FREQUENTLY ASKED QUESTIONS

Q: Where do I have my ALCAT sample drawn?

There are multiple options available depending on your geographic location. Contact the ALCAT customer service team for information.

Q: I know I have an allergy to a food. Why is it on my acceptable food list/Green Column?

This is due to the fact that the ALCAT Test detects sensitivities/intolerances and NOT allergies (IgE reactions).

Q: What is the shipping procedure for the ALCAT Test?

Specimens must be shipped via UPS/FEDEX the SAME DAY blood is drawn. Check with UPS/FEDEX prior to draw for express delivery cutoff times.

Q: What do the blue boxes on the ALCAT Test results mean?

The blue boxes include items that should be removed from your diet due to reactions with other items.

Q: What do the asterisks on the ALCAT Test results mean?

An asterisk represents a mild intolerances.

Q: Is fasting required before taking the ALCAT Test?

No.

Q: Is this a blood test?

Yes.

Q: What are the medication restrictions for the ALCAT test?

Please click here to view medication restrictions.

Q: Is the ALCAT test covered by insurance?

Cell Science Systems does not accept/file insurance.

Q: Is this a food allergy test?

The ALCAT test is NOT a food allergy (IgE) test. It is designed to test for intolerances/sensitivities, which have a delayed reaction.

Q: How long will it take to receive my ALCAT test results?

General turnaround times range from 7-14 business days (longer for more complicated tests). If you have been waiting longer than 21 business days, please email us [testing@thedr.com] with the following information:
• Name of the test recipient
• Name of lab company and test
• Date of blood drawn or return kit shipment
• Name and location of the draw center

Q: Do I need to fill each tube completely?

Each tube must be filled to capacity. Failure to do so may require recollection.

Q: Do I fill out the billing information and signature area on the form I received?

You have already paid for your tests, so leave any billing sections on your form blank. You may see an area for a physician’s signature. We have already electronically signed the form so no physical signature is needed. All other information does need to be completed (name, address, sample collection time etc.).

Q: What day should I mail my test kit back?

If the test(s) you are ordering requires a test kit, you will need to mail it back to the lab. The return shipping label and bag is included. It is suggested to mail the kit back on a Monday or Tuesday in order to avoid weekend mailing delays. We do not suggest you mail kits on Fridays.

Q: What type of blood samples are collected for these tests?

The ALCAT portion is whole blood and the Gut Heath Profile (GHP) is both whole blood and serum. The GHP has 2 blue top vials and 1 gold top vial whereas the ALCAT is only blue top vials.

Q: How do I schedule a blood draw?

Please visit https://www.alcat.com/alcattesting.php and select option #3.

Q: Does ALCAT drop-ship test kits globally?

Yes.

Q: Should I fast before taking the test?

Yes. The Doctor’s Data Cardiovascular Risk Profile requires an overnight fasting prior to the morning blood draw. Avoid food for 8-10 hours before the blood draw. Only water is permitted during your fast.

P: Yo soy celíaco y mi hijo ha desarrollado alopecia. El le habló de mi diagnóstico a su doctor quien lo despidió diciéndole que se dejara crecer el cabello sobre su calva. ¿Deberia el médico de familia hacerle examenes para la celiaquía?

R: En una encuesta reciente enviada a 1,560 miembros de la Sociedad Sueca para Celíacos escogidos al azar, divididos igualmente por edad, sexo, y estrato, el 2.3% presentó alopecia. Después de hacer una dieta libre de gluten, el 1.1% no presentó ningún cambio. Los demás no presentaron ningún síntoma adicional de pérdida de cabello.

 

P: ¿El consumo de gluten puede causar problemas en la piel?

R: Sí, la dermatitis herpetiforme (DH) es una de las 2 enfermedades autoinmunes para las cuales hay evidencia concluyente que demuestra su asociación con la exposición al gluten (la otra es la enfermedad celíaca). La DH es una enfermedad de la piel que usualmente afecta a los dos codos, rodillas y/o glúteos. Los individuos con DH no siempre tienen síntomas digestivos, pero la mayoría tienen el daño intestinal que se asemeja al de las personas con enfermedad celíaca.

Si su piel no se recupera con una dieta estricta sin gluten, debe entonces consultar a un profesional médico que esté bien informado, pues es posible que otros factores desencadenantes estén actuando, como por ejemplo alimentos con reactividad cruzada, bacterias o virus, sobrecrecimiento bacteriano en el intestino delgado, disbiosis, etc. .

Además de la conocida asociación entre la enfermedad celíaca y la dermatitis herpetiforme (DH), también existe asociación con otras enfermedades mucocutáneas, que son autoinmunes, alérgicas e inflamatorias. El presente estudio sugiere que los pacientes deben hacerse análisis en busca de enfermedad celíaca cuando se encuentran afectados por psoriasis, alopecia areata, urticaria crónica, edema angioneurótico hereditario y la dermatitis atópica, en especial en los casos que son resistentes a las terapias de primera línea. Ver: “Celiac disease and dermatologic manifestations: many skin clue to unfold gluten-sensitive enteropathy,” Gastroenterol Res Pract. 2012;2012:952753.

Además, 34.1% de los pacientes de psoriasis tienen una elevada cantidad de anticuerpos contra la alfa-gliadina o AGA (un péptido del trigo) y contra la transglutaminasa. Este estudio encontró una correlación altamente significativa entre la positividad del AGA sérico y la duración de la psoriasis. Ver: “Estimation of (IgA) anti-gliadin, anti-endomysium and tissue transglutaminase in the serum of patients with psoriasis,” Clin Exp Dermatol. 2011 Apr;36(3):302-4.

“Varios trastornos de la piel se ven asociados con la enfermedad celíaca. La dermatitis herpetiforme, por ejemplo, es el más común, pero hay otras enfermedades como la alopecia, el eczema atópico y el vitíligo. También se han reportado casos de prurigo nodular asociados a la enfermedad celíaca”. Ver: “Gluten-sensitive enteropathy associated with genital lichen simplex chronicus,” JRSM Short Rep. 2010 Oct 21;1(5):43.

P: ¿El consumo de gluten puede causar problemas en las articulaciones?

R: La causa del dolor en las articulaciones de los niños y adultos va desde una leve sobreutilización (en cuyo caso el dolor desaparece en pocos días) hasta artritis severa (se siente dolor en muchas articulaciones). En individuos sensibles, se ha evidenciado el alivio del dolor después de cambiar a una estricta dieta libre de gluten.

“Se les debe hacer exámenes de sangre en busca de enfermedad celíaca a todos los pacientes con artritis cuya etiología (causa) no es clara, pues el compromiso de las rodillas podría ser (el único) síntoma manifiesto de la EC.” (Ver: “Silent celiac disease presenting with polyarthritis,” J Clin Rheumatol. 2010 Jun;16(4):195-6, .)

“Los niños con artritis idiopatica juvenil tienen una mayor prevalencia de tiroiditis autoinmune, hipotiroidismo subclínico y enfermedad celíaca. Estos datos parecen indicar un cuidadoso monitoreo de la función tiroidea, de los anticuerpos antitiróideos y de la enfermedad celíaca en niños con AIJ”. Ver: “Thyroid function, autoimmune thyroiditis and coeliac disease in juvenile idiopathic arthritis,” Rheumatology (2005) 44 (517): 44-517.

P: ¿Qué enfermedades pueden ser causadas por un trastorno relacionado con el gluten?

R: La respuesta a esta pregunta es muy muy amplia, pues los trastornos relacionados con el gluten se pueden manifestar en cualquier tejido del cuerpo. En mi opinión, CUALQUIERA que tenga una enfermedad autoinmune debería hacerse los exámenes para detectar trastornos relacionados con el gluten.

P: ¿Puede el gluten causar X enfermedad/síntoma?

R: Actualmente se acepta que los péptidos tóxicos del gluten que se encuentran en el trigo, el centeno y la cebada pueden ser perjudiciales para cualquier tejido del cuerpo. En otras palabras, su acción NO se limita a los intestinos. De hecho, un artículo publicado en 2002 en la revista “The Journal of Neurology, Neurosurgery and Psychiatry” dice que: “Considerar la sensibilidad al gluten como una enfermedad que afecta principalmente al intestino delgado es un error histórico“.

Los péptidos tóxicos del gluten que se encuentran en el trigo, el centeno y la cebada pueden ser perjudiciales para CUALQUIER tejido del cuerpo.

Si bien no estoy en condiciones de opinar sobre la condición de salud de un individuo desconocido, sí puedo recomendarles que investiguen si el gluten es uno de los factores que causan su dolencia o síntomas.

P: ¿Qué enfermedades se relacionan con el gluten y con los trastornos relacionados con el gluten?

R: En palabras del Dr. Rodney Ford, un gastroenterólogo pediátrico que comenzó a hablar de los trastornos relacionados con el gluten a mediados de la década de 1990: “¿Quién debe preocuparse por el gluten? Pues bien, cualquier persona que esté enferma; es decir si uno se siente enfermo, ¡hay que tener en cuenta al gluten!”

Sería tonto decir que “todas” las enfermedades están asociadas con el gluten, pero sí es razonable decir que cualquier enfermedad “podría” estar asociada con un trastorno relacionado con el gluten.

Encuentre un profesional certificado en el gluten en este sitio: http://tinyurl.com/find-a-cgp

Q: Does Cyrex have any references from medical literature that explain how opioids can come from food?

Following is the evidence that wheat gluten and casein indeed can act like opioids. As for how to test for this, this has been known since 1986.

REFERENCES
1. Gardner MLG. Exorphins and other biologically active peptides derived from diet. Chapter 33; in Food Allergy and Intolerance. Brostoff and Challacombe, eds. Sanders 2002.
2. Zioudrou C et al. Opioid derived from food proteins. J Biol Chem, 1979; 245:2446-2449.
3. Fukudome S et al. Opioid peptides derived from wheat gluten: their isolation and characterization. FEBS Letters, 1992; 296:107-111.
4. Shah NP. Effects of milk-derived bioactives: an overview. Brit J Nutr, 2000; 84 (Suppl 1):S3-S10.
5. Roy BF et al. Human antiidiotypic antibody against opiate receptors. Ann Neurol, 1998; 24:57-63.
6. Roy BF et al. Anti-beta-endorphin immunoglobulin G in humans. Proc Natl Acad Sci USA, 1986; 83:8739-8743.
7. Ng DSS et al. Anti-morphine anti-idiotypic antibodies. Opiate receptor binding and isolated tissue responses. Biochem Pharmacol, 1985; 34(16):2853-2858.
8. Verebey K et al. Endorphins in psychiatry. Arch Gen Psychiatry, 1978; 35:877-888.
9. Watson SJ et al. Some observations on the opiate peptides in schizophrenia. Arch Gen Psychiatry, 1979; 36:35-41.
10. Vojdani A et al. Immune response to dietary proteins, gliadin and cerebellar peptides in children with autism. Nutritional Neuroscience, 2004; 7(3):151-161.
11. Vojdani A et al. Infections, toxic chemicals and dietary peptides binding to lymphocyte receptors and tissue enzymes are major instigators of autoimmunity in autism. Int J Immunopathol Pharmacol, 2003; 16(3):189-199.

Q: Does Cyrex have any references from medical literature to support the testing done in Array 3?

Please read Camarca’s publication (reference 1). Here is just a taste, “Consistent with previous studies, our results demonstrate that HLA-DQ2+ CD patients respond to a wide and heterogeneous array of peptides; in some cases many peptides from multiple or single gliadin families are recognized, while in others only one of the peptides was active.”

REFERENCES
1. Camarca A et al. Intestinal T cell responses to gluten peptides are largely heterogeneous: implications for a peptide-based therapy in celiac disease. J Immunol, 2009; 182:4158-4166.
2. Tye-Din JA et al. Comprehensive, quantitative mapping of T cell epitopes in gluten in celiac disease. Sci Transl Med, 2010; 2:41-51.
3. Shan L et al. Identification and analysis of multivalent proteolytically resistant peptides from gluten: implications for celiac sprue. J Proteome Res, 2005; 3:1732-1741.
4. Anderson RP et al. Antagonists and non-toxic variants of the dominant wheat gliadin T cell epitope in coeliac disease. Gut, 2006; 55:485-491.
5. Vader LW et al. Characterization of cereal toxcicity for celiac disease patients based on protein homology in grains. Gastroenterol, 2003; 125:1105-1113.
6. Vader LW et al. The gluten response in children with celiac disease is directed toward multiple gliadin and glutenin peptides. Gastroenterol, 2002; 122:1729-1737.
7. Van de Wal Y et al. Glutenin is involved in the gluten-drive mucosal T cell response. Eur J Immunol, 1999; 29:3133-3139.
8. Ensari A et al. Studies in vivo of omega-gliadins in gluten sensitivity (coeliac sprue disease). Clin Sci, 1998; 95:419-424.
9. Tatham A et al. Extraction, separation and purification of wheat gluten proteins and related proteins of barley, rye, and oats. Humana: Totowa, 2000, pp. 55-73.
10. Sollid LM et al. Antibodies to wheat germ agglutinin in celiac disease. Clin Exp Immunol, 1986; 63:95-100.
11. Kitano N et al. Detection of antibodies against WGA bound glycoproteins on the islet-cell membrane. Diabet Med, 1988; 5:139-144.
12. Kottgen E et al. The lectin properties of gluten as the basis of pathomechanism of gluten-sensitive enteropathy. Klin Wochenschr, 1983; 61(2):111-112.

Q: Does Cyrex have references to support the transport of bacteria from the gut into the blood stream, which can happen in a patient with severe leaky gut?

Cyrex brochures discuss leaky gut in relation to undigested food proteins or peptides and bacterial endotoxins, NOT the whole bacteria. Here is the exact quote from the brochure: “The destruction of the intestinal barrier’s integrity, commonly caused by gram-negative bacteria, results in release of occludin/zonulin (paracellular destruction). These antigens are presented to T- and B-cells, resulting in the production of IgA, IgM, and IgG autoantibodies against self- occludin/zonulin, actomyosin, and the triggering factor LPS. Measurements of these auto-antibodies can be used as an early biomarker of GI disorders and autoimmune diseases. The development of autoimmunity requires three ingredients: genetic predisposition, an environmental trigger (antigen) and, finally, transportation of the antigen—such as lipopolysaccharides (LPS)— through the GI barrier into the gut submucosa.”

REFERENCES
1. Clemente M et al. Enterocyte actin autoantibody detection: a new diagnostic tool in celiac disease, resulst of a multi-center study. Am J Gastroenterol, 2004; 99:1551-1556.
2. Klatt NR et al. Compromised gastrointestinal integrity in pigtail macaques is associated with increased microbial translocation, immune activation, and IL-17 production in the absence of SIV infection. J Mucosal Immunol, 2010; 3:387-398.
3. Maes M et al. The gut-brain barrier in major depression: intestinal mucosal dysfunction with an increased translocation of LPS from gram negative enterobacteria (leaky gut) plays a role in the inflammatory pathophysiology of depression. Neuroendocrinol Lett, 2008; 29(1):117-124.
4. Maes M et al. Increased serum IgA and IgM against lipopolysaccharide of enterobacteria in chronic fatigue syndrome (CFS): indication of the involvement of gram-negative enterobacteria in the etiology of CFS and for the presence of an increased gut-intestinal permeability. J Affect Disord, 2007; 99(1-3):237-240.
5. Maes M. An IgM-mediated immune response directed against nitro-bovine serum albumin (nitro-BSA) in chronic fatigue syndrome (CFS) and major depression: evidence that nitrosative stress is another factor underpinning the comorbidity between major depression and CFS. Neuro Endocrinol Lett, 2008; 29(3):313-319. “Both Chronic Fatigue Syndrome and Major Depressive Disorder are accompanied by a) an increased gut permeability which has allowed an exaggerated passage of bovine serum albumin through a compromised epithelial barrier; b) increased nitrosative stress which has induced damage to BSA; and c) an IgM-mediated immune response which is directed against the nitro-BSA neoepitopes. Nitrosative stress is one of the factors underpinning the comorbidity and clinical overlap between CFS and MDD”
6. Neisser A et al. Serum antibodies against gangliosides and Campylobacter jejuni lipopolysaccharides in Miller Fisher Syndrome. Infect Immunity, 1997; 65(10):4038-4042.
7. Poxton IR et al. Antibodies to lipopolysaccharide. J Immunol Methods, 1995; 186:1-15.
8. Sumazaki R et al. Monoclonal antibody against bacterial lipopolysaccharide cross-reacts with DNA-histone. Clin Exp Immunol, 1986; 66:103-110.
9. Ziegler TR et al. Detectable serum flagellin and lipopolysaccharide and upregulated anti-flagellin and lipopolysaccharide immunoglobulins in human short bowel syndrome. Am J Physiol Regul Integr Comp Physiol, 2008; 294:R402-R410.
10. Chen Y-H et al. COOH terminus of occluding is required for tight junction barrier function in early Xenopus embryos. J Cell Biol, 1997; 138(4):891-899.
11. Fasano A. Intestinal zonulin: open sesame! Gut, 2001; 49:159-162.
12. Fasano A and Shea-Donahue T. Mechanisms of disease: the role of intestinal barrier function in the pathogenesis of gastrointestinal autoimmune diseases. Nat Clin Pract Gastroenterol Hepatol, 2005; 2(9):416-422.
13. Gassler N et al. Inflammatory bowel disease is associated with changes of enterocytic junctions. Am J Physiol Gastrointest Liver Physiol, 2001; 281:G216-G228.
14. Sander GR et al. Rapid disruption of intestinal barrier function by gliadin involves altered expression of apical junctional proteins. FEBS Let, 2005; 579:4851-4855.
15. Sapone A et al. Zonulin upregulation is associated with increased gut permeability in subjects with type 1 diabetes and their relatives. Diabetes, 2006; 55:1443-1449.
16. Wong V and Gumbiner BM. A synthetic peptide corresponding to the extracellular domain of occludin perturbs the tight junction permeability barrier. J Cell Biol, 1997; 136(2):399-409.

Q: Does Cyrex have references to support the concept that patients lacking secretory IgA compensate by making extra IgM?

Abstract from one of the articles below: “The finding that ingestion of antigens results in the selective induction of IgA antibodies in external secretions suggests that antigen sensititizes Peyser’s patch lymphoid cells, which migrate to mucosal sites and generate local secretory IgA (S-IgA) antibody responses. Evidence for a common mucosal immune system in humans has been scanty because of the difficulty in demonstrating migratory behavior of Peyer’s patch cells. In the present study, peripheral blood mononuclear cells (PBMC) from human volunteers who had ingested capsules containing killed Streptococcus mutans were assayed for spontaneous antibody-producing cells. Four of five volunteers exhibited circulating IgA-producing cells within 7 days and reached maximum responses by days 10-12. One IgA-deficient subject exhibited IgM responses with identical kinetics.”

To quote some of the researchers referenced in A: Czerkinsky, “IgA deficient individuals make secretory IgM;” Coelho, “saliva of IgA deficient patient contained IgG and IgM;” G. Norhagen E., “A statistically significant increase in salivary IgM and IgG levels was noted in individuals with selective IgA deficiency compared to healthy normal individuals. Healthy individuals with selective IgA deficience did not have increased concentrations of salivary IgM compared to infectious-prone patients;” Stiehm, “In IgA deficient individuals, there may be an increase in secretory IgM in the saliva and other intestinal fluids.”

REFERENCES
1. Cardinale F et al. Aberrations in titer and avidity of serum IgM and IgG antibodies in microbial and food antigens in IgA deficiency. Adv Exp Med, 2005; 371:713-716.
2. Hvatum M et al. Serum IgM subclass antibodies to a variety of food antigens in patients with celiac disease. Gut, 1992; 33:632-638.
3. Czerkinsky C et al. IgA antibody-producing cells in peripheral blood after antigen ingestion: evidence for a common mucosal immune system in humans. Proc Natl Acad Sci, 1989; 84:2449-2453.

Q: Does Cyrex have references from medical literature to support Array 1 as being able to detect reactivity to gluten before villous atrophy?

Gluten-sensitivity, like any other food sensitivity, can be measured in a variety of ways, including skin prick, oral fluid, blood, stool and for the alternative practitioners muscle testing. These methods are not new and have been used by practitioners for decades. Before a blood test can be positive, in most patients, there has to be some kind of GI damage in order for the systemic immune system to be challenged by the food antigens. Protecting the gut barrier from antigen penetration is a mucosal layer. If the mucosal layer is functioning, food antigens cannot penetrate the GI barrier. Therefore, before gut damage can occur, the mucosa must be made dysfunctional. A salivary assessment can uncover mucosal immune challenges that if not addressed, could result in the breakdown of the mucosal layer, which leaves the GI barrier vulnerable to penetration of invading antigens. For the genetically susceptible individual this could mean the development of celiac disease. The Wheat/Gluten Proteome Reactivity and Autoimmunity panel offered by Cyrex is the most sensitive wheat reactivity test available clinically. Rather than depending on one molecule of wheat to determine gluten-sensitivity Cyrex is assessing twelve proteins, peptides and enzymes associated with wheat.

REFERENCES
1. Bonamico M et al. First salivary screening of celiac disease by detection of anti-transglutaminase autoantibody radioimmunoassay in 5000 Italian primary school children. J Pediatr Gastroenterol Nutr, 2011; 52(1):17-20.
“In conclusion, the present study demonstrates that it is possible to perform a powerful, noninvasive, simple, well-accepted, inexpensive, reproducible, and sensitive CD screening using saliva.”
2. Tosco A et al. Immunoglobulin A anti-tissue transglutaminase antibody deposits in the small intestinal mucosa of children with no villous atrophy. J Pediatr Gastroenterol Nutr, 2008; 47:293-298.
3. Bonamico M et al. Tissue transglutaminase autoantibody detection in human saliva: a powerful method for celiac disease screening. J Pediatr, 2004; 9:69-76.
4. Bonamico M et al. Radioimmunological detection of anti-transglutaminase autoantibodies in human saliva: a useful test to monitor celiac disease follow-up. Aliment Pharmacol Ther, 2008; 28:364-370.
5. Hakeem V et al. Salivary IgA antigliadin antibody as a marker for celiac disease. Arch Dis Child, 1992; 67:724-727.
6. Al-Bayaty HF et al. Salivary and serum antibodies to gliadin in the diagnosis of celiac disease. J Oral Pathol Med, 1989; 18:578-581.
7. Di Leo M et al. Serum and salivary antiendomysium antibodies in the screening of coeliac disease. Panminerva Med, 1999; 41:68-71.
8. Brandtzaeg P. Do salivary antibodies reliably reflect both mucosal and systemic immunity? Ann N Y Acad Sci, 2007; 1098:288-311.
9. Rumbo M et al. Detection and characterization of antibodies specific to food antigens (gliadin, ovalbumin and beta-lactoglobulin) in human serum, saliva, colostrums and milk. Clin Exp Immunol, 1998; 112:453-458.

Q: Does Cyrex have any references from medical literature to support that some gluten-sensitive people also have immune cross-reactions to other foods? For instance, eating dairy can trigger a gluten-like immune response because the body sees them as one and the same?

Antibodies against wheat can not only cross-react with other foods, such as milk, but also can cross-react with human tissue, in particular, cerebellar and synapsin.

Cross-reactivity among foods is very common. Google “cross-reactive food” and thousands of publications will be displayed. This is one of the reasons testing for food sensitivities is so difficult. Is the patient really sensitive to corn, or is the sensitivity really to rice or soybean (Lehrer)? Additionally, how can a kosher patient test positive to lobster when never having consumed it? The answer is cross-reactivity. If the gluten-sensitive patient does not recover on a gluten-free diet, then he(s)he may be experiencing a cross-reaction or a sensitivity to a food that has been recently introduced on the gluten-free diet. Identifying these foods and eliminating them, could assist the patient in his/her recovery. Gluten-sensitivity and dairy-sensitivity often go hand-in-hand. Celiac patients have a high degree of intolerance to milk (Cabrera-Chávez, Kristjánsson). People on the Autism spectrum also have a common co-occurrence of gluten- and casein-sensitivity (Nazni, Rossignol).

REFERENCES
1. Vojdani A et al. Immune response to dietary proteins, gliadin and cerebellar peptides in children with autism. Nutritional Neuroscience, 2004, 7(3):151-161.
Please see Figure 5 in this manuscript showing how affinity-purified gliadin peptide antibody cross-reacted with milk proteins.
2. Alaedini A et al. Immune cross-reactivity in celiac disease: anti-gliadin antibodies bind to neuronal synapsin I. J Immunol, 2007; 178:6590-6595.
3. Kristjánsson G et al. Mucosal reactivity to cow’s milk in coeliac disease. Clin Exp Immunol, 2007; 147: 449-455.
From this article’s abstract: “Ten of these 20 patients showed a similarly strong inflammatory reaction to cow’s milk (CM) challenge. Six of the CM sensitive patients were challenged with specific CM proteins: casein and alpha-lactalbumin. Casein, in contrast to alpha-lactalbumin, induced an inflammatory response similar to that produced by cow’s milk. A mucosal inflammatory response similar to that elicited by gluten was produced by CM protein in about 50% of the patients with coeliac disease. Casein, in particular, seems to be involved in this reaction…In conclusion, our data raise the possibility that sensitivity to cow’s milk may be a feature in a proportion of patients with CD and may therefore contribute to persistent symptoms in coeliac patients who are on a gluten-free diet.
4. Ellis HJ et al. Coeliac disease: characterization of monoclonal antibodies raised against a synthetic peptide corresponding to amino acid residues 206-217 of a gliadin. Gut, 1992; 33: 1504-1507.
Article’s conclusion: Monoclonal antibody made against alpha-gliadin 206-217 reacted moderately with casein and many other antigens.
5. Bonds R et al. A structural basis for food allergy: the role of cross-reactivity. Curr Opinion Aller Immun, 2008; 8:82-86.
6. Zoller-Utz IM et al. Natural hidden autoantibodies to tissue transglutaminase cross-react with fibrinogen. J Clin Immunol, 2010; 30(2):204-212.
7. Lehrer SB et al. Corn Allergens: IgE antibody reactivity and cross-reactivity with rice, soy, and peanut. Int Arch Allergy Immunol, 1999; 118:298-299.
8. Cabrera-Chávez F and Calderón M. Bovine milk intolerance in celiac disease is related to IgA reactivity to a- and b-caseins. Nutrition, 2009; 25(6):715-716.
9. Nazni P et al. Impact of casein and gluten free dietary intervention on selected autistic children. Iran J Pediatr, 2008; 18(3):244-250.
10. Rossignol DA. Novel and emerging treatments for autism spectrum disorders: a systematic review. Annals Clin Psychiatry, 2009; 2(14):213-236.

Q: Do you have any references from medical literature showing that measuring tTG or anti-gliadin in the IgM component has any clinical value?

Based on the references below, and many more, it is logical to measure IgA plus IgM antibodies in saliva in order to avoid the reporting of false negative results for an individual with IgA deficiency. If the patient is IgA deficient, s/he will get false negative results by measuring IgA alone. For decades immunologists have accepted that when the patient is IgA deficient, s/he will compensate for the lack of IgA by producing more IgM when the mucosa is challenged (Coelho, Czerkinsky, Norhagen, Stiehm). Thus, Cyrex always assesses IgA + IgM combined in its salivary antibody screenings. Studies show that measuring IgA anti-gliadin and tTG are excellent biomarkers, with highly significant sensitivity and specificity for the early detection of gluten-sensitivity and the early stages of possible celiac disease in the genetically susceptible individual (Bonamico and multiple studies reviewed by Pastore). Cyrex Laboratories measures IgM along with the IgA for greater sensitivity.

REFERENCES
1. A quote from the textbook “Mucosal Immunology”
Mayer, Lloyd. Immunodeficiency and mucosal immunity: an overview. Chapter 63 in the textbook Mucosal Immunology, edited by Mestecky, LAMM; Strober, Bienenstock, McGhee and Mayer. Elsevier Academic Press. 2005.
Direct quote from page 1147 of the textbook:
Substitution of IgM or IgG isotypes for IgA
With regard to the biologic actions of S-IgA, a number of studies have been done in the last few decades to determine what effect the lack of this immunoglobulin has on people who are IgA-deficient. In IgA deficiency there is a paucity of IgA-secreting plasma cells in the submucosa of all secretory tissues, little or no S-IgA in mucosal fluids, and the substitution of IgM-secreting plasma cells for IgA-secreting cells in the intestinal tract (Brandtzaeg). The substitution of IgM for the IgA isotype may have a biologic role, although the data for this hypothesis are relatively meager. The colostrums of IgA-deficient subjects contains abundant amounts of IgM (Stiehm) and the saliva of IgA-deficient individuals does contain biologically active IgM antibody, such as secretory IgM to Streptococcus mutans (Arnold).
2. Arnold RR et al. Secretory IgM antibodies to Streptococcus mutans in subjects with selective IgA deficiency. Clin Immunol Immunopathol, 1977; 8:475-486.
3. Brandtzaeg P et al. The clinical condition of IgA deficient patients is related to the proportion of IgD and IgM producing cells in the nasal mucosa. Clin Excp Immunol, 1987; 67:626-636.
4. Fernandes FR et al. Compensatory levels of salivary IgM anti-Streptococcus mutans IgA-deficient patients. J Invest Allergol Clin Immunol, 1995; 5:151-155.
5. Cardinale F et al. Aberrations in titer and avidity of serum IgM and IgG antibodies to microbial and food antigens in IgA deficiency. Adv Exp Med, 1995; 371:713-716.
6. Norhagen GE et al. Immunoglobulin levels in saliva in individuals with selective IgA deficiency, Compensatory IgM secretion and its correlation with HLA and susceptibility in infections. J Clin Immunol, 1989; 9:279-286.
7. Coelho IM et al. Salivary immunoglobulins in a patient with IgA deficiency. Clin Exp Immunol, 1974; 18:685-699.
8. Czerkinsky C et al. IgA antibody-producing cells in peripheral blood after antigen ingestion: evidence for a common mucosal immune system in humans. Proc Natl Acad Sci, 1987; 84:2449-2453.
9. Stiehm ER et al (eds) Immunologic disorders in infants and children (5th edition). Philadelphia: Elsevier Saunders, 2004.
10. Pastore L et al. Orally based diagnostics of celiac disease: studies evaluating salivary AGA and anti-tTG as a means of screening for CD. J Dent Res, 2008; 87(12):1100-1107.
11. Bonamico M et al. First salivary screening of celiac disease by detection of anti-transglutaminase autoantibody radioimmunoassay in 5000 Italian primary schoolchildren. J Pediatr Gastroenterol Nutr, 2011; 52(1):17-20.

Q: Why doesn’t Cyrex offer genetic testing for celiac disease and gluten sensitivity?

The clinical application of genetic testing is specifically ruling out celiac disease in high-risk individuals. It is not appropriate for the broad-spectrum immune response against gluten. There is value in the genetic testing of the celiac genes (HLA typing for DQ2 (DQA1*05; DQB1*02) and DQ8 (DQA1*03; DQB1*0302), but it is not a first-tier test. There is a strong correlation with certain other conditions and celiac disease such as diabetes type 1, Down’s syndrome, a family history of celiac disease, Williams syndrome, etc. The genetic testing is required with these conditions if the celiac serology is negative. Even with negative celiac serology, a patient on the spectrum of gluten sensitivity may be positive to other gluten peptides (Array 3).

When negative for these genes, the patient’s likelihood of developing celiac disease is very small. But that patient may still be at risk for non-celiac gluten sensitivity. When positive for these genes, a patient’s risk of developing full-blown celiac disease is estimated to only be about 2%. These patients require ongoing monitoring of an immune reaction to the peptides of gluten.

Q: Quinoa has been shown to be a great alternative food for the gluten-sensitive patient. Why is it included on Array 4?

Cyrex does not claim that quinoa is “toxic” only that some people may be sensitive to it. Quinoa has also been shown to cross-react with rice, sunflower and amaranth. It is correct that quinoa is generally safe for celiac patients. But a small percentage may have sensitivity to quinoa or other food antigens. The purpose of the test is to see that any proposed replacement for gluten be safe and healthy for any individual.

REFERENCES
1. Astier C et al. First case report of anaphylaxis to quinoa, a novel food in France. Allergy, 2009; 64(5):819-820.
2. Jancurová M et al. Quinoa – a review. Czech J Food Sci, 2009; 27(2):71-79.
3. Aphalo P et al. Surface physicochemical properties of globulin-P amaranth protein. J Agric Food Chem, 2004; 52:616-622.

Q: How can coffee be cross-reactive to a gliadin protein?

It is established in scientific literature that coffee, like any seed, contains protein. The literature is also clear that amounts of coffee protein sufficient to activate the immune system transfer to the brewed product. The ability, for example, for coffee to cross-react with ragweed was demonstrated in 1981. It may take only micro-grams of antigen to challenge the immune system and create cross-reactivity.

Confusion has arisen regarding coffee’s protein content because the dietary facts panel on many coffee products list no protein content. While coffee may not be a significant source of nutritional dietary proteins, its actual protein content is quite significant immunologically. M.J. Arnaud of Nestle Research has written, “Protein content in roasted coffee amounts to about 10% when estimated by hydrolysis. During roasting some protein nitrogen is lost as a result of browning reactions between proteins and carbohydrates producing heterocyclic aroma volatiles. We can expect the ‘proteins’ to be extracted with water, and when ingested with coffee hydrolysed in the GI tract, giving free amino acids which are absorbed.”

REFERENCES
1. Becker GC et al. Tobacco, cocoa, coffee and ragweed: cross-reacting allergens that activate factor-XII-dependent pathways. Blood, 1981; 58:861-817.
2. Maraccini P et al. Update on coffee biochemical compounds, protein and gene expression during bean maturation and in other tissues. In: XIX Int Sci Collog Coffee, Trieste, CD-ROM:2001.
3. M. J. Arnaud, The Metabolism of Coffee Constituents. Nestle Research Center, Switzerland, Chapter 2, Page 35
4. Philippe Montavon,* Anne-France Mauron, and Eliane Duruz. “Changes in Green Coffee Protein Profiles during Roasting” Nestlé Research Centre, Nestec Ltd., Vers-chez-les-Blanc, P.O. Box 44, CH-1000 Lausanne 26, Switzerland. J. Agric. Food Chem., 2003, 51 (8), pp 2335–2343

Q: Are all 24 of the foods on Array 4 cross-reactive with gliadin?

Cyrex does not state that all 24 foods on the Gluten-Associated Cross-Reactive Foods and Foods Sensitivity panel are cross-reactive. As the title implies, some are sensitivities. In the research laboratory, Cyrex scientists worked with purified gliadin antigens to study cross-reactivity to other foods, human tissues and stealth organisms. The foods positive for cross-reactivity were included on this panel of tests. The additional foods were chosen due to their possibility of being newly introduced on a gluten-free diet. Humans develop their tolerance to foods when they are children. If one was not exposed to amaranth, for example, as a child and later goes on a gluten-free diet that person may develop a sensitivity to it. Amaranth is used in many gluten-free baked goods. So the gluten-free adult, who never ate amaranth before, will have extensive exposure to amaranth. Quinoa, as well, tends to be introduced later in life. For the gluten-free person who avoids oats due to their high rate of cross-contamination, looks for a good substitute, quinoa is often chosen for a hearty, hot breakfast. Sensitivities to newly-introduced foods must be identified and eliminated from the patient’s diet for the best chance of recovery. The Gluten-Associated Cross-Reactive Foods and Foods Sensitivity panel can rationally save time and energy for both clinicians and patients. Not doing this cross-reactivity and sensitivity test, a clinician may find himself solving the puzzle by long-term elimination diet and follow up (serology and clinical follow up for each food one at a time), which can take months even years to be elucidated. The assessment of food cross-reactivity is recommended not only for gluten-sensitive patients, but also for any patent with an autoimmune condition. By eliminating any known antigen that can trigger an immune system response, the patient has a better chance for recovery.

Q: If I do Array 4, the cross-reactive foods test, and something (or multiple things) comes back as reactive, then can I assume that I am gluten sensitive?

No. A positive result may represent a sensitivity response or gluten cross-reactivity. Therefore, one may not assume gluten sensitivity based on positive results. Confirming gluten sensitivity requires a direct method of testing. Furthermore, wheat is made up of more than the gliadin (gluten) proteins and peptides. Some patients are sensitive to other components of wheat, such as wheat germ agglutinin or gluteomorphin. These are not gliadin and therefore not technically gluten. These patients would be considered wheat sensitive. For these patients, the gluten-containing grains on Array 4 may not elicit an immune response.

Q: I tested positive for many of the foods on Array 4, but my Array 2 results were normal. What do I do?

It is unusual but not impossible for a patient to have multiple food sensitivities with an intact intestinal barrier.

Q: For the out-of-range items, what is the recommended procedure? Specifically, should these items be completely avoided for 6 months, 12 months, etc.? Should I re-test after a certain length of time, and then slowly reintroduce those foods if the re-test shows they are okay?

The cross-reactive foods must be avoided for life, just like wheat. If the patient is gluten sensitive, then the gluten-containing grains should also be avoided for life. Patients who test positive for all other foods can be slowly reintroduced to the foods on a rotation diet only after the gut has been healed. Retesting of Array 4 can take place a few months after the reintroduction has been implemented. If any of the foods are still positive, the patient should be instructed to avoid the food for life.

Q: Can a gluten-free patient who tests positive for dairy sensitivity on Array 4 consume whey?

No. Whey is a milk product.

Q: What kind of coffee is tested in Array 4?

The cross-reactivity of coffee identified with Array 4 is specific to instant coffee.

Q: What kind of yeast is tested?

A combination of brewer’s and baker’s yeasts are tested.

Q: What kind of rice is tested?

Regular white rice is tested.

Q: What kind of potato is tested?

White potato is tested.

Q: What kind of chocolate is tested, milk or semi-sweet?

The test is for milk chocolate.

Q: I don’t see sugar listed on Array 4, but sugar can be as reactive as dairy, right?

Sugar by itself is too small to elicit an immune response. However, if sugar combines with a protein to form a complex, the body could react to the complex. The number of possible complexes is nearly endless, and therefore, it is not part of the panel.

Q: Since Array 4 tests for Polish wheat, can I save money and do Array 4 instead of Array 3?

No, Array 4 does NOT test for multiple peptides of gluten.

Q: What is Polish wheat?

A form of wheat also called Kamut.

Q: My test results show a sensitivity to alpha gliadin 33, glutenin, prodynorphin, GAD 65, and transglutaminase. Even if these didn’t cross-react with rye or barley, I should not have them, correct?

Gluten-sensitive patients should abstain from all gluten-containing grains, whether or not the four gluten-containing grains on Array 4 result positive. You may not respond to those grains due to the fact that Cyrex is testing the whole grain molecule, which is made up of multiple proteins. The proportion of the gluten proteins may not be enough to elicit an immune reaction in all gluten-sensitive patients. However, if the patient consumes the grain, during the digestive process, the gluten proteins of rye, barley, spelt, and Polish wheat will likely cause an immune response.

Q: Why are gluten-containing grains included on Array 4 when it seems that these would always show a reaction, given they contain gluten?

These grains are included because they are often overlooked and are still consumed by patients on a gluten-free diet.

Q: Array 4 Are all the foods on Array 4 cross-reactive?

No. Some foods are included based on cross-reactivity in vitro (cow’s milk, casein, casomorphin, milk butyrophilin, American cheese, chocolate, milk, rye, barley, Polish wheat, spelt, yeast, oats and coffee). Therefore, they have the potential to cross-react based on an individual’s immune reactions. Other foods were not assessed for cross-reactivity but are included on the panel because they may cause food reactions in patients for whom such foods are often newly introduced when changing to the gluten-free diet.

Q: Array 3 Can a person test positive for one component of wheat, but negative for the whole kernel?

Yes. Wheat is made up of many proteins and peptides. The immune response to the whole kernel may be limited, even if a patient is very reactive to the smaller proteins and peptides, such as glutenin or gluteomorphin.

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

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 for such a person.

Q: What is the sensitivity and specificity of the Intestinal Antigenic Permeability Screen™? If a patient comes up completely negative on this test, would it be safe to assume that (s)he doesn’t have leaky gut, and further, that additional testing (Arrays 3 and 4) would not be necessary?

The sensitivity of the intestinal permeability to large molecules that are antigenic is believed to be greater than 80%. However, this test is not highly specific for gluten sensitivity, since positive results may also be caused by other factors, such as inflammatory bowel disease, gastritis, and others. Our scientific advisory board strongly believes that if the test is completely negative for all seven tested parameters, it is very unlikely for a person to have a leaky gut to macromolecules such as food antigens and bacterial toxins. If this test is completely negative, it is unlikely that Arrays 3 and 4 would be positive; however, this test is not designed to be a determinate of Arrays 3 and 4.

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?

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

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.

Intestinal permeability is a generic term related to the passage of various molecules—ranging from small inert solutes (normal) to large immune complexes (abnormal)—through the intestinal epithelial barrier. Intestinal permeability is not a bad thing. It is the mechanism by which we receive our nutrients into the body. The measurement of permeability in the clinical setting is complex and is highly dependent on the probes used and the underlying intestinal transit.

These two approaches offer very different perspectives/observations on intestinal tract functionality. It’s like apples and green beans. In a way, they cannot be compared.

One, Lactulose/Mannitol, is a marker of small-size access through the intestines and was originally designed as a marker of nutrient absorption; however, this test is not indicative of the status of macromolecular transport, does not reflect antigen handling by the gut, and does not identify an immune response. Indeed, studies have shown the lack of correlation between the permeation of inert sugars and the passage of macromolecules. To this extent, experimental studies involving the assessment of intestinal permeability using small inert molecules do not necessarily correlate with the uptake of larger dietary antigens.

The other, the Intestinal Antigenic Permeability Screen™, identifies an immune response indicating damage to the intestinal mucosal microstructures, including the epithelial cell network and the intercellular tight junctions. Measuring the continuity of the intestinal barrier is accomplished by identifying antibodies against the tight junction proteins (occludin and zonulin) and antibodies to the actomyosin network (a protein complex that regulates intestinal barrier function by maintaining the plasticity of tight junctions).

The increased permeability to antigenic macromolecules across the gut epithelium is identified in Array 2 by measuring an immune response to lipopolysaccharides, and this can have further effects on initiation and/or perpetuation of chronic, systemic inflammation. Thus, one value in identifying antigenic macromolecular permeability is that it acts as a biomarker to follow the success of a healthcare professional’s protocols in reducing a common contributor to systemic inflammation.

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

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.

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

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

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:
a. Immunosuppressant and corticosteroid drugs can reduce antibody production and cause false negative results.
b. Limited assessments on the effects of aspirin, acetaminophen, and antipsychotics on Arrays 1-4 have been performed. No noticeable effects were observed.
c. Inhalers can affect the results of Cyrex’s oral fluid testing (Array 1). Wait two weeks after completion of inhalant dosages before collecting the specimen.
d. 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.
e. A gluten-free diet can cause false negative results on gluten protein/peptide tests.
f. Certain conditions, such as ileal pouch surgery, may cause a false positive celiac serology.

Q: Will I need follow-up testing?

Identifying an elevated immune reaction is the purpose of Cyrex testing. The immune system can be “screaming” inside with very few outside symptoms. Calming down the immune system, by selected food choices and nutrition, is the marker of choice when measuring higher levels of health. Thus, client progress may be monitored by follow-up testing. This is typically recommended at 3- or 6-month intervals depending upon the severity of the case.

Q: What do I need to bring to my blood draw appointment?

• Your Cyrex Test Requisition and Instructions Form
• Your printed Appointment Confirmation
• The Blood Draw Kit and included UPS shipping label and envelope.
• After your blood draw, the lab will ship your test kit and Test Requisition form directly to Cyrex Labs.

NOTE: It is very important that you remember to bring all listed items with you for your blood draw appointment or you will not be able to conduct the test. The requisition is also proof that you have paid for your test.

Q: Can I order Cyrex tests internationally?

Cyrex testing is available in United Kingdom and Ireland through Regenerus Labs. TheDr.com is unable to fulfill test requests in the UK or Ireland. Please contact Regenerus Labs for more information.
• Website: www.regeneruslabs.com
• Email: info@regeneruslabs.com
• Telephone: +44 (0)333 9000 979

Q: I ate something before collecting my oral fluid. Should I rinse out the tube and recollect my specimen?

No. You will need to obtain a new collection kit. Do not rinse and reuse the collection tube. Please click here to contact us. [testing@thedr.com]

Q: The test kit came with saliva and blood collection tubes. Do I use them all?

There is one kit for all tests. If you did not order Array 1 or the SIgA, you can discard the saliva vial

Q: Can I get a refund or reimbursement of phlebotomy fees if I use a collection lab that is not part of Cyrex’s contracted services?

Out-of-network fees are your responsibility. Refunds or reimbursements are not provided when choosing to use an out-of-network lab service.

Q: Do I have to get my blood drawn at a Cyrex contracted draw center?

Cyrex serum specimens may be drawn by your medical doctor or at the lab location of your choice. You are responsible for any fees incurred when utilizing a non-Cyrex-contracted phlebotomy service provider. Phlebotomy and shipping instructions are provided in every collection kit.

Please note: Cyrex-contracted phlebotomy service providers do not perform collection on patients under the age of 16.

Can I ship my specimen on a Friday or Saturday?
In order for Cyrex to provide the best results, specimen shipments should be sent Monday through Thursday.

Q: Do I have to fast before my Cyrex test?

Sample collection instructions regarding fasting are included in each sample collection kit. Please read before collecting any samples. Oral fluid testing requires collection between 6:00 A.M. and 9:00 A.M., with no eating an hour prior and no drinking 30 minutes prior to collection. Blood testing has no fasting requirements or collection restrictions. We recommend doing a blood draw before 1:00 P.M. in order to accommodate shipping requirements.

Q: Can I order Cyrex tests for children under the age of 16?

Yes, however, there are some stipulations:
• You will have to arrange the blood draw for the pediatric patient.
• Cyrex does not accommodate pediatric blood draws.
• You may use any draw center of your choice. You are responsible for any additional fees.

Q: How long does it take to receive my results?

The average turnaround time for all Cyrex testing is 14 business days. We will email you the results the day we receive them from Cyrex Labs. If you do not receive your results after 21 business days, please contact us. [testing@thedr.com].

Q: I want to order a test for someone else. What do I do?

When checking out, complete the necessary information for the person who should receive the test. Your information goes in the billing section.

Q: What is the procedure to order tests?

1. Add the test to the cart then proceed with checkout.
2. The test kit(s) will be mailed to you.
3. You will receive your requisition form via email within 24 hours.
4. Print and place in the kit box prior to mailing it back to the lab (free return shipping is included with the kit).
5. Schedule your blood draw. Once you have received your requisition form via email and received your test kit via mail, you can schedule a blood draw for free at one of the Cyrex approved locations: [https://www.cyrexlabs.com/PayformyTest/tabid/126/Default.aspx]. You may also make an appointment with your medical doctor or call a local draw center to have your specimen drawn. You are responsible for any fees from a non-Cyrex approved lab. Cyrex Array 1 is saliva only and can be completed at home.

Q: I’ve read that in order to get accurate results for Arrays 1 and 3, gluten needs to have been consumed within the previous two weeks. I have been gluten free for more than a year. Will Array 1 or 3 results be accurate given that I have been gluten free for so long?

If your gluten-free lifestyle in the last year has been successful, a test for antibodies to peptides of gluten should come back negative. However, in clinical practice, over 60% of people on a gluten-free diet still will have antibodies to peptides of gluten. This critically important information could tell you that all of your effort in the last year has not been completely successful. This could be because of:
• Exposure to a hidden source(s) of gluten
• Cross-reactivity
• GI infection

If the test results come back within range, you have been successful and the results do not identify whether or not you are sensitive to gluten. You would need to do a gluten challenge for accurate results. Click here to learn why a gluten challenge is not recommended. [http://www.thedr.com/images/glutenchallenge.pdf]

Q: Where is Cyrex testing available?

Cyrex tesing is available in the United States (except for New York state), the United Kingdom and Ireland. In the United Kingdom and Ireland, it is available through Regenerus Labs. TheDr.com is unable to fulfill test requests in the UK or Ireland. Please contact Regenerus Labs for more information.
• Website: www.regeneruslabs.com
• Email: info@regeneruslabs.com
• Telephone: +44 (0)333 9000 979

Q: I am already on a gluten-free diet. Would the Cyrex Array #3 test still come back positive if I am sensitive to gluten?

A: Every Cyrex sample is analyzed twice, at no extra charge. If there is more than a 3% discrepancy between the two analyses, Cyrex will throw the sample out and carry out the analysis again. You can therefore be confident that your Cyrex test results are accurate.

When a gluten sensitive person goes gluten-free, the antibody production line does not turn off for a few weeks. Now, consider the way the body responds to being exposed to the measles virus. When you are vaccinated against measles you start to produce antibodies. Subsequently, after each exposure to measles you will produce antibodies for weeks. The lifespan of the antibodies themselves is 2-4 months. A person who is sensitive to gluten could have elevated antibodies for 3-6 months after each exposure.

With that in mind, 6 in 10 people who have been on a gluten-free diet for a year or more and then carry out Array #3 come back with elevated antibodies to peptides of gluten. This demonstrates that either a cross-reaction is taking place, or the person has been exposed to hidden gluten contamination. It would then be necessary to speak to your healthcare practitioner to determine which of these is taking place and to identify the next step.

What if a person was sensitive to gluten, had not been exposed to gluten at all for many months, and had no cross-reactivity? In this case it would be necessary to carry out a gluten challenge in order for the result to demonstrate sensitivity to gluten. This is NOT recommended. Please see this article to find out why.

The other marker we have to know whether a person is sensitive to gluten is the presence of DQ2 or DQ8, “the celiac genes”. The presence of DQ2 or DQ8 means that a person is sensitive to gluten, but we just don’t know whether they have lost tolerance to gluten yet. For some people with DQ2 or DQ8, a single exposure of gluten will be enough to trigger the production of antibodies. Others can consume gluten for many years before they finally “lose oral tolerance” (the straw that broke the camel’s back).

Q: Can I cancel my order?

There is a USD $50 processing fee for all cancelled tests. Shipping fees will not be refunded. You must cancel within 30 days of placing your order. There is no refund after 30 days. You must cancel prior to specimen collection.

Q: Does Medicare cover my tests?

No. TheDr.com is not contracted with any insurance companies.

Q: Will my healthcare provider receive a copy of my results?

We deal directly and confidentially with you. You will be able to print out your results and take them to your healthcare practitioner

Q: How do I check on the status of my test results?

General turnaround times range from 7 business days up to 14 business days for more complicated tests. If you have been waiting for more than 21 business days, please contact us [testing@thedr.com] with the following information:
• Name of test recipient
• Name of Lab Company and Test
• Date of blood drawn or return kit shipment
• Name and location of the draw center

Q: How do I access my test results?

Test results are emailed to you as soon as we receive them. If you do not receive your results within 21 days of returning your sample, please contact us. [testing@thedr.com]

Q: Are my results confidential?

Absolutely. We respect your privacy and maintain your confidentiality. You are the only one who receives the results (email or fax). Not even your doctor or insurance company will obtain results.

Q: Can I order tests in my state or country?

Please see information provided for each laboratory company. Some tests cannot be collected in the state of NY or outside the USA. This restriction will be noted in the test description. If it is not noted, then the test can be collected in all states except New York.

Q: When will I receive my test kit?

You will receive your test kit(s) via mail 4-10 business days after your order. If you are located outside of the continental United States, it may take longer to receive your test kit.

• You will receive the requisition form(s) via email. Check the requisition form for errors. If asked, check the box(s) for “bill physician” (no signature is required).
• Take the test kit with you to an approved draw center or a draw center of your choice (fees may apply).
• Saliva and stool tests are completed at home.
• All kits come with free return shipping labels and packaging.

Q: When will I receive my results?

The results will be emailed to you the day we receive them. Most tests are reported quickly, however, some tests can take 2 weeks or more. If you do not receive your results within 21 days of returning your sample, please contact us. [testing@thedr.com]

Q: Do I need to see my healthcare provider to order testing?

We recommend that you request testing through your healthcare practitioner. If you do not have a healthcare practitioner who orders these tests, you can order the testing (if available in your area) through theDr.com. This testing service is provided for those who are currently unable to find a knowledgeable healthcare practitioner. We highly recommend that you find a healthcare practitioner in your area for ongoing care, advice and treatment.

Q: What should I do if I am ordering for multiple persons?

Please place a separate order for each person.

Q: What if I have questions about the results?

Questions regarding abnormal results should be discussed with your healthcare provider. If you are unable to find a healthcare practitioner, please consider:
• A Certified Gluten Practitioner in your area.
• A Functional Medicine practitioner in your area.
• Limited appointments are available for a Skype or phone consult with a healthcare practitioner at theDr.com.

Q: Is there a Certified Gluten Practitioner in my area?

Please click here to “Find A Certified Gluten Practitioner.” The CGPs shown on the map have been through a rigorous training process. They have attended in person, or via self-study, Dr. O’Bryan’s full-day educational workshop on gluten-related disorders and passed a challenging examination. Thus, they may be able to accurately recognize, test for, and differentiate between non-celiac gluten sensitivity and celiac disease. This is by no means an endorsement or recommendation of any specific healthcare practitioner or any specific healthcare practitioner’s treatment protocol or recommendations. You can also click here to schedule an appointment with a Functional Medicine Practitioner,  Limited appointments are available for a Skype or phone consult with a healthcare practitioner at theDr.com.

Q: Will I understand the results?

We recommend that you discuss your test results with a healthcare practitioner who has been trained and is knowledgeable about the testing and interpretation.

Q: What if I receive an abnormal result?

Abnormalities should be considered an early warning, but do not necessarily mean you have an illness or disease. We strongly recommend discussing your results with your healthcare provider for evaluation, further testing and diagnosis.

If you are unable to find a healthcare practitioner who is knowledgeable regarding your test results, please consider:
• A Certified Gluten Practitioner in your area. [http://tinyurl.com/find-a-cgp] • A Functional Medicine practitioner in your area [http://www.functionalmedicine.org/practitioner_search.aspx?id=117#results] • Limited appointments are available for a Skype or phone consult with a healthcare practitioner at theDr.com. [http://thedrcom.fullslate.com/]

Q: Is a test interpretation included with cost of the test?

No. We encourage you to go over your test results with your personal medical doctor or healthcare practitioner.

If this is not possible, please consider:
• A Certified Gluten Practitioner in your area. [http://tinyurl.com/find-a-cgp] • A Functional Medicine practitioner in your area [http://www.functionalmedicine.org/practitioner_search.aspx?id=117#results] • Limited appointments are available for a Skype or phone consultation with a healthcare practitioner at theDr.com. [http://thedrcom.fullslate.com/]

Q: Which test should I order?

We are unable to advise you as to which test(s) to order because we cannot make individual health recommendations. This is exactly why we offer a free service to the public to “Find A Certified Gluten Practitioner (CGP).” [ [http://tinyurl.com/find-a-cgp]

The CGPs shown on the map have been through a rigorous training process. They have attended in person, or via self-study, Dr. O’Bryan’s full-day educational workshop on gluten-related disorders and passed a challenging examination. Thus, they may be able to accurately recognize, test for, and differentiate between non-celiac gluten sensitivity and celiac disease. This is by no means an endorsement or recommendation of any specific healthcare practitioner or any specific healthcare practitioner’s treatment protocol or recommendations.

If you have a complex health concern, you may find it of value to locate a Functional Medicine practitioner in your area, who would be able to identify and treat what may be multiple causes of the symptoms you are experiencing. http://www.functionalmedicine.org/practitioner_search.aspx?id=117#results

Q: Are any of the tests reimbursed by insurance?

No. Testing ordered through theDr.com is not reimbursed by insurance.

Q: Can we diagnose celiac with just anti endomysial abs? Or do we need a biopsy to make the diagnosis?

A little more than a year ago there was approval of a diagnosis that includes EMA as part of the process. If EMA and TTG are both elevated +10x normal AND the genetic profile is present AND the patient experiences a positive response to a gluten-free diet the conclusion of active celiac disease can be made without the endoscopic biopsy.
A long time ago, when CD was recognized as a new disease, its diagnosis was exclusively based on the finding of villous atrophy during a small intestine biopsy. The most relevant feature of the disease was histological change, and histology became the gold standard for diagnosis.
Despite substantial changes in the mode of presentation and the availability of new diagnostic tools, small bowel mucosal biopsy has remained the gold standard for CD diagnosis until now…
There is a general agreement that the best strategy for CD serological screening is the detection of IgA tissue transglutaminase antibodies (tTGA). These antibodies are the most sensitive test for CD (up to 97%), whereas IgA Endomysium antibodies are employed as a confirmatory test in tTGA positive cases due to their higher specificity (about 100% versus 91% of tTGA). Cellular & Molecular Immunology (2011) 8, 96–102
With the advent of an accurate, quatatative serological test, the requirement for small bowel biopsy to establish the diagnosis of Cd in every case has been questioned. We have shown that a transglutaminase antibody level > 30 U⁄ mL, i.e. 10 x’s above upper limit of normal, gives a positive predictive value of 100% for CD. Aliment Pharmacol Ther 27, 572–577.

Within the endoscopy unit, a prebiopsy algorithm accomplished a rare milestone. The algorithm is simple—a positive serological test for IgA antibody to tTGA combined with being at high risk (defined as having weight loss, diarrhea, or anemia) achieved 100% sensitivity in CD detection. The rule identified every patient with the disease in a cohort of 2000 patients, all of whom underwent intestinal biopsy as the gold standard and the final diagnostic step. Thus, in the subset of patients presenting with weight loss, diarrhea, or anemia, this algorithm is of value.

Q: How important is it to see a Certified Gluten Practitioner?

We believe that it is very important to see someone who can help you understand and improve your health.

Studies have shown that the majority of persons with celiac disease had visited 5+ doctors prior to diagnosis, and it took between 5-10 years, after initial presentation, to receive that diagnosis. Unfortunately, most doctors and health practitioners have outdated training about gluten-related disorders, thereby lacking the current protocols to recognize, differentiate, accurately identify, test for and properly treat these conditions.

Certified Gluten Practitioners (CGPs) are knowledgeable about non-celiac gluten sensitivity and celiac disease, as they have been exposed to our certification course.

Q: What if I can’t get tested for gluten sensitivity or celiac disease?

I believe it’s important to determine whether gluten is an issue for you, so I hope you will find a way to get tested. If not, there’s nothing to stop you from trying a gluten-free and dairy-free diet (dairy also needs to be removed during this trial period because it is problematic for many people) for 3 weeks. If improvement in your symptoms occurs, then you have discovered that consuming gluten is detrimental to your health and, therefore, you shouldn’t consume it.

Q: I’m unable to access or afford testing from Cyrex Labs. What should I do?

If you’re unable to order the Cyrex Lab tests, I recommend that you remove both gluten and dairy (dairy should also be removed during this trial period because it is problematic for many people) from your diet for 3 weeks. To do this, review the ingredients in your food, cosmetics, bathroom items (especially toothpaste), medications and supplements, and remove them from your diet if they contain gluten. Then, listen to your body!

● Have your symptoms improved or disappeared?
● Do you feel any better in general?
● Does your health change when you reintroduce gluten and dairy after 3 weeks?

If you feel better on a gluten-free diet and worse when you consume gluten, this is a signal from your body that gluten is not good for you and should be avoided.

Q: I’ve received my blood test results. Can you tell me what they mean?

Unfortunately, it’s not as easy as it sounds! If you have elevated antibodies in your blood your immune system is trying to tell you something. Interpreting why they’re elevated depends on your history, symptoms, genetics and environment.

We suggest working with one of our Certified Gluten Practitioners (CGPs). Find your nearest CGP: http://tinyurl.com/find-a-cgphttp://www.thedr.com/index.php?option=com_locator&view=directory&layout=combined&Itemid=38

Q: How do I find a Certified Gluten Practitioner in my area?

You’ve come to the right place! Please use our “Find a Certified Gluten Practitioner” search engine at the following link on our website: http://tinyurl.com/find-a-cgp

http://tinyurl.com/find-a-cgp

The Certified Gluten Practitioners (CGPs) listed have been through our rigorous training and certification process by attending one of our educational workshops or engaging in a self-study review of our extensive program on gluten-related disorders. Certification and addition to our search engine is only given once each practitioner has passed our examination to prove that they can accurately recognize, test for and differentiate between non-celiac gluten sensitivity and celiac disease.

Please note, being listed in our search engine is by no means an endorsement or recommendation of any specific healthcare practitioner, practitioner’s treatment protocol or recommendations he or she may make.

Q: My tests came back positive for a gluten-related disorder even though I’m on a gluten-free diet. What does that mean?

The question you’ve asked the tests to answer is, “Am I sensitive to gluten?” A positive result tells us that your immune system is reacting to gluten exposure. If you’re not eating gluten, the reason for a positive result could include:

● Presence of hidden exposure to gluten
● Consumption of cross-reactive food(s)
● Presence of a cross-reactive virus or bacteria
● Poorly functioning GI Tract (consider having your medical professional order an Array #2-Intestinal Antigenic Permeability Screen from Cyrex Labs)
● An unknown cause, which could be refractory sprue

I recommend that you speak with your healthcare practitioner about all of the above, including the possibilities of digestive dysfunction, small intestinal bacterial overgrowth, dysbiosis, enzyme deficiencies and others possible disorders.

Q: I suspect that I have a gluten-related disorder. What should I do?

If you suspect that gluten could be making you sick, I suggest the following course of action:

1. Ask your physician to test you for celiac disease.
2. If the tests come back negative, get tested for non-celiac gluten sensitivity with the Cyrex Laboratories tests at http://www.cyrexlabs.com. Your physician, healthcare practitioner or a Certified Gluten Practitioner, who has been trained in identifying and testing for celiac disease/non-celiac gluten sensitivity, must order these tests and interpret the results for you.
3. If you can’t access or afford testing, consider trying both gluten-free and casein-free diets for 3 weeks. If you feel better you’ve discovered that gluten is contributing to your symptoms and should be kept out of your diet.

Locate a Certified Gluten Practitioner: http://tinyurl.com/find-a-cgphttp://www.thedr.com/index.php?option=com_locator&view=directory&layout=combined&Itemid=38
[TAGS: diagnosis, gluten, self-diagnosis, Cyrex, testing]

P: ¿Se puede diagnosticar a un celíaco con solo anticuerpos anti-endomisiales? ¿O se necesita una biopsia para hacer el diagnóstico?

 

R: Hace poco más de un año se aprobó un diagnóstico que incluye anticuerpos anti-endomisiales como parte del proceso. Si los anticuerpos anti-endomisiales y los anticuerpos anti-transglutaminasa tisular están ambos elevados más de 10 veces de lo normal Y el perfil genético está presente Y el paciente experimenta una respuesta positiva a una dieta libre de gluten, la conclusión de la enfermedad celíaca activa puede hacerse sin la biopsia endoscópica.

Hace mucho tiempo, cuando la EC fue reconocida como una enfermedad nueva, su diagnóstico se basaba exclusivamente en el hallazgo de atrofia de las vellosidades durante una biopsia del intestino delgado. La característica más relevante de la enfermedad fue el cambio histológico, y la histología se convirtió en el estándar de oro para el diagnóstico.

A pesar de los cambios significativos en la forma de presentación y la disponibilidad de nuevas herramientas de diagnóstico, la pequeña biopsia de la mucosa intestinal sigue siendo el estándar de oro para el diagnóstico de EC hasta ahora…

Hay un acuerdo general en que la mejor estrategia para la detección serológica de EC es la detección de anticuerpos IgA transglutaminasa en los tejios (tTGA). Estos anticuerpos son la prueba más sensible para la EC (hasta un 97%), mientras que los anticuerpos de endomisium son usados como una prueba de confirmacion en casos positivos de tTGA debido a su alta especificidad (cerca de 100% contra 91% de tTGA). Cellular & Molecular Immunology (2011) 8, 96–102.

Con el advenimiento de una prueba serológica exacta, cuantitativa, el requisito de una biopsia del intestino delgado para establecer el diagnóstico de EC en todos los casos ha sido cuestionado. Hemos demostrado que un nivel de anticuerpos transglutaminasa > 30 U⁄ mL, es decir, 10 veces por encima del limite normal, da un valor predictivo positivo de 100% para el EC. Aliment Pharmacol Ther 27, 572–577.

Dentro de la unidad de endoscopia, un algoritmo prebiopsia logró un hito poco frecuente. El algoritmo es simple: una prueba serológica positiva para anticuerpos IgA a tTGA combinado con ser de alto riesgo (que se define como tener pérdida de peso, diarrea, o anemia) alcanzó 100% de sensibilidad en la detección de EC. La regla identificó a todos los pacientes con la enfermedad en una cohorte de 2.000 pacientes, los cuales se sometieron a una biopsia intestinal como el estándar de oro y la etapa de diagnóstico definitiva. Por lo tanto, en el subconjunto de pacientes que se presentan con pérdida de peso, diarrea, o anemia, este algoritmo es de valor.

 

 

P: Tengo sensibilidad extrema al gluten. Nunca consumo gluten. Ni siquiera un poco porque me siento muy mal. Soy positivo para la mitad del gen DQ2. Quisiera saber, ¿es posible que sea celíaco?

R: El examen que puede ayudar es Array #3 de Cyrex Labs. Que tenga EC or no, no es tan importante como identificar si usted ES sensible al gluten. El lenguaje corporal nunca miente. Si su cuerpo reacciona al gluten, sea en el tracto gastrointestinal, en el cerebro, o en las mitocondrias (generando fatiga), si su cuerpo ESTA reaccionando, usted no puede consumir gluten.

 

P: El doctor de mi hija dice que ella tiene “el gen celíaco ”. ¿Eso quiere decir que ella tiene la enfermedad celíaca?

R: Cuando alguien tiene un gen DQ2 y/o DQ8, esto quiere decir que ellos tienen un riesgo incrementado de desarrollar un desorden relacionado con el gluten, no especificamente la enfermedad celíaca. Puede ser la enfermedad celíaca. O puede ser sensibilidad al gluten no celíaca. La persona tiene un riesgo incrementado de desarrollar la condición, pero tener el gen no significa que tenga la condición.

 

P: ¿Qué tan importante es consultar a un Profesional Certificado en el Gluten?

R: Creemos que es muy importante ver a alguien que puede ayudarle a entender y mejorar su salud.
Los estudios han demostrado que la mayoría de las personas que sufren de la enfermedad celíaca había visitado más de 5 médicos antes de obtener el diagnóstico; además, el diagnóstico tardó de 5 a 10 años en llegar (habiendo ya tenido los síntomas iniciales). Infortunadamente, la mayoría de los médicos y profesionales de la salud tienen una formación obsoleta con respecto a los trastornos relacionados con el gluten, razón por la cual no tienen los protocolos actuales para reconocer, diferenciar, identificar con precisión, realizar exámenes y tratar adecuadamente estas enfermedades.

Los Profesionales Certificados en el Gluten (CGP por sus siglas en inglés) conocen muy bien la sensibilidad al gluten no celíaca y la enfermedad celíaca, pues hicieron nuestro curso de certificación.

P: ¿Y si no puedo hacerme los exámenes para detectar la sensibilidad al gluten o la enfermedad celíaca?

R: Creo que es importante determinar si el gluten es un problema para usted, así que espero que pueda encontrar una manera de hacerse los exámenes. Ahora bien, si no puede hacerlo, no hay nada que le impida probar con una dieta sin gluten y sin lácteos (los lácteos también deben ser retirados durante este período de prueba porque pueden ser problemáticos para muchas personas) por 3 semanas. Si sus síntomas mejoran, entonces ha descubierto que el gluten perjudica su salud y, por lo tanto, no debe seguir consumiéndolo.

P: No tengo acceso o no puedo costearme los exámenes de Cyrex Labs. ¿Qué debo hacer?

R: Si no puede hacerse los exámenes, le recomiendo que retire el gluten y los lácteos (los lácteos también deben ser retirados durante este período de prueba porque pueden ser problemáticos para muchas personas) durante tres semanas. Para ello, revise los ingredientes de los alimentos, cosméticos, artículos de baño (en especial el dentífrico), medicamentos y suplementos que consume; si alguno de ellos contiene gluten, retírelo de su dieta. Y después de hacer eso, ¡escuche a su cuerpo!

  • ¿Sus síntomas mejoraron o desaparecieron?
  • ¿En general, se siente mejor?
  • ¿Nota algún cambio en su salud cuando vuelve a incorporar el gluten y los lácteos a su dieta después de las tres semanas?

Si usted se siente mejor con una dieta libre de gluten y peor cuando lo consume, es una señal que su cuerpo le está dando. Le está diciendo que el gluten no es bueno para usted y que debe evitarlo.

P: Ya me llegaron los resultados de mi examen de sangre. ¿Puede decirme qué significan?

R: Por desgracia, ¡no es tan fácil como parece! Si los niveles de anticuerpos en su sangre son elevados, esto significa que su sistema inmune está tratando de decirle algo, sin embargo, la interpretación de por qué están elevados depende de su historial, síntomas, características genéticas y del ambiente.

Le sugerimos que consulte con uno de nuestros Profesionales Certificados en el Gluten (PCG). Encuentre el Profesional Certificado en el Gluten más cercano.

P: ¿Me puede recomendar un profesional de la salud en mi región que pueda determinar si tengo la sensibilidad al gluten no celiaca?

R: Personas de todas partes del mundo nos escriben porque están buscando profesionales con un conocimiento profundo de la sensibilidad al gluten y la enfermedad celíaca.

Por eso ofrecemos un servicio gratuito para el público, ‘Encuentre un Profesional Certificado en el Gluten’, en nuestra página principal. Se puede limitar la búsqueda de acuerdo a su región.

Entre poco tiempo, theDr.com capacitará a Profesionales Certificados en el Gluten en muchos más países.

Los profesionales identificados en el mapa han pasado por una capacitación rigurosa. Asistieron en persona, o por medio del los DVD, a un día completo de talleres educativos del Dr. O’Bryan sobre los trastornos relacionados con el gluten. Todos los Profesionales Certificados en el Gluten tuvieron que ganar un examen exigente para poder aparecer como PCG en el sitio web http://www.theDr.com. Por lo tanto, deben saber identificar y diferenciar entre la sensibilidad al gluten no celíaca y la enfermedad celíaca. Esta no es una recomendación o promoción de ningún profesional de la salud específico, ni tampoco de sus protocolos o tratamientos. Lo que podemos decir, y con mucha seguridad, es que los PCG han recibido toda la información necesaria, y que han ganado el examen de certificación, y ahora son Profesionales Certificados en el Gluten (PCG).

P: Los exámenes para detectar un trastorno relacionado con el gluten me salieron positivos a pesar de que estoy haciendo una dieta sin gluten. ¿Qué significa eso?

R: La pregunta que usted le hace a los exámenes es: “¿Soy sensible al gluten?” y una respuesta positiva nos dice que su sistema inmune está reaccionando a la exposición al gluten. Ahora bien, si usted no está consumiendo gluten, la razón de un resultado positivo podría ser una de las siguientes:

  • Exposición al gluten oculto
  • Consumo de alimentos con reactividad cruzada
  • Reactividad cruzada con virus o bacterias
  • Mal funcionamiento del tracto gastrointestinal (considere la posibilidad de pedirle a su profesional de la salud que solicite Array #2 examen de permeabilidad antigénica intestinal de Cyrex Labs).
  • Una causa desconocida como por ejemplo enfermedad celíaca refractaria.

Le recomiendo que hable con su médico sobre todo lo anterior y sobre la posibilidad de que sea disfunción digestiva, sobrecrecimiento bacteriano en el intestino delgado, disbiosis, deficiencias enzimáticas, y otros posibles trastornos.

P: Sospecho que tengo un trastorno relacionado con el gluten. ¿Qué debo hacer?

R: Si usted sospecha que el gluten lo está enfermando, le sugiero lo siguiente:

1. Solicítele a su médico que le haga un examen para detectar enfermedad celíaca.
2. Si los exámenes para la celiaquía salen negativos, entonces hágase los que buscan la sensibilidad al gluten no celíaca. Estos exámenes son ofrecidos por Cyrex Laboratories. Su médico, profesional de la salud o un Profesional Certificado en el Gluten, quien estudió para identificar y hacer exámenes que detecten la enfermedad al gluten o la sensibilidad al gluten no celíaca, tiene que mandar a hacer estos exámenes y también debe interpretarlos para que usted pueda comprender los resultados.
3. Si usted no tiene acceso a los exámenes o no puede costearlos, considere probar con una dieta sin gluten y otra sin caseína por 3 semanas; si siente mejoría, entonces ha descubierto que el gluten contribuye a sus síntomas y por lo tanto debe mantenerlo fuera de su dieta.

Encuentre un Profesional Certificado en el Gluten en este sitio.

P: Tengo x síntomas, ¿cree usted que tengo x trastorno relacionado con el gluten?

R: Su salud es mi mayor preocupación, pero por favor entienda que no puedo hacer recomendaciones de salud particulares a través de Internet. Sin embargo, le recomiendo que busque a un profesional de la medicina funcional (ver más adelante), quien podrá investiga y tratar las causas de la dolencia que usted tenga en el momento, pues puede haber muchos factores involucrados.

Encuentre a un profesional de la medicina funcional en este sitio.

Además, si los exámenes de sangre que usted se haga para verificar si tiene enfermedad celíaca resultan negativos, pero usted sospecha que el gluten puede estar afectando su salud, es bueno que considere hacerse el examen de sensibilidad al gluten no celíaca mediante los exámenes de Cyrex Laboratories. Su médico, profesional de la salud o un Profesional Certificado en el Gluten, quien estudió para identificar y hacer exámenes que detecten la enfermedad al gluten o la sensibilidad al gluten no celíaca, tiene que mandar a hacer estos exámenes y también debe interpretarlos para que usted pueda comprender los resultados.

Encuentre un Profesional Certificado en el Gluten en este sitio.

Si usted no tiene acceso a los exámenes o si no puede costearlos, considere hacer la prueba con una dieta estricta sin gluten y sin lácteos (los lácteos también deben ser retirados durante este período de prueba porque pueden ser problemáticos para muchas personas) durante tres semanas y hágase un seguimiento: si siente mejoría, entonces ha descubierto que el gluten perjudica su salud y, por lo tanto, no debe seguir consumiéndolo.

Q: Is it necessary to fast prior to taking the Doctor’s Data Cardiovascular Risk Profile?

Yes. The Doctor’s Data Cardiovascular Risk Profile requires an overnight fasting prior to the morning blood draw. Avoid food for 8-10 hours before the blood draw. Only water is permitted during your fast.

Q: What are the instructions for the Doctor’s Data Comprehensive Stool Analysis with Parasitology x3 ?

Follow all directions included in the test kit. On day 3, you must induce diarrhea and collect a purged stool sample. Parasites live in the intestinal lining and not in the stool, so sampling only the last few inches of stool often misses them. Submitting a purged sample increases detection of parasites by forcing them out of the bowel lining. Purging involves drinking a laxative to induce diarrhea. Some laxatives may interfere with parasite morphology. Use one of the following products for inducing diarrhea.

• Fleets Phospho-Soda: Purchase from your local pharmacy. Speak to your pharmacist regarding dosage. If Fleets Phospho-Soda is unavailable, speak to a pharmacist about what product is recommended for a “purged stool sample”.
• Magnesium citrate: The product is called Natural Calm [http://www.calmnatural.com/natural-calm-16oz] and can be purchased online or at a Natural Foods Store.
o Take 30g of the Natural Calm powder. Stir it into water and drink.
o Take the night before collecting the day 3 sample, or in the morning on day 3, ½ – 1 hour before breakfast.

Important Instructions:
• You need a thorough bowel movement–it needs to run like water.
• Drink plenty of water.
• Do not use castor oil or salt water to induce diarrhea.
• Collect the first watery bowel movement once diarrhea has been induced. This provides a much better opportunity to test positive for these hard to find parasites.

Q: Are there additional shipping fees for Doctor’s Data testing?

There is a $55 shipping charge for mailing the test kit for international orders. Doctor’s Data provides prepaid shipping materials for use in shipping specimens from Australia, Canada, Ireland, United Kingdom, and the United States. If you are located outside of these countries or choose to use a different courier or level of service than provided, you must make your own shipping arrangements at your own expense.

Q: Are Doctor’s Data tests available internationally?

Doctor’s Data provides prepaid shipping materials for use in shipping specimens from Australia, Canada, Ireland, United Kingdom and the United States. If you are located outside of these countries or choose to use a different courier or level of service than provided, you must make your own shipping arrangements at your own expense. These tests are not available where prohibited by law (North Korea, Cuba, Iran, Russia or Ukraine.)

P: ¿Debo ayunar antes de tomar la prueba para al Perfil de Riesgo Cardiovascular de Doctor’s Data?

R: Si. El perfil de Riesgo Cardiovascular de Doctor’s Data requiere un ayuno durante la noche antes de la extracción de sangre por la mañana. Evite comer por 8 – 10 horas antes de la extracción de sangre. Solo agua es permitida durante su ayuno.

 

P: Instrucciones para el Análisis de Heces Integral (x 3 días) de Doctor’s Data

 

R: Siga todas las instrucciones incluidas en el kit de la prueba. En el día 3, se debe inducir diarrea y recolectar la muestra purgada. Los parásitos viven en el revestimiento intestinal y no en las heces, por lo que la muestra de sólo los últimos centímetros de heces a menudo no los incluye. Envío de una muestra purgada aumenta la detección de parásitos al forzarlos a salir del revestimiento del intestino. La purga consiste en tomar un laxante para inducir diarrea. Algunos laxantes pueden interferir con la morfología del parásito. Use uno de los siguientes productos para inducir la diarrea.

Fleets Phospho-Soda: Consígala en su farmacia local. Hable con su farmacéutico sobre la dosis. Si Fleets Phospho-Soda no está disponible, hable con un farmacéutico acerca de qué producto se recomienda para una “muestra de heces purgado”.

Citrato de magnesio: El producto se llama Natural Calm y puede ser comprado en línea o en una tienda de alimentos naturales.
Tome 30 gramos de Natural Calm en polvo. Revuelva en agua y bébalo.
Tómelo la noche antes de recoger la muestra del tercero día, o en la mañana del día 3, media hora antes del desayuno.

Instrucciones importantes:

Es necesario una evacuación intestinal a fondo – es necesario que fluya como el agua.
Tome abundante agua.
No utilice aceite de recino o agua salada para inducir diarrea.
Recoja la primera deposición acuosa una vez la diarrea se haya inducido. Esto proporciona una mejor oportunidad de un resultado positivo para estos parásitos difíciles de encontrar.

 

 

P: ¿Hay costos adicionales de envío para las pruebas de Doctor’s Data?

R: Hay un cargo de $55 para el envío del kit de prueba en los pedidos internacionales. Doctor’s Data proporciona los materiales de envío prepago para su uso en el envío de muestras de Australia, Canadá, Irlanda, Reino Unido y los Estados Unidos.. Si usted se encuentra fuera de estos países o elige utilizar un servicio de mensajería o nivel de servicio distinto al proporcionado, usted debe hacer sus propios arreglos de envío a su propio costo.

 

P: ¿Los exámenes de Doctor’s Data están disponibles internacionalmente?

R: Doctor’s Data proporciona los materiales de envío prepago para su uso en el envío de muestras de Australia, Canadá, Irlanda, Reino Unido y los Estados Unidos. Si usted se encuentra fuera de estos países o elige utilizar un servicio de mensajería o un nivel de servicio distinto al proporcionado, usted debe hacer sus propios arreglos de envío a su propio costo. Estos exámenes no están disponibles donde esté prohibido por la ley (Corea del Norte, Cuba, Irán, Rusia y Ucrania).

 

P: ¿Dónde puedo obtener la extracción de mi muestra ALCAT?

R: Hay múltiples opciones disponibles dependiendo de su ubicación geográfica. Póngase en contacto con el equipo de servicio al cliente de ALCAT para obtener más información.

 

 

P: Sé que tengo una alergia a un alimento. ¿Por qué es aceptado en mi lista de alimentos / la columna verde?

R: Esto es debido al hecho de que la prueba ALCAT detecta sensibilidades / intolerancias y NO alergias (reacciones IgE).

 

 

P: ¿Cuál es el procedimiento de envio para el examen ALCAT?

R: Las muestras deben ser enviadas a través de UPS / FEDEX el MISMO DIA que la sangre se extrae. Consulte con UPS / FEDEX las fechas de corte de entrega inmediata antes de la extracción de sangre.

 

 

P: ¿Qué significan los cajones azules en los resultados de la prueba ALCAT?

R: Las cajones azules incluyen elementos que deben ser eliminados de su dieta debido a las reacciones con otros elementos.

 

 

P: ¿Qué significan los asteriscos en los resultados de la prueba ALCAT?

R: El asterisco representa intolerancias leves.

 

 

P: ¿Es necesario ayunar antes de tomar la prueba ALCAT?

R: No.

 

P: ¿La prueba ALCAT es una prueba de sangre?

R: Si.

 

P: ¿Cuáles son las restricciones de medicamentos para la prueba ALCAT?

R: Por favor clic aquí para ver las restricciones de medicamentos.

 

 

 

P: ¿ALCAT es una prueba cubierta por el seguro médico?

 

Cell Science Systems no acepta/procesa seguros.

 

 

P: ¿La prueba ALCAT es una prueba de alergia a los alimentos?

R: La prueba ALCAT NO es una prueba de alergia a los alimentos (IgE). Está diseñada para poner a prueba intolerancias / sensibilidades que tienen una reacción retardada.

 

 

P: ¿Cuánto tiempo debo esperar para recibir los resultados de mi prueba ALCAT?

Los tiempos de respuesta generalmente van desde 7-14 días hábiles (o más tiempo para las pruebas más complejas). Si usted ha estado esperando por más de 21 días hábiles, por favor envíenos un correo electrónico a testing@thedr.com con la siguiente información:

- Nombre del destinatario de la prueba
- Nombre de la empresa de laboratorio y de la prueba
- Fecha de la extracción de sangre o la devolución del envío del kit
- Nombre y ubicación del centro de extracción

 

 

P: ¿Tengo que llenar cada tubo por completo?

R: Cada tubo debe estar lleno a su capacidad total. El no hacerlo puede requerir recolección.

 

P: ¿Debo llenar la información de facturación y área de la firma en el formulario que recibí?

R: Usted ya pagó por sus pruebas, entonces puede dejar cualquier sección de facturación en el formulario en blanco. Es posible que vea un espacio para la firma del médico. Ya hemos firmado electrónicamente la forma así que no hay necesidad de una firma física.

El resto de información necesita ser completado (nombre, dirección, hora de recogida de muestras, etc).

 

P: ¿Qué día debo enviar de regreso el kit de prueba?

R: Si la prueba(s) que usted está pidiendo requiere un kit de prueba, tendrá que enviarlo por correo al laboratorio. La etiqueta de envío de devolución y la bolsa están incluidos. Se sugiere enviar por correo el kit de nuevo el lunes o el martes con el fin de evitar retrasos de correo de fin de semana. No sugerimos que usted envie kits los viernes.

 

P: ¿Qué tipo de muestras se recogen para las pruebas de ALCAT?

R: La porción ALCAT es sangre entera y el Perfil de la Salud Intestinal (Gut Health Profile, o GHP) es ambos, la sangre entera y el suero. El GHP tiene 2 viales de tapa azul y 1 vial de tapa dorada mientras que el ALCAT solo tiene viales de tapa azul.

 

P: ¿Cómo programo una extracción de sangre?

R: Por favor visite https://www.alcat.com/alcattesting.php y seleccione la opción #3.

 

P: ¿ALCAT envía kits de prueba a nivel mundial?

R: Si.

 

P: ¿Dónde están disponibles los exámenes de Cyrex?

R: Los exámenes de Cyrex Labs están disponibles en los Estados Unidos (excepto en el estado de Nueva York), el Reino Unido e Irlanda. En el Reino Unido e Irlanda, están disponibles a través de los Regenerus Labs. TheDr.com no puede cumplir con las solicitudes de exámenes en el Reino Unido e Irlanda. Por favor contacte a los Regenerus Labs para más información.

Sitio web: www.regeneruslabs.com
Correo Electrónico:
info@regeneruslabs.com

Teléfono: +44 (0)333 9000 979

 

Q: What does an affiliate of The Gluten Summit do?

An affiliate of The Gluten Summit simply agrees to promote registration for the event to her or his network of peers and/or patients. In return, an affiliate will receive 50% from any of those attendees who purchase an archive of The Gluten Summit. There is no cost to become an affiliate.

Q: Will I be able to watch The Gluten Summit on a mobile device?

We’ve tested the viewing of the summit on multiple devices without issue. There may be a problem, however, if you choose to purchase any of the products that are associated with the summit, depending on your device. If that is the case, simply reach out to us and we’ll assist.

Q: What is the goal of the summit?

Dr. Tom O‘Bryan has made it part of his personal mission to move this question into today’s conversations between patients and healthcare professionals. Asking this question could, potentially, improve the lives of millions now instead of years from now, which is how long it often takes for groundbreaking research to make it to mainstream practice.

Q: Why should I buy the summit?

The Gluten Summit will:

Bring the latest research to the public eye with interpretation from Dr. O’Bryan;
Call more attention to gluten-related disorders;
Potentially improve diagnosis and treatment in practice;
Teach better practices for safely eating outside of the home;
Encourage more clinicians, practitioners and patients to ask, “Could it be gluten?”

Q: What is The Gluten Summit?

The Gluten Summit gathers the world’s experts and opinion leaders (scientists, researchers, and nutritionists)–those on the cutting edge of gluten-related disorders and what to do about them–each for a one-to-one conversation with Dr. Tom O’Bryan of theDr.com about celiac disease, food sensitivities, autoimmunity, nutrition and more.

Q: What conditions are related to gluten and gluten-related disorders?

In the words of Dr. Rodney Ford, a pediatric GI who started talking about gluten-related disorders in the mid-1990s, “Who should be concerned about gluten? Well, anyone who is sick. If you are sick, you should think about gluten!”
It would be silly to say that “all” conditions are associated with gluten, but it’s rational to say that any condition “may” be associated with a gluten-related disorder.
Watch this interview with Dr. O’Bryan that addresses this question. Locate a Certified Gluten Practitioner.

Q: Can eating gluten lead to skin issues?

Yes, dermatitis herpetiformis (DH) is one of 2 autoimmune diseases conclusively shown to be associated with gluten exposure (the other being celiac disease). DH is a skin condition that usually occurs on both elbows, knees and/or buttocks. Persons with DH do not always have digestive symptoms, but most have the intestinal damage similar to those with celiac disease.

If your skin is not recovering on a strict, gluten-free diet, you should consult a knowledgeable medical professional; there may be other triggers at play, such as cross-reactive foods, bacteria or viruses, small intestinal bacterial overgrowth, dysbiosis, etc.

Besides the well-known association between celiac disease and dermatitis herpetiformis (DH), there is also the association with other mucocutaneous diseases, both autoimmune, allergic, and inflammatory. The following study suggests patients should screen for celiac disease in patients affected by psoriasis, Alopecia Areata, Chronic Urticaria, Hereditary Angioneurotic Edema and Atopic Dermatitis, especially in cases resistant to first-line therapies. (See: “Celiac disease and dermatologic manifestations: many skin clue to unfold gluten-sensitive enteropathy,” Gastroenterol Res Pract. 2012;2012:952753)

In addition, 34.1% of psoriasis patients have elevated antibodies to alpha-gliadin (AGA) a peptide of wheat, and to transglutaminase. This study found a highly significant correlation between positive serum AGA and the duration of psoriasis. (See: “Estimation of (IgA) anti-gliadin, anti-endomysium and tissue transglutaminase in the serum of patients with psoriasis,” Clin Exp Dermatol. 2011 Apr;36(3):302-4)

“A number of skin disorders are seen in association with coeliac disease. Dermatitis herpetiformis is the most common but others include diseases such as alopecia, atopic eczema and vitiligo. There have also been reported cases of prurigo nodularis in association with coeliac.” (See: “Gluten-sensitive enteropathy associated with genital lichen simplex chronicus,” JRSM Short Rep. 2010 Oct 21;1(5):43, http://www.ncbi.nlm.nih.gov/pubmed/21103135.) http://www.ncbi.nlm.nih.gov/pubmed/?term=celiac+disease+and+dermatologic+presentations%3A+many+skin+clue+to+unfold+gluten-sensitive+enteropathy

Q: Can consuming gluten affect the body’s joints?

Aching joints in children and adults can be range anywhere on the spectrum from a mild overuse (that goes away in a few days) to severe arthritis (many joints hurt). In sensitive individuals, reversal of pain has been shown after switching to a strict, gluten-free diet.

“Blood tests for celiac disease should be performed in all patients with arthritis of unclear etiology (cause) since joint involvement could be (the only) presenting symptoms of CD. (See: “Silent celiac disease presenting with polyarthritis,” J Clin Rheumatol. 2010 Jun;16(4):195-6.)

“JIA children have an increased prevalence of autoimmune thyroiditis, subclinical hypothyroidism and coeliac disease. These data seem to suggest careful monitoring of thyroid function, thyroid autoantibodies and coeliac disease in JIA children.” (See: “Thyroid function, autoimmune thyroiditis and coeliac disease in juvenile idiopathic arthritis,” Rheumatology (2005) 44 (4): 517-520.

Q: I have , do you think I’m ?

Your health is my greatest concern, but please understand that I’m unable to make individual health recommendations over the internet. However, I do recommend that you seek a Functional Medicine practitioner (see below), who will be able to investigate and treat the causes of your current health condition, as there may be many factors involved.

Locate a Functional Medicine Practitioner

Furthermore, if your blood tests for celiac disease are negative but you suspect that gluten may be impacting your health, you should consider testing for non-celiac gluten sensitivity with the Cyrex Laboratories tests. Your physician, healthcare practitioner or a Certified Gluten Practitioner, who has been trained in identifying and testing for celiac disease/non-celiac gluten sensitivity, must order these tests and interpret the results for you.

Locate a Certified Gluten Practitioner

If you are unable to access or afford testing, consider experimenting with a strict, gluten-free and dairy-free diet (dairy also needs to be removed during this trial period because it is problematic for many people) for 3 weeks. Monitor your progress. If you feel better, then you’ve discovered that consuming gluten is detrimental to your health and, therefore, you should no longer consume it.

Q: What diseases can be caused by a gluten-related disorder?

The answer to this question is extremely extensive, as gluten-related disorders can manifest themselves in any tissue of the body. In my opinion, ANY person with an illness or autoimmune condition should be tested for a gluten-related disorder.

Q: Can gluten cause ?

It is now accepted that the toxic peptides of gluten found in wheat, rye and barley may detrimentally affect any tissue in the body, In other words, they are NOT restricted to the intestines. In fact, a 2002 article in “The Journal of Neurology, Neurosurgery and Psychiatry” stated, “That gluten sensitivity is regarded as principally a disease of the small bowel is a historical misconception“. The toxic peptides of gluten found in wheat, rye and barley may detrimentally affect ANY tissue in the body.

Whilst I am unable to comment on an any individual’s health condition, I do encourage you to investigate whether a gluten-related disorder could be a causal factor behind your condition or symptoms.

Q: What conditions are related to gluten and gluten-related disorders?

In the words of Dr. Rodney Ford, a pediatric GI who started talking about gluten-related disorders in the mid-1990s, “Who should be concerned about gluten? Well, anyone who is sick. If you are sick, you should think about gluten!”

It would be silly to say that “all” conditions are associated with gluten, but it’s rational to say that any condition “may” be associated with a gluten-related disorder.

Watch this interview with Dr. O’Bryan that addresses this question.

Locate a Certified Gluten Practitioner

Q: Is celiac disease genetic?

Celiac disease is genetic, but simply because you have the genes does not guarantee that you will have the disease. 1/3 of the U.S. population has the genes, but only a small percentage of those have the disease become active. Some European countries see an incidence of celiac disease in 2-5% of the population. In the U.S., at this time, 1 in 133, or ~1% of Americans have celiac disease. Your environment, genetics and health history are all factors in the presence, or lack thereof, of celiac disease.

“The single most important risk factor for celiac disease is having a first-degree relative [parent, child, sibling] with already-defined celiac disease, particularly a sibling. A rate up to 20% or more has been noted. Risk is even greater if a specific family has 2 siblings affected, particularly if a male carries the human leukocyte antigen-DQ2.” (See: “Risk factors in familial forms of celiac disease,” World Journal of Gastroenterology, April 21; 16(15): 1828-1831,

Q: My daughter’s doctor says she has “the celiac gene”. Does that mean she has celiac disease?

A: When someone carries a DQ2 or/and DQ8 gene, it means they carry the increased risk of developing a gluten-related disorder, not specifically celiac disease. It could be celiac disease. Or it could be non-celiac gluten sensitivity. The person carries an increased risk of developing the condition, but having the gene does not mean that they have the condition.

Q: Is it true that sensitivities and allergies are due to proteins getting into the blood stream due to leaky gut syndrome, and a leaky gut is caused by mycotoxins?

Yes and no. There are many causes for intestinal permeability, so it would be a stretch to say leaky gut syndrome is primarily caused by mycotoxins that attach to and perforate the gut lining. I haven’t seen a study to document that. Mycotoxins can cause intestinal permeability (and many other problems), but to say they are the primary cause for intestinal permeability is not supported in the literature. The two most common initiators of intestinal permeability are gluten and lipopolysaccharides (LPS). Gluten because it’s in our diet multiple times per day, every day, and LPS because it’s produced and resides in the intestines, so there’s a constant exposure to it (just like mycotoxins). Now, the exception to this is if a person has severe concentration of mycotoxin-producing fungi in the intestines. Then, for that person, mycotoxin could be the primary cause of their continuing intestinal permeability.

Whatever the trigger that’s producing the inflammation leading to intestinal permeability, the primary objective is to reduce the trigger. If it’s mycotoxin, then clean the gut and remove mycotoxin-laden food. If it’s gluten, then remove the gluten. In other words, stop throwing gasoline on the fire!

Q: Is Biocidin still a safe and recommended anti-bacterial (as part of a gut healing protocol)? Or is it better to use grapefruit extract instead?

A: Grapefruit seed extract is an excellent anti-bacterial in some cases, as are most anti-bacterials. In some cases. It’s pretty close to the top of the list as a single product protocol. The single-product protocol is the basis of pharmaceuticals (one condition-one drug).

Biocidin approaches bacterial and fungal parasites from a pleiotropic perspective (multiple approaches activating multiple genes to achieve a common result). It includes bilberry extract, noni, milk thistle, echinacea (purpurea & angustifolia), goldenseal, shiitake, white willow, garlic, grape seed extract, black walnut (hull and leaf), raspberry, fumitory, gentian, tea tree oil, galbanum oil, lavender oil, oregano oil. If you were to research any one of these ingredients, they read like grapefruit extract in the studies-multiple studies showing remarkable benefit. Biocidin product shows a remarkable broad spectrum of activity that can not be accomplished with a single product approach.This approach can be thought of as ‘All Roads Lead to Rome’ – all ingredients in this product address the one condition from many different avenues – no place for the bug to hide. Single products can not address all of the strains that may be present in a bacterial overload. Bacteria are like different types of dogs. For example, with probiotics-there are multiple strains of lactobacilli. One bacterial family-lactobaciili, multiple strains. One mammal-dog, multiple breeds. And you do not bring a chihuaua when you need a rottweiler. Single-herb products, grapefruit extract as an example, may not address all strains of an infection. that’s why you want a pleiotropic approach.

Biocidin addresses the biofilm that develops with chronic infestations – NIH tells us that this is why we’ve developed ‘drug-resistant microorganisms’. They’re protected by a ‘force-field’ that does not allow the anti-microbial (whether antibiotics or grape seed extract) getting to the bug.

There will always be someone who will benefit more from a single-compound approach to address microbes, but the vast majority of people, and I believe for the well-being of individuals across the spectrum, we are better served with a pleiotropic approach.

 

Q: I am sensitive to casein. Is it safe for me to include colostrum products in my healing protocol?

A: Everyone who is including colostrum in their healing protocol should remember that no mammal on the planet consumes colostrum for more than a few days. In nature, colostrum is a short-term food, and my clinical experience is that we shouldn’t take colostrum for more than a couple of months.

There is nothing as comprehensive for turning on the genes to heal the gut as colostrum, and there is such a great benefit to taking it for a short period of time. If a patient has consumed dairy for many years, and we have just discovered that she needs to remove dairy, I would explain to her that the benefits of colostrum are so significant that if she is able to use colostrum for 8 weeks without noticeable side-effects, then it is a clinical decision to take it. If the patient experiences any symptoms, she should discontinue use immediately.

I would make the same recommendation to a patient who had been dairy-free for some time. The incredible benefits of colostrum far outweigh any short-term antigenicity. As long as you do not experience any symptoms, taking colostrum for a couple of months provides enormous benefits.

Additionally, Dr. Keech’s colostrum contains the lowest concentration of casein of any colostrum on the market, and his manufacturing process is the strictest in the world.

 

Q: I have coeliac and my son has developed alopecia. He mentioned my diagnosis to his doctor who dismissed him telling him to grow his hair over his bald patch.. Surely the GP should be testing him for coeliacs?

A: In a recent questionnaire sent to 1,560 randomly selected members of the Swedish Society for Coeliacs, divided into equal-sized age- and sex strata, 2.3% reported alopecia. After implementing a GFD, 1.1% reported no change. All others reported no further symptoms of hair loss.
www.ncbi.nlm.nih.gov/pubmed…
And it appears the ‘type’ of alopecia also is associated with CD. Blood obtained through the National Alopecia Areata Registry of the United States from 16 AAT (transient), 24 AAP (patchy persistent), 27 AT (total scalp hair loss) and 32 AU (complete body hair loss) AA patients, were screened for CD using the traditional blood tests anti-tissue transglutaminase and anti-deamidated gliadin peptide IgA and IgG antibodies (anti-tTG/DGP).
Titers >20 IU were considered positive and titers >30 IU strongly positive and suggestive of CD. RESULTS. Of 99 samples (females=64, males=35), a total of 9 (9%) patients (all female) were positive for anti-tTG/DGP antibodies and 4% (2 AT, 1 AU and 1 AAP) were strongly positive.
By type of presentation, anti-tTG/DGP titers were elevated in 15% AT, 9% AU and 8% AAP patients but in none of AAT patients.
CONCLUSIONS. Our results suggest that AA patients have a higher prevalence of CD-associated antibodies (9%) than the general population (3%). CD seropositivity seems related to the more severe forms of AA since the transient form does not appear to have an elevated risk for CD
Poster Presentation at the 14th ICDS Conference
Hopefully this slightly more technical information will help your Dr understand your rationale

Q: I have extreme gluten sensitivity. I never eat gluten. Not one bite because it makes me so ill. I just tested positive for half the DQ2 gene. I just want to know is it possible I am celiac?

A: The test that will help is Cyrex Labs Array #3. Whether you have CD or not is not as important as identifying IF you are Gluten Sensitive. Body language never lies. IF your body reacts to gluten, whether in the GI tract, or the brain, or in the mitochondria (thus fatigue), IF your body is reacting, you can not eat gluten.

Q: Is it ok for a person with a gluten-related disorder to drink wheatgrass juice?

A: It is generally thought that the genes for gluten proteins are selectively expressed only in the endosperm of the wheat grain and not in the vegetative tissues. So long as no heads are formed on the young wheat, then the leaves should be OK. Once heads have formed and flowered, there is potential gluten protein synthesis going on. I think grass harvested before about 15-20 days after sprouting usually should be OK and not have any heading-out, but a visual inspection of the entire crop for heading is necessary.
Also, it is important if short-term sprouting is involved, that only the leaves should be taken. If there are any remnants of the grain that was sprouted left, there might still be some gluten protein or peptides remaining there.

Q: Is it safe for those with gluten-related disorders to eat einkorn?

A: No. If an individual has elevated antibodies to peptides of gluten, they cannot safely consume einkorn or other forms of ancient wheat.
In the Gluten Summit Dr. Fasano and I discussed whether it may be advantageous to introduce infants (who do not have gluten-related disorders) to ancient grains before modern grains.
Dr. O’Bryan: “If a parent is going to be introducing grains to a healthy infant, does the theory of using more ancient grains seem valid? Or would there be any risk in using more ancient grains?”
Dr Fasano: “I’m not aware of studies in which kids were introduced to ancient grains rather than modern grains to see if this will eventually be beneficial in protecting them against reaction to gluten…but I don’t think that there are any risks.
Now again, these ancient grains supposedly have a lower content of gluten. So the gluten load probably will be reduced. I don’t have any data that I’m aware of, at least to support the notion that this can be beneficial or not.
In theory, if we believe that the amount of gluten–not just the quality, but also the quantity of gluten–can drive a response that leads to a clinical situation like celiac disease or gluten sensitivity and food allergies, then it makes a lot of sense to use low gluten-containing grains.”
To learn more about the introduction of gluten into infants’ diets, plus the three mechanisms that contribute to autoimmunity, and why no human can digest gluten, you can access Dr. Fasano’s interview ‘Why Creating the Healthiest Intestinal Environment Possible Can Arrest Your Vulnerability to the #3 Cause of Getting Sick and Dying

Q: Is it safe for a person with non-celiac gluten sensitivity to receive a communion wafer once a week?

A: No. If tests have shown that a person has elevated antibodies to any peptide of gluten, the amount of gluten required to reactivate the immune system is miniscule.
This article from ‘Living Without‘ magazine provides some great practical alternatives for receiving the Eucharist while on a strict gluten-free diet.

Q: Can gluten can become airborne in the baking process and ingested when inhaled?

In sensitive individuals, several different water- and salt-soluble proteins from wheat grains, (most of these being plant defense proteins), can stimulate an immune response that can trigger respiratory problems (asthma, bronchitis, rhinitis, etc.) when inhaled.

“Baker’s asthma and rhinitis are among the most common occupational diseases. Inhaled cereal flours, such as wheat, especially cause this disease.” (See:“Thaumatin-like protein and baker’s respiratory allergy,” Annals of Allergy, Asthma & Immunology, Ann Allergy Asthma Immunol. 2010;104:139 –146.

Q: Does contain gluten?

Growing, harvesting, transporting and manufacturing varies product by product, flavor by flavor and country by country. Therefore, it is always advisable to check directly with the company about their products. More and more companies are posting ingredient information online, but if you cannot locate your answers there, please contact the company for more information.

Oats provide a classic example of this concern. When oats grow out of the ground, there are no toxic peptides of gluten in them. However, when you buy oats from the store they are frequently cross-contaminated (often at alarming levels) due to cross-contamination from harvesting, transporting or manufacturing, for instance. If oats are part of your gluten-free diet, make sure they are “certified gluten-free” oats.

Q: Should I replace gluten grains with non-gluten grains?

There is no universal answer to this question. First of all, we recommend that you determine whether gluten is an issue for you. Not all persons have a medical reason for eating gluten-free, and we believe a medical reason or ethical reason (prefer non-hybridized, non-GMO foods) should be present. Second, your body might also struggle with other grains and foods, including dairy. It is for these varied scenarios that we urge you to locate a medical professional who can help you make these decisions.

Hundreds of thousands of people are finding value in eating a grain-reduced or grain-free diet. But should you be attracted to this approach, you must be well-educated by a nutritionist, registered dietitian, or someone else who is familiar with this approach to ensure you are eating a healthy, well-balanced diet.

Locate a Certified Gluten Practitioner on our website.

Q: I’ve been eating a gluten-free diet, but my symptoms aren’t improving. What should I do?

In general, we recommend that persons who are struggling to achieve improved health on a gluten-free diet consider the following steps:

1. Make sure your diet is actually gluten-free. Gluten can be found in toothpaste, medications, vitamins, salad dressings and many other places.
2. If a gluten-free diet is confirmed, seek other reasons for your symptoms and/or tissue damage and follow the recommended medical advice for resolution. This should include speaking with your healthcare practitioner to consider digestive dysfunction, intestinal permeability, small intestinal bacterial overgrowth, dysbiosis, enzyme deficiencies, etc.
3. Identify whether cross-reactive foods (Cyrex Labs Array 4 Test), bacteria and viruses are impacting your health.

For all of these steps, we encourage you to work with a Certified Gluten Practitioner. Locate a Certified Gluten Practitioner nearest to you.

Q: Should I have another endoscopic biopsy to see whether my intestines have healed?

Symptomatic relief is no basis for rationalizing that healing has taken place. Therefore, a follow-up endoscopy after an initial positive endoscopic biopsy is used to ensure that healing has occurred on a gluten-free diet. There have been many cases of persons who had a positive biopsy, incurring symptom relief on a gluten-free diet, but who developed refractory sprue that was never identified because a follow-up endoscopy did not occur. The continued activation of celiac disease can lead to intestinal cancers and lymphoma, so it’s very important to know for sure that healing has occurred.

In the following study it was found that intestines normalized in only 48% of celiac patients on a gluten-free diet for a median of 9.7 years, even with patients having negative celiac antibodies (not detectable in blood work) and normal intestinal permeability. Meaning, biopsies (and intestinal permeability markers) may remain abnormal despite resolution of symptoms and apparent compliance to a gluten-free diet. Therefore, I believe that testing of intestinal permeability may offer important clinical information in the follow-up of patients with celiac disease even when symptoms have resolved. (See: “A comparison of antibody testing, permeability testing, and zonulin levels with small-bowel biopsy in celiac disease patients on a gluten-free diet,” Dig Dis Sci. 2010 Apr;55(4):1026-31.

Q: What bloodwork should persons with celiac disease or non-celiac gluten sensitivity have done annually?

Annual testing for those with a gluten-related disorder primarily exists to make sure that gluten isn’t somehow sneaking into your diet and triggering the immune system or manifesting itself in other bodily harm.

For those with celiac disease, I recommend the following annual tests (listed in order of priority):
1. Multiple Peptides of Gluten (Cyrex Labs Array #3)
2. Tissue Transglutaminase Antibodies (only sensitive with complete villous atrophy)
3. Endomysial Antibodies (only sensitive with complete villous atrophy)
4. Deamidated Gliadin Antibodies

For those with non-celiac gluten sensitivity, I recommend the following annual tests (listed in order of priority):
1. Multiple Peptides of Gluten (Cyrex Labs Array #3)
2. If the above is not available, then Anti-Gliadin antibodies (AGA), both IgG and IgA versions

P: ¿Es cierto que las sensibilidades y alergias son causadas por proteínas que entran en la sangre debido al síndrome de intestino permeable, el cual es causado por micotoxinas?

R: Sí y no. La permeabilidad intestinal tiene muchas causas, por lo que sería exagerado decir que el síndrome de intestino permeable se origina principalmente por las micotoxinas que se unen a la pared intestinal y la perforan. No he visto ningún estudio que documente eso. Las micotoxinas pueden causar permeabilidad intestinal (y muchos otros problemas), pero decir que son la causa principal de dicha dolencia es algo que no encuentra respaldo en la literatura. Los dos desencadenantes de la permeabilidad intestinal son el gluten y los lipopolisacáridos. El gluten es porque aparece todos los días en nuestra dieta, el LPS porque se reproduce y se queda en los intestinos, por lo que hay una exposición constante a él (al igual que a las micotoxinas). Ahora bien, la excepción a esto es cuando una persona tiene una concentración considerable de hongos que producen micotoxinas en los intestinos, pues en ese caso, la micotoxina podría ser la causa principal de su permeabilidad intestinal crónica.

Sin importar cuál sea el desencadenante de la inflamación que conlleva a la permeabilidad intestinal, el objetivo primario es reducir ese elemento desencadenante. Si se trata de micotoxinas, entonces hay que limpiar el intestino y eliminar los alimentos cargados de micotoxinas. Si se trata del gluten, entonces hay que suspenderlo. Dicho de otro modo: ¡deje de echarle gasolina al fuego!

P: ¿La enfermedad celíaca es genética?

R: La enfermedad celíaca es genética, pero tener los genes no garantiza que esta se vaya a manifestar. 1/3 de la población de EE.UU tiene los genes, pero solo un pequeño porcentaje de estas personas desarrollan la enfermedad. Algunos países europeos registran una incidencia de la enfermedad celíaca del 2 al 5% de la población. Actualmente en EE.UU., 1 de cada 133 (o ~1%) de los estadounidenses tienen la enfermedad celíaca. Su entorno, genética y antecedentes de salud son factores que desempeñan un papel determinado en la presencia o ausencia de la enfermedad celíaca.
“El factor de riesgo más importante para la enfermedad celíaca es tener un pariente de primer grado de consanguinidad (padre, hijo o hermano, en especial hermano) con la enfermedad celíaca claramente definida. De hecho, se ha observado un porcentaje de hasta 20%. El riesgo es incluso mayor si una familia tiene 2 hermanos afectados, en especial si un hombre tiene el antígeno leucocitario humano-DQ2″ (ver el texto citado en la revista World Journal of Gastroenterology “Risk factors in familial forms of celiac disease,” 2010 Abril 21; 16(15): 1828-1831.

P: ¿Está bien para una persona con trastornos relacionados con el gluten beber jugo de hierba de trigo?

R: Generalmente se considera que los genes para las proteinas del gluten son selectivamente expresados solo en el endosperma del grano de trigo y no en los tejidos vegetativos. Entonces mientras no se hayan formado espigas en el trigo joven, las hojas deberían estar bien. Una vez las espigas se hayan formado y florecido, hay probabilidades de que la síntesis de la proteina del gluten se esté llevando a cabo. Considero que las plantas cosechadas antes de aproximadamente 15 – 20 dias después de retoñar deberían estar bien y no tener ningún brote, pero una revisión visual en busca de espigas en todo el cultivo es necesaria.

De igual forma es importante, si hay brotes de corto plazo involucrados, que solo se tomen las hojas. Si hay algún residuo del grano que brotó, aún puede haber algo de la proteína del gluten o de péptidos restantes.

 

P: ¿Es seguro para aquellos con trastornos relacionados con el gluten comer trigos antiguos, como el trigo escaña cultivada (en inglés, einkorn)?

R: No. Si un individuo tiene anticuerpos elevados ante péptidos de gluten, ésta persona no puede consumir einkorn u otra forma de trigo antiguo de forma segura.

 

P: ¿Es seguro para una persona con sensibilidad al gluten no celíaca recibir la hostia de la comunión una vez a la semana?

R: No. Si los exámenes han mostrado que una persona tiene anticuerpos elevados ante cualquier péptido de gluten, la cantidad de gluten requerida para reactivar el sistema inmune es minúscula.

Este artículo tomado de la revista ‘Living Without’ nos proporciona algunas magníficas alternativas prácticas para recibir la Eucaristía estando en una estricta dieta libre de gluten. 

 

P: ¿Es posible que, durante el proceso de preparación en la panadería, el gluten se mezcle con el aire y sea entonces ingerido cuando alguien lo inhale?

R: Hay varias proteínas de los granos de trigo que son solubles al agua y a la sal y que, de ser inhalados, pueden estimular una respuesta inmune en individuos sensibles la cual puede a su vez desencadenar problemas respiratorios como asma, bronquitis y rinitis, entre otras.

“El asma del panadero y la rinitis se encuentran entre las enfermedades ocupacionales más comunes. de hecho, esta enfermedad puede ser causada especialmente por la inhalación de harinas de cereales como el trigo.” (Ver: Annals of Allergy, Asthma & Immunology, “Thaumatin-like protein and baker’s respiratory allergy,” Ann Allergy Asthma Immunol. 2010;104:139 –146.)

P: ¿El producto/ingrediente x contiene gluten?

R: El cultivo, la cosecha, el transporte y la fabricación varían para cada producto, sabor y país. Por esta razón siempre es aconsejable preguntarle a cada empresa por sus productos; pues cada vez es más común que las empresas publiquen información sobre los ingredientes que usan en Internet. Sin embargo, si no puede encontrarla, por favor contacte a la empresa para obtener más información.

Las avenas son un ejemplo clásico de esta preocupación: cuando crecen y salen de la tierra, no contienen ningún péptido tóxico de gluten; pero cuando uno las compra en el supermercado, con frecuencia hay contaminación cruzada (y a menudo los niveles de contaminación son alarmantes) originada en los procesos de cosecha, transporte o producción, por ejemplo. Si las avenas son parte de su dieta sin gluten, asegúrese de que esté certificado que son avenas verdaderamente libres de gluten.

P: ¿Debo reemplazar el grano con gluten con tipos de grano que no lo contengan?

R: No hay una respuesta definitiva para esta pregunta. Primero que todo, le recomendamos que determine si el gluten le está causando problemas. No todo el mundo tiene una razón médica para llevar una dieta sin gluten y nosotros creemos que debe existir una razón médica o ética (preferir alimentos no híbridos y no producidos por organismos modificados genéticamente). Además, es posible que a su cuerpo le cueste procesar otros granos y alimentos, incluyendo los lácteos. Por todo lo anterior le recomendamos encarecidamente que encuentre un profesional de la medicina que pueda ayudarle a tomar estas decisiones.

Cientos de miles de personas están viendo lo valioso que es tener una dieta reducida en grano o totalmente libre de este. Ahora bien, si usted está interesado en hacer esto, debe contar con una buena asesoría por parte de un nutricionista, dietista registrado o alguien que esté familiarizado con este enfoque para que así usted esté seguro de estar consumiendo una dieta saludable y bien balanceada.

Use nuestro sitio para encontrar un Profesional Certificado en el Gluten.

P: He estado llevando una dieta sin gluten, pero no hay mejoría. ¿Qué debo hacer?

R: En general, recomendamos seguir los siguientes pasos a las personas que están teniendo dificultades para lograr una mejoría en su salud con una dieta sin gluten:

1. Asegurarse de que su dieta esté verdaderamente libre de gluten, ya que este se puede encontrar en dentífricos, medicamentos, vitaminas, aderezos para ensaladas y en muchos otros lugares.

2. Si se confirma que su dieta es 100% libre de gluten, busque entonces otras razones para sus síntomas/daños en los tejidos y siga las recomendaciones médicas. Lo anterior incluye hablar con su médico para que este considere la posibilidad de que sea disfunción digestiva, permeabilidad intestinal, sobrecrecimiento bacteriano en el intestino delgado, disbiosis, deficiencias enzimáticas, etc.

3. Identifique si su salud está siendo afectada por comidas con reactividad cruzada (Cyrex Labs Array 4 Test), bacterias o virus.
Le recomendamos que siga todos estos pasos de la mano de un profesional certificado en el gluten. Puede encontrar el profesional más cercano usando nuestro sitio.

P: ¿Debo hacerme otra biopsia endoscópica para averiguar si mis intestinos ya sanaron?

R: El alivio sintomático no es razón válida para asumir que los intestinos ya sanaron. Por esa razón se utiliza una endoscopia de seguimiento después de una biopsia endoscópica positiva inicial para asegurar que los intestinos del paciente ya han sanado. Ha habido muchos casos de personas que obtuvieron resultados positivos en la biopsia y experimentaron un alivio sintomático al seguir una dieta sin gluten, pero luego desarrollaron enfermedad celíaca refractaria que nunca fue identificada porque no se realizó una endoscopia de seguimiento. La continua activación de la enfermedad celíaca puede causar cáncer intestinal y linfoma, por lo que es muy importante saber con certeza que los intestinos hayan sanado.

En el siguiente estudio se encontró que los intestinos se normalizan solo en el 48% de los pacientes celíacos que siguen una dieta sin gluten por una mediana de 9,7 años, incluso en el caso de los pacientes con anticuerpos celíacos negativos (es decir, que no se pueden detectar con los exámenes de sangre). Esto significa que las biopsias (y los marcadores de permeabilidad intestinal) pueden seguir siendo anormales aun cuando los síntomas hayan desaparecido y aparentemente se esté siguiendo una dieta sin gluten. Por lo tanto, considero que hacer exámenes para probar la permeabilidad intestinal puede proporcionar información clínica importante en el seguimiento de pacientes con enfermedad celíaca aun cuando los síntomas hayan desaparecido. (Ver: “A comparison of antibody testing, permeability testing, and zonulin levels with small-bowel biopsy in celiac disease patients on a gluten-free diet,” Dig Dis Sci. 2010 Apr; 55(4):1026-31.

P: ¿Cuáles son los análisis de sangre que las personas con enfermedad celíaca o sensibilidad al gluten no celíaca deben hacerse cada año?

Los exámenes anuales para las personas con un trastorno relacionado con el gluten existen principalmente para asegurarse de que el gluten no se esté colando de alguna manera en la dieta de estos individuos, activando así el sistema inmune o manifestándose en otras lesiones.

Para quienes padecen la enfermedad celíaca, recomiendo hacerse anualmente los siguientes exámenes: (la lista está en orden de prioridad):

1. Examen en busca de diferentes péptidos de gluten (Cyrex Labs Array #3)
2. Examen de anticuerpos de transglutaminasa tisular (el cual solo es preciso cuando se tiene atrofia vellositaria total)
3. Examen de anticuerpos endomisios (solo es sensible cuando se tiene atrofia vellositaria total)
4. Anticuerpos de gliadina desamidada

Para quienes tienen sensibilidad al gluten no celíaca, recomiendo hacerse anualmente los siguientes exámenes: (la lista está en orden de prioridad):
1. Examen en busca de diferentes péptidos de gluten (Cyrex Labs Array #3)
2. Si el anterior no está disponible, entonces se puede usar el examen de anticuerpos antigliadina (AGA), tanto la versión IgG como la IgA.

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