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  • Scott Adams
    Scott Adams

    What is a Gluten Challenge and How Long Must it Last?

    Reviewed and edited by a celiac disease expert.

    A Three Month Gluten Challenge May be Necessary, and the Length Can Differ Between Kids and Adults.

    What is a Gluten Challenge and How Long Must it Last? - A gluten challenge can be daunting to those with symptoms. Image: CC BY 2.0--2017 Canada Summer Games
    Caption: A gluten challenge can be daunting to those with symptoms. Image: CC BY 2.0--2017 Canada Summer Games

    Celiac.com 06/04/2020 - Currently, in order to properly diagnose celiac disease based on serology and duodenal histology, doctors need patients to be on gluten-containing diets, even if they are causing symptoms, and this is called a "gluten challenge." This is a problem for many people, especially those who have already given up gluten, and see benefits from the gluten-free diet. For those people, going back on gluten for several weeks can be demoralizing. For many, it's a deal breaker. This can present challenges for doctors attempting to diagnose celiac disease.

    According to the University of Chicago Celiac Disease Center, a gluten challenge should be done as follows:

    • Eat gluten prior to celiac disease blood tests: The amount and length of time can vary, but is somewhere between 2 slices of wheat bread daily for 6-8 weeks and 1/2 slice of wheat bread or 1 wheat cracker for 12 weeks 12 weeks;
    • Eat gluten prior to the endoscopic biopsy procedure: 2 slices of wheat bread daily for at least 2 weeks;

    A Three Month Gluten Challenge May be Necessary, and the Length Can Differ Between Kids and Adults

    Celiac.com Sponsor (A12):
    In a 2013 study by Maaike J. Bruins, of the DSM Biotechnology Center, The Netherlands, found that:

    Quote

    The onset of symptoms upon gluten intake varied largely from days to months and did not parallel serum antibody or histological changes. Within 3 months of gluten challenge, 70%–100% of pediatric CD patients became positive for AGA-IgA and EMA-IgA antibodies and 50%–70% for AGA-IgG. A limited number of trials suggest that no more than half of adult patients developed positive AGA-IgA, EMA-IgA, tTG-IgA or DGP-IgA/IgG titers. Approximately 50%–100% of pediatric and adult patients experienced mucosal relapse of gluten provocation within 3 months, which was preceded by increased mucosal intra-epithelial lymphocytes within several days of challenge. A 3-month high-dose gluten challenge should be suitable to diagnose the majority of CD patients. In some cases prolonged challenge may be needed to verify diagnosis. Combination testing for antibodies and mucosal histology may fasten the diagnosis.

    Future Tests May Spot Celiac Disease Without Prolonged Gluten Consumption

    Research on systemic cytokine release that occurs after gluten sensitive individuals ingest gluten may lead to new tests that can spot celiac disease without gluten consumption, however, until further research is done, and such tests are developed and made available, a gluten challenge will be necessary to make a formal celiac disease diagnosis.

     



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    thedarkvole

    M, 17. Testing after a ten day period gluten free. How many days will I have to eat gluten for for an accurate blood test?

    ( I plan on eating at least 2 slices of bread each day before the test.  )

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    Scott Adams

    For a blood test this article indicates 12 weeks, but there are other experts who say only 6-8 weeks.

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    trents
    4 minutes ago, thedarkvole said:

    M, 17. Testing after a ten day period gluten free. How many days will I have to eat gluten for for an accurate blood test?

    ( I plan on eating at least 2 slices of bread each day before the test.  )

    6-8 weeks of significant (1-2 slices of wheat bread of the equivalent) daily consumption of gluten before the test is the guideline.

    It is possible that if you have only been eating gluten-free for two weeks or less that there may be enough antibodies left in your blood to give a positive test if you are a celiac or gluten sensitive. I wouldn't count on it, however. Most likely the results would be borderline.

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    Peter Smith
    On 6/5/2020 at 6:28 PM, Guest Dru said:

    Is there any other disease or illness for which the "confirmed" diagnosis requires that the patient subject themselves to bodily harm, possibly irreversible?  Is there any other disease or illness that requires the patient to submit themselves to conditions that could be called torture in order to arrive at a "confirmed" diagnosis?  If you have positive blood tests, and have been helped by eliminating gluten, why should you have to endure this extra challenge to your entire body (not just your digestive system)?  I didn't and won't submit myself to these extraordinary requirements, just so my doctor can be satisfied with a "gold standard" diagnosis.  If you, yourself want that gold standard diagnosis, and don't mind the extra harm that will be inflicted on your body, then you should have the test.  In the meantime, I'm going to wait until a test is developed that doesn't require that I torture and damage my body by ingesting gluten.

    Damn Right !

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    plumbago
    On 6/5/2020 at 6:28 PM, Guest Dru said:

    If you, yourself want that gold standard diagnosis, and don't mind the extra harm that will be inflicted on your body,

    What is the "extra harm?"

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    Guest Irina

    I’ve been on a gluten diet my whole life, and I present some of the symptoms of celiac disease. My question is, the morning of the test should I eat (gluten) or not? Normally for blood work you go on an empty stomach. I cannot find this information anywhere on the whole www.

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    ravenwoodglass
    4 hours ago, Guest Irina said:

    I’ve been on a gluten diet my whole life, and I present some of the symptoms of celiac disease. My question is, the morning of the test should I eat (gluten) or not? Normally for blood work you go on an empty stomach. I cannot find this information anywhere on the whole www.

    As long as you haven't already gone gluten free whether you eat gluten that morning doesn't matter. The blood test isn't looking for 'gluten' in your blood. The test is looking for the antibodies that will be found if you are celiac. If you are having other blood work done at the time of the celiac panel just do as your doctor instructs. If you have already gone gluten free you will need to go back on gluten for 6 to 8 weeks before the blood screening to give the antibodies to build up to a detectable level.

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    Guest gluten and distillation

    Posted

    On 3/19/2021 at 8:38 AM, trents said:

    Hm! Never thought of alcohol based sanitizers as being a potential source of gluten. But it is something to be aware of for sensitive celiacs who feel they get glutened transdermally. Would depend on what grain it is made from. A lot of it is made from corn or wood.

    The distillation -process to produce alcohol does not allow gluten molecule to pass through.  The problem might be flavorings or other additives added after the distillation process. Pure grain alcohol does not contain gluten no matter what grain was used.

     

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    Guest Kymla Montgomery

    Posted

    I wonder does the dishes come right away out the next day after eating wheat products? Mine is north and sometimes if I think I’mok it’ll even cause me to have a severe accident on myself! Are these symptoms likely celiac? I’ve had the tests after stopping for a week so it said not celiac disease but am allergist told me I am allergic to wheat!

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    trents
    9 minutes ago, Guest Kymla Montgomery said:

    I wonder does the dishes come right away out the next day after eating wheat products? Mine is north and sometimes if I think I’mok it’ll even cause me to have a severe accident on myself! Are these symptoms likely celiac? I’ve had the tests after stopping for a week so it said not celiac disease but am allergist told me I am allergic to wheat!

    What? Kyma, please read your first two sentences. They don't make sense. Are you using translation software or speech to text software?

    You could also have NCGS (Non Celiac Gluten Sensitivity) which shares many of the same symptoms with celiac disease but cannot be tested for. celiac disease must first be ruled out. NCGS is 10x more common than celiac disease.

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    GardeningForHealth

    Very soon, there will finally be one or more medications that receive FDA approval for the treatment of Celiac Disease.

    However, for those of us such as myself who tested positive for the Celiac Panel, but never followed up with an endoscopy to confirm, we do not have a diagnosis of Celiac Disease. Therefore, we will not have access to these medications.

    In order to gain access to FDA-approved medications for the treatment of Celiac Disease, an official diagnosis of Celiac Disease will be required. This will require going on a gluten challenge. 

    However, how are folks like myself supposed to get through a gluten challenge if we react violently, such as vomiting? The last time I ate a large amount of gluten was when a mexican chain restaurant served me a meal with a burrito that they claimed was made with a gluten-free tortilla, but that tortilla was actually whole wheat. Starting at about 1 hour and 40 mins later, I began vomiting. That vomiting lasted for the next 6 hours. 

    I cannot subject myself to that again, thus I am in a predicament. There is at least one medication (not yet available) for Celiac Disease that I am very interested in and want access to, when it becomes available. 

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    Scott Adams

    It's really hard to say when there will be a prescription treatment available for celiac disease. I've been saying that we're really close for over ten years now. A few attempts have already fizzled out in the later stages of FDA approval. I now think we're at least 5 years away, but I could be wrong.

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    Scott Adams was diagnosed with celiac disease in 1994, and, due to the nearly total lack of information available at that time, was forced to become an expert on the disease in order to recover. In 1995 he launched the site that later became Celiac.com to help as many people as possible with celiac disease get diagnosed so they can begin to live happy, healthy gluten-free lives.  He is co-author of the book Cereal Killers, and founder and publisher of the (formerly paper) newsletter Journal of Gluten Sensitivity. In 1998 he founded The Gluten-Free Mall which he sold in 2014. Celiac.com does not sell any products, and is 100% advertiser supported.


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