confirmed diagnosis is not even close to being realistic given the current rate of diagnostic ineptness of the professional health community. I wish I could say that my profession is doing better but it probably isn’t.

#4 An excellent study of about 4000 people was completed about 2001 and published in The Lancet that looked at the mortality rates of undiagnosed first degree relatives of diagnosed celiac patients. Yes, we are talking death rates. It was determined that these first degree relatives were 2-8 times more likely to die at every age (from whatever people die from) than the general population. Keep in mind that 97 of 100 people with celiac disease are undiagnosed and that all of their brothers, sisters, sons, daughters, mother and fathers are also at risk for early death.

Does it make sense then to wait for the medical community to get up to speed on gluten sensitivity diagnosis before going gluten free? The disease and death toll would say otherwise.

#5 We have mostly been talking about celiac disease. The most conservative estimates say that about 6-7 times as many people as have CD are what I call non-celiac gluten sensitive people. That would mean that about 1:20 at least are gluten sensitive and would therefore need a gluten-free diet to be healthy. These non-celiac gluten sensitive people are subject to the same long list of disorders as a celiac and are subject to the same early death. Some researchers put the incidence of the North American population at 50% or more that are gluten sensitive to some degree. The celiac gene is present in about 35% of the NA population and other genes that have been shown to predispose a person to gluten sensitivity are more common still.

#6 Many good studies have shown that often the only sign that a person is gluten sensitive is some sore of neurological disorder. The research in this field has not relied on blood testing or biopsies because they are negative. These people have demonstrated signs of blood flow abnormalities to the brain and abnormal MRI’s. The gluten link has been well established because when these people go gluten free, their blood flow normalizes and the MRI’s begin to normalize as well. Anyone with ADD, ADHD, dementia, memory loss, difficulty walking or speaking, strokes or any other neurological disorder would be wise to go gluten free just in case. I would say get evaluated for gluten sensitivity by an experienced doctor but I have already explained why that probably won’t work.

#7 Many other conditions will be similar to the neurological problems, that is the condition can exist without positive tTG antibodies detectable in the blood and a negative biopsy but the damage is caused by gluten anyway. I am referring to osteoporosis, multiple sclerosis, rheumatoid arthritis, Hashimoto’s thyroiditis, lupus, any other auto immune disorders, any unexplained skin problems and more. The best test for osteoporosis would be a DEXA, go gluten free and repeat the test in 18 months for example.

Each person will have to figure out what symptoms they are going to monitor. As one researcher put it, gluten sensitivity is a clinical chameleon. It has so many presentations that each person will have a different set of symptoms. One person will monitor their headaches, another acid reflux, another quality of sleep and another brain fog.

I trust you get the idea and why you CAN start a gluten-free diet without the high priest’s blessing.

Gluten Related Disorders

Gluten Sensitivity Quick Facts
Daniel Schlenger, DC, DACNB                     775-841-6306 Clinic

Gluten Sensitivity is the broad category and includes both celiac and non-celiac forms. Celiac Disease (CD) is therefore a small subset of Gluten Sensitivity (GS).
Gluten Sensitivity refers to all those who have negative health consequences from dietary gluten. See the list that starts on page 2 for conditions frequently related to GS. Gluten Sensitivity is a genetic disorder and is a lifelong condition.
The celiac disease form of gluten sensitivity consists of physical changes and damage to the small intestine and is likely to include one or more of the multitude of chronic related conditions that occur outside the intestines from systemic inflammation and autoimmune disorders. Celiac Disease can present with or without obvious intestinal symptoms even though an intestinal biopsy would show malformations either way. Only about 1 in 8 people with CD have significant intestinal symptoms related to dietary gluten. The treatment is a gluten-free diet (GFD) along with supplements such as anti-oxidants and probiotics.
Non-celiac GS includes the same likelihood as a celiac patient of developing one or more of the multitude of chronic and inflammatory conditions outside the intestines and autoimmune and/or neurological disorders without abdominal symptoms and without celiac-type small intestine pathology. Most often the only sign of gluten sensitivity is the onset of an autoimmune or neurological disorder. Treatment is the same as the celiac gluten sensitive form and that is a GFD and supplements.
Research is ongoing but some authorities estimate that as many as 50% of the North American population is affected by gluten sensitivity in one form or another and most of these are non-celiac GS.
In spite of the life threatening nature of GS, it remains grossly under diagnosed in all forms even in the classic celiac form that affects about 1 in 100 in the US. Doctors of all kinds routinely miss even celiac patients with obvious intestinal signs. Genetic testing has improved greatly in the past several years. A person can be reliably tested for celiac and non-celiac GS predispositions.
All forms of GS are inflammatory responses to dietary gluten. Gluten is a grain protein and is found in highest quantities in the family of grains that includes wheat, rye and barley (WRB). Gluten is a combination of two proteins, gliadin and glutenin. Gliadin and glutenin are extensively cross-linked in nature so most references are to this gluten complex instead of the biologically-active component gliadin. Gliadin is difficult if not impossible for the GS person to digest. Our body makes anti-bodies to gliadin primarily in the small intestine (95%). 5% of the anti-gliadin antibodies are made in the blood where they may be detected by blood testing. Most often a gluten sensitive person will have a negative blood test but more often a positive stool test for the antibody. A negative blood test or even a negative stool test does not automatically rule out gluten sensitivity. The most reliable indicators that a person will benefit from a gluten free diet (GFD) is one of the clinical conditions listed below plus a positive genetic test. Ultimately a person will have to go GF for many weeks to months and observe health patterns (symptoms and appropriate testing) to know if he or she is gluten sensitive.
Gluten Sensitivity in both forms is a life-long condition. The only treatment is elimination of gluten from the diet. Most gluten-related conditions respond favorably to a truly GFD. A low gluten diet is not an effective treatment for gluten-related conditions. Even minute amounts of gluten once a month can perpetuate the condition(s). Gluten is not an essential nutrient so the only negative aspect of a GFD is convenience. It only feels like an essential nutrient because of the addictive nature of gluten. Portions of the gluten protein (exorphins) bind to opiate receptors in the brain like opium, heroin or cocaine so some withdrawal is expected once a person truly goes gluten free. The addiction should not be underestimated. If any other agent in our diet caused so much misery and death, it would cause a social uproar and legislation would be enacted to limit its use.
To be gluten free, a person will have to learn to read labels and reread labels and watch for hidden sources of gluten and gluten contamination. Rice is a low gliadin food is considered safe for most people as long as they are not contaminated with wheat, barley or rye in transport, processing or packaging. Oats does contain significantly high gliadin percentages so can be a problem food for some GS people. Oats is usually contaminated with wheat gluten unless grown and processed apart from wheat, rye & barley completely.
You can download the Enterolab form for antibody and/or genetic testing from soarchiro.com (look for gluten resources) or OVitaminPro.com (look for Resources then Gluten Resources). This Quick Facts publication is also available for a free download from these sources.
Dangerous Grains by Braly is an excellent resource as well. It was published in 2002 so some things have become dated especially in the genetics descriptions. I still recommend reading this book. I want to stress that a quick genetic test is extremely valuable in sorting out this gluten issue for you and your loved ones.
Below is a partial list of conditions or diseases that have been scientifically or clinically linked to gluten sensitivity.  Any of these listed conditions or any chronic inflammatory or auto-immune reaction is a good enough reason to suspect gluten sensitivity and warrants the simple, one-time genetic test ($149). Which condition or conditions that show up will vary greatly from person to person even with a similar genetic profile. Some conditions will also vary during your lifetime. A past history of any of these will warrant testing.

Gluten Sensitivity Watch List

Abdominal bloating and/or distension
Abdominal pain and/or cramping
Acquired hypertrichosis lanuginosa
ADD and ADHD
Addison’s Disease
Alzheimer’s Disease
Allergic rhinitis
Alopecia areata
ALS
Anemia or Low iron
Anxiety
Aphthous stomatitis (canker sores)
Aplastic Anemia
Appetite Disorder (increase or decrease)
Arthritis
Asthma
Ataxia
Atypical mole syndrome
Autism
Auto-immune conditions
Auto-immune thyroiditis (Hashimoto’s)
Back pain
Behavioral difficulties
Behavioral problems in children
Behget’s Disease
Bell’s Palsy
Biliary Cirrhosis
Bipolar disorder (Manic depression)
Bone or joint pains
Bowel cancer
Brachial neuritis
Bursitis
Cancer
Carpal Tunnel Syndrome
Chronic muscle or joint pain or stiffness
Congenital giant nevus
Cravings for sweets, bread, carbohydrates
Crohn’s Disease
Cutaneous Vasculitis
Depression
Dermatitis herpetiformis
Dermatomyocitis
Diabetes – Juvenile Onset
Diabetes – Adult Onset
Difficulty digesting dairy products
Difficulty in relaxing or chronic tension
Drowsiness after eating
Dysautonomia
Eczema
Edema (puffy swollen legs)
Epilepsy
Erythema elevatum dilantum
Erythema nodosum
Esophageal metaplasia (Barrett’s esophagus)
Esophageal reflux (GERD)
Failure to thrive
Fatigue (chronic)
Fibromyalgia
Flatulence
Gastric reflux and digestive complaints
Generalized acquired cutis laxa
Headache
Hearing Loss
Heart Disease
Heartburn after pasta, pizza or pastry
Hepatitis (AutoImmune)
Hereditary angioneurotic edema
Herpetiformis dermatitis
Huntington’s
Ichthiosiform dermatosis
Infertility
Insomnia
Iron-deficient anemia
Iron-overload
Irritable bowel syndrome (IBS)
Lactose intolerance
Learning difficulties
Linear IgA Bulbous Dermatosis
Liver abnormalities – elevated enzymes
Lupus
Malabsorption problems – Malnutrition
Metabolic syndrome – Syndrome X
Mineral deficiency
Mood swings
Multiple sclerosis
Muscle cramps and spasms
Myopathy
Nausea and vomiting
Necrolytic migratory erythema
Neutropenia
Obesity
Oral Lichen planus
Osteopenia
Osteoporosis
Pale, bulky, greasy and/or smelly stools
Parkinson’s and Parkisonian Syndromes
Pellagra
Peripheral neuropathy
PMS symptoms/hormonal imbalances
Porphyria
Premature gray hair
Psoriasis
Psychological disorders
Pyoderma gangrenosum
Rashes of unexplained origin
Recurrent Febrile Infections
Regional enteritis
Resistant hypothyroidism
Restless Leg Syndrome
Rheumatoid arthritis
Schizophrenia
Sciatica
Sclerosing cholangitis
Seizures/epilepsy
Short stature
Sjögren’s syndrome
Skin problems of unexplained origin
Tendency to over-consume alcohol
Tinnitis
Ulcerative colitis
Urticaria (Hives)
Vitiligo
Weight gain

Dr. Gott and Seizures of Unknown Origin

Here is a copy of a letter I sent to Dr. Gott about his column regarding a person with seizures of unknown origin. He dropped the ball on this one because gluten sensitivity isn’t on the radar as a diagnosis unless there is come overt intestinal involvement. This person is complaining of three problems linked to gluten sensitivity, diabetes, thyroid problems and neurological problems. It all seems too easy once you understand gluten. I am not expecting a response but sent the email anyway.

Dr. Gott,

I read your column in our local Nevada Appeal today. The topic was a person with diabetes, a diagnosis of autoimmune thyroid disorder and now with seizures of unknown origin.

All of these symptoms can be related to gluten sensitivity. As you may know, the HLA-DQ genes are among the set of chromosome 6 genes that code for immune function and are also are specific to gluten sensitivity. Direct genetic testing advances of the last few years has been able to correlate different combinations of these alleles that predispose a person for celiac disease (HLA-DQ*0201 or HLA-DQ*0302) or the more common non-celiac gluten sensitivity problems such as neurological and/or autoimmune disorders.

I would be happy to consult with these folks free of charge to see if I can help. I would instruct them to keep you posted as to their progress.

Daniel Schlenger, DC

soarchiro.com

775-841-6306

Gluten and Cytokines

I am writing this in response to a notion that some practitioners have concerning energy medicine and gluten sensitivity. Some of the practitioners use techniques such as TBM, NAET or devices such as the BAX 3000. I am a big fan of energy medicine from a professional and a personal point of view. TBM and NAET have eliminated a lot of my own personal suffering and I have seen wonderful results with my patients over the years as well.

My problem is with those who think they can cure celiac disease or gluten sensitivity. That means that once you are fixed, you can eat the offending foods again without symptoms.

Here is what I think is happening. When a GS person eats gluten, the gliadin fragments activate cytokine pathways that reach the nucleus and the DNA is activated and the immune system goes into action creating the autoimmune cascade that causes the problems. When a GS sensitive person continually activates these cytokines and genetic autoimmune expression, disease and symptoms result.

When a person stops eating gluten, the feedback continues for some time anyway. Maybe some of the pathways wind down but some my keep going for some years because that’s what they have been conditioned to do and that is probably a particular weakness of the person. That is the person has trouble stopping that particular response even though the trigger has been removed.

Enter the BAX 3000. It is my guess that the BAX 3000 can help unwind some of these cytokine pathways. The person doesn’t have the same inflammatory response to the gluten at that point. It is kind of like a bell that has been ringing for many years. Once you stop pulling on the rope, the bell can continue to ring for a time. Using energy medicine, you can more directly stop the ringing.

If you continue to eat gluten, however, you risk activating destructive pathways maybe without the same symptoms but with the autoimmune destruction anyway. Most of the gluten sensitivity problems don’t come with symptoms until the problem has reached a certain point.

Therefore the energy medicine can maybe reduce the cytocine inflammation cascade to an earlier time where a person had not symptoms. That doesn’t mean that damage isn’t occurring, however.

My recommendation is to find out if you are gluten sensitive, if you are, go off the gluten, get some BAX 3000 or NAET treatments to speed the healing and shut off those cytokine cascades. Don’t reintroduce the gluten, because that will be pulling the rope on the bell again.

Response to Costco Connection

Costco Connection ran an article about celiac disease in the June 2010 issue. Speaking of issues, I had some with the article. The following is my letter to the editor.

Dear Mr. Fuller,

I am writing about the June 2010 article Celiac Disease: an illness on the rise.

First, thank you for helping bring attention to the problem that many have with gluten. I need to correct a couple of things, however.

1.       Celiac disease is not synonymous with gluten sensitivity. Gluten sensitivity is a broad category and celiac disease is a small subset of a particular presentation of gluten sensitivity. Celiac disease probably makes up only 5% of those with gluten sensitivity, that is those who would benefit from a gluten free diet.

2.      Most people with gluten sensitivity will not have a positive small intestine biopsy. These patients have an extremely wide range of possible gluten-related autoimmune and or neurological problems that are usually the only clue that anything is amiss.

3.      Blood testing for anti-gliadin antibodies will not detect most people with gluten sensitivity. Only 5% of the anti-gliadin antibodies are produced in the blood. The other 95% are produced in the small intestine, the body’s first line of defense.

4.      Other blood testing procedures have been shown to correlate at over 95% with the invasive intestinal biopsy thereby eliminating the necessity of the biopsy in most cases.

5.      Why go to all that trouble anyway when genetic testing can quickly and cheaply help determine who is at risk from dietary gluten? A quick cheek swab can reliably determine the particular genes associated with celiac disease (HLA-DQ*0201 or HLA-DQ*0302) or the non-celiac HLA-DQ gluten genes.

6.      Dr. Hehra is quoted as saying that a person shouldn’t eliminate gluten without a confirmed celiac diagnosis. That thinking is not just erroneous, it is poor medicine. Gluten is not an essential nutrient by any standard and can safely be eliminated by anyone gluten sensitive or not. Non-celiac gluten sensitive people make up the bulk of those who will benefit from a gluten-free diet. Given that type of poor advice, these gluten sensitive people, maybe with osteoporosis, diabetes, cerebellar ataxia, dementia, asthma and other serious problems would continue adding to their disease state several times a day in the form of dietary gluten.

7.      From my reading, celiac disease and non-celiac gluten sensitivity is probably not on the rise. The increase in incidence is most likely related to an increase in awareness by doctors and patients alike with better diagnostic methods each decade.

I have tried to keep this is a brief as I could. The gluten topic is very involved and is most difficult to treat adequately in a short article. Most articles in the lay press repeat the same misconceptions, however and that does a huge disservice to those non-celiac gluten sensitive people.

I am attaching my gluten sensitivity quick facts sheet in case you are interested or know someone who is.

Sincerely,

Daniel Schlenger, DC, DACNB
Carson City, NV

Gluten Sensitivity Presentation CD Part 2

Part 2 is a natural follow-up to part 1. In this CD we discuss the implementation of the gluten-free diet, that is strategies at home, strategies in the grocery store and also restaurants.

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We also discuss supplements that will be helpful. You will need a heads up about diagnosis. This has been worked out nicely but you have to know whether you are looking for celiac disease specifically or non-celiac gluten sensitivity.

You can jump to the description and order page here: Gluten Sensitivity Presentation CD Part 2

Gluten Sensitivity CD Part 1

An educational CD has just been completed and uploaded to OVitaminPro.com for sale. This CD is meant to run on your PC or Mac and is a powerpoint format with audio.

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Topics discussed:

Magnitude and Severity

Disorders associated with gluten sensitivity

What is Gluten

Genetics

Diagnosis

GS and Autoimmune and Neurological problems

You can jump to the order page here: Gluten Sensitivity CD

Gluten and Health

Received an Enterlab test report a few days ago. This person has had much difficulty with energy and has tried desperately to regain health by trying to normalize blood sugar. I told him we really had to rule out gluten so we ran the entire profile.

His test came back with positive antibodies and a couple of genetic markers for celiac and gluten sensitivity. So we had a long talk and he understands that he can’t be healthy until he gets all the gluten out of his diet.

I have sent away for the test kit for my granddaughter’s DNA test. We will see what happens there but I have a pretty good idea. Her grandmother on one side has full blown celiac d. and on the other side one celiac gene and one gluten sensitive gene. I want it in black and white so all involved will get it.

I am convinced that at least 1 in 30 of the general population is gluten sensitive and will benefit from a gluten free diet.

Gluten Diagnosis

I have been doing a lot of reading about the diagnosis of gluten sensitivity and am just beginning to get lab tests back so I can make some general comments. What we are trying to discover is who will most likely benefit from taking steps to remove gluten from their diet.

It appears that the most sensitive indicator is the clinical picture. That means your history and family history of chronic and autoimmune disorders. If you or someone in your family has one of the 100 or so chronic disorders that is often related to GS, then this is paramount in your diagnosis. You ignore those symptoms at your peril.

To that I would then add a good genetic profile. If you don’t have any celiac or gluten sensitivity genes, then maybe this isn’t your problem even if you have one of those disorders mentioned above. If your test comes back positive AND you have a chronic illness, then your next step should be to get off gluten for a year and see what happens. You should notice something in the first several weeks of being truly gluten free but complete healing or maximum healing could take a year or two.

Next comes anti-body testing. My preference is stool testing and then blood testing. If one or both of these is positive along with the other indicators above, you are off gluten forever or you risk misery and an early death. If the anti-body testing is negative, that is only a maybe because anti-body testing isn’t as sensitive as what your body is saying or the health of close family and the genetic tests.

Next comes intestinal biopsies. Biopsies will show damage in some cases but not in all people that will be healthier with gluten out of their diets.