General Testing Frequently Asked Questions (FAQs)

Q:  Are any of the tests reimbursed by insurance?

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

Q:  Which test should I order?

A:  We are unable to advise you as to which tests to order.  Please understand that we are unable to make individual health recommendations. You may wish to seek out a Functional Medicine practitioner in your area, who will be able to investigate and treat the causes of your current health condition, as there may be various factors involved.

We see requests from literally all over the world, for practitioners that have a comprehensive knowledge of gluten sensitivity and celiac disease.  This is exactly why we offer a free service to the public to ‘Find A Certified Gluten Practitioners (CGPs).  At this main site, you can narrow the search to your area.

The Practitioners identified 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.  They have passed a challenging examination, and only then can they be listed as Certified Gluten Practitioners (CGPs) on theDr.com website.  Thus, they should know how 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, any specific healthcare practitioner’s treatment protocol or recommendations.  What we can tell you, with much confidence, is that they have reviewed the requisite information, passed the certification test, and are now Certified Gluten Practitioners (CGPs).

If you have a complex health concern, you may find it of value to locate a Functional Medicine practitioner in their 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:  Is a test interpretation included with cost of the test?

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

If this is not possible, you can contact:

Q:  What if I receive an abnormal result?

A:  Abnormalities should be considered an early warning, but do not necessarily mean you have an illness or disease. We strongly recommend you discuss the 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, you can contact:

Q:  Will I be able to understand the results?

A:  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:   Is there a Healthcare Provider in my area?

A:  We see requests from literally all over the world, for practitioners that have a comprehensive knowledge of gluten sensitivity and celiac disease.  This is exactly why we offer a free service to the public to ‘Find A Certified Gluten Practitioner’.  At this main site, you can narrow the search to your area.

The Practitioners identified 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.  They have passed a challenging examination, and only then can they be listed as CGPs on theDr.com website.  Thus, they should know how 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, any specific healthcare practitioner’s treatment protocol or recommendations.  What we can tell you, with much confidence, is that they have reviewed the requisite information, passed the certification test, and are now Certified Gluten Practitioners (CGPs).

You can also 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.  This will be available shortly at theDr.com.

Q:  What if I have questions about the results?

A:  Questions regarding abnormal results should be discussed with your healthcare provider.  If you are unable to find a healthcare practitioner you can contact:

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

A:  Please place a separate order for each person.

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 healthcare practitioner knowledgeable about this testing.  We highly recommend that you find a healthcare practitioner in your area who can give you ongoing care, advice and treatment.

Q:  When will I receive my results?

A:  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 result within 21 days of returning your sample, please contact us.

Q:  When will I receive my test kit?

A:  After you order your test(s) online, you will receive your test kit(s) via mail 4-10 business days after your order.  If you are located outside 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:  Can I order tests in my state or country?

A:  Please see info provided for each laboratory company.  Some tests cannot be collected in the state of NY, NJ, MA, MD, CA, RI, 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:  Are my results confidential?

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

Q:  How do I access my test results?

A:  Test results are emailed to you.

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 email us 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:  Will my healthcare provider receive a copy of my results?

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

Q:  Does Medicare cover my tests?

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

Q:  Are my tests covered by my insurance?

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

Q:  Can I cancel my order?

A:  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 the specimen collection.

Q: How do you spell the probiotic, mentioned in the webinar, that some people should avoid and who should avoid it?

A: Saccharomyces boulardii needs to be avoided for anyone with Anti-Saccharomyces Cerevisiae Antibodies (ASCA). For anyone without ASCA antibodies. Saccharomyces boulardii can be very beneficial for issues like Clostridium difficile infection as well as other conditions.

Cyrex FAQs

Q:  Where is Cyrex Testing available?

A:  United States (except for New York State), United Kingdom and Ireland.

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.

Q:  Are Cyrex tests reimbursed by insurance?

A:  Cyrex Lab tests are not reimbursed by insurance. Cyrex Laboratories is not contracted with any insurance provider.

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?

A: There are two answers to give you.  The first answer specific to your question is that 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.  This is not recommended.  For more information, please read:

Link to http://www.thedr.com/images/glutenchallenge.pdf

Q:  What is the Ordering Procedure?

A:

  • Add the test to the cart then proceed with checkout.
  • The test kit(s) will be mailed to you.
  • You will receive your requisition form via email within 24 hours.
  • Print and place in the kit box prior to mailing it back to the lab (free return shipping is included with the kit).
  • 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;  schedule here: 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 any non Cyrex approved labs. Cyrex Array 1 is saliva only and can be completed at home.

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

A:  When checking out, complete the necessary information for the person you are ordering the test.  Your information goes in the billing section.

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

A:  The average turnaround time for all Cyrex testing is 14 business days. We will email you the results the day we received them from Cyrex Labs.

If you do not receive your results after 21 business days, please contact us.

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

A:  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 draw fees.

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

A:  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 one hour before and no drinking 30 minutes before 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: Do I have to get my blood drawn at a Cyrex contracted draw center?

A: Cyrex serum specimens may be drawn by your medical doctor or at the lab location of your choosing, it does not need to be at a Cyrex contracted facility. The patient is 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.

Q:  Can I ship my specimen on a Friday or Saturday?

A:  In order for Cyrex to provide the best results, specimen shipments should be sent Monday-Thursday.

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?

A: Out-of-network fees are the responsibility of the patient. Refunds or reimbursements are not provided when choosing to go out-of-network for lab services.

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

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

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

A:  No.  You will need to obtain a new collection kit. Do not rinse and reuse the collection tube.   Please contact us.

Q:  Can I order Cyrex tests internationally?

A:  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.

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

A:

  • 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:  Will I need follow-up testing?

A:  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 is monitored by follow-up repeat testing, which is typically recommended at 3- or 6-month intervals depending upon the severity of the case.

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

A: 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:

  • Immunosuppressant and corticosteroid drugs can reduce antibody production and cause false negative results.
  • Limited assessments on the effects of aspirin, acetaminophen, and antipsychotics on Arrays 1-4 have been performed. No noticeable effects were observed.
  • 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.
  • 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.
  • A gluten-free diet can cause false negative results on gluten protein/peptide tests.
  • Certain conditions, such as ileal pouch surgery, may cause a false positive celiac serology.

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

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

A: 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.

Array 1

Q:  If I have negative results on Array 1, does this mean I don’t have a gluten sensitivity?

A:  When negative results are obtained with Array 1, yet symptoms seem to be apparent, Array 3 is recommended as Array 3 is extremely sensitive and comprehensive, looking at many peptides of gluten, not just gliadin.

Array 2

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

A: 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: How long does it take to see reductions in the antibodies to the lipopolysaccharides, actomyosin, or occludin/zonulin after the gut barrier is restored?

A: 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: 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 he(s)he doesn’t have leaky gut, and further, that additional testing (Arrays 3 and 4) would not be necessary?

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

A: 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.

Array 3

Q: Can a person test positive against one of the components of wheat but be negative for a response to the whole kernel of wheat?

A: 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: I had Cyrex Array 3 testing done. The results showed I have five EQUIVOCALs and no OUT OF RANGE results. Does this mean that it is likely that I am not gluten intolerant?

A: As is the case in all markers of our bodies’ health, there is a scale of severity. For some people a ‘mild’ problem is a nuisance in the background, and for others a ‘mild’ problem is debilitating. EQUIVOCAL is one standard deviation out of range. OUT OF RANGE is two standard deviations out of range, but both are out of range. Any marker EQUIVOCAL or OUT OF RANGE can represent a gluten sensitivity or a gluten-related disorder.

Array 4

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

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

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

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?

A: 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:  What is Polish wheat?

A:  A form of wheat also called Kamut.

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

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

Q: I don’t see sugar listed on Array 4, but I have heard that sugar can be as reactive as dairy.

A: 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, we cannot add it to our panel.

Q: What kind of chocolate do you test, milk or semi-sweet?

A: Milk chocolate

Q: What kind of potato do you test?

A: White potato

Q: What kind of rice do you test?

A: Regular white rice

Q: What kind of yeast do you test?

A: A combination of brewer’s and baker’s yeasts

Q:  What kind of coffee is being tested on Array 4?

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

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

A: No. Whey is a milk product.

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?

A: 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: I tested positive for many of the foods on Array 4, but my Array 2 results were normal. Is this correct?

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

Q: If a 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?

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

A: As to cross-reactivity, a plethora of references have already been provided. Furthermore, 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 our research laboratory, our 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: How can coffee be cross-reactive to a gliadin protein?

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

A: Cyrex does not claim that quinoa is “toxic” only that some people may be sensitive to it. Some are (Astier, Jancurová). Quinoa is also shown to cross-react with rice, sunflower and amaranth (Aphalo). 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.

Additional Questions

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

A: 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.

The Science Behind the Tests

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

A: There are many publications that support the measurement of IgM, here are but a few:

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.

Based on the above references, 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, he(s)he will get false negative results by measuring IgA alone. For decades immunologists have accepted that when the patient is IgA deficient, he(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.

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?

A: Antibody 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.

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.

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).

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

A: 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.

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.

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

A: 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.

“Abstract from this article. 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.”

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?

A: 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 autoantibodies 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 any references from medical literature to support the testing done in Array 3?

A: 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 any references from medical literature that explain how opioids can come from food?

A: 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.

Doctor’s Data General Questions

Q:  Are Doctor’s Data tests available internationally?

A:  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.)

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

A:  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.

Data Comprehensive Stool Analysis with Parasitology x3 Instructions

Important – Please read and follow these instructions.

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 dosing.  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.
    • Take 30g of the Natural Calm powder.  Stir it into water and drink.
    • 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.

Doctor’s Data Cardiovascular Risk Profile

Q:  Should I fast before taking the test?

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

ALCAT

Q: Does ALCAT drop-ship test kits globally?

A: Yes

Q: How do I schedule a blood draw?

A: https://www.alcat.com/alcattesting.php

Select option #3

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

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

A:  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 or Saturdays.

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

A:  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:  Do I need to fill each tube completely?

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

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

A: General test result turnaround times, from the date on which ALCAT receives your sample, range from within 14 business days for orders from the United States to within 21 days business days for international orders. If you have been waiting for more than 21 business days, please email us hyperlink [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:  Is this a food allergy test?

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

Q:  Is the ALCAT test covered by insurance?

Cell Science Systems does not accept/file insurance.

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

Please click here to view medication restrictions:

https://www.alcat.com/pages/medication/

Q:  Is this a blood test?

A:  Yes

Q:  Is fasting required before taking the ALCAT Test?

A:  No

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

A:  An asterisk represents your mild intolerances.

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

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

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:  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:  Where do I have my ALCAT sample drawn?

A:  We have multiple options available depending on your geographic location. Contact our customer service team for information. https://www.alcat.com/contact.php

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