Does this Antigliadin IgG antibody number indicate I've accidentally consumed gluten?

[Milo Milo]

I'm still awaiting an endoscopy next month due to a "positive" celiac panel back in March (221 Antigliadin IgG, no detectable total IgA)

They ran another celiac panel for me yesterday, 3 months later, and the number is now 171. Shouldn't it be far lower than that by now given the half life I'm seeing online? (21-24 days)

Does this suggest I've accidentally consumed gluten in the past 3 months or likely in the past few weeks I suppose?

Not part of the question but I start the gluten challenge for the endoscopy next week.

Thanks for any advice on interpreting this number!

[Scott Adams]

Can you include the positive value for this test: 221 Antigliadin IgG. 

It can take months or longer for the value to normalize after being 100% gluten-free, but for many people gluten can still seep into their diets. Do you eat outside your home, for example in restaurants? This can be a source of contamination.

 

[Milo Milo]

Hi Scott! Negative for this test is <15 u/ml

Generally I haven't been eating at restaurants however one thing that comes to mind is I did have a bowl of oatmeal at a hotel almost 3 weeks ago.  I also got scrambled eggs at a hotbar at a whole foods a few days. Perhaps there could have been cross contamination?

I assume the oatmeal wasn't gluten free because I don't know why the hotel would opt for gluten free oats.

My wife eats gluten still at home but I don't use the toaster anymore. The only risky item I've used is a sieve for rinsing rice/draining gluten-free pasta. I've read this can be risky.

I'm new to this. Could a tiny trace amount of gluten shoot those numbers up that high?

One of my GI's does not think I have celiac but my other thinks it's very possible and wants to rule it out via endoscopy. Having a GI who thinks I do not have celiac disease (this is because of the DNA HLA test.. one of my GIs considers it negative and the other considers it positive) resulting in me thinking it probably wasn't a big deal to eat that oatmeal and eggs from the hotbar while travelling. But maybe it was?

 

[Scott Adams]

Oats are often cross-contaminated, so it's possible you got some gluten at that point. Many people on this forum have reported that it has taken a year or even longer for their anti-body levels to normalize.

Did they do a tTG-IgA (tissue transglutaminase IgA) test? This is the most accurate for celiac disease.

This article might be helpful. It breaks down each type of test, and what a positive results means in terms of the probability that you might have celiac disease. One test that always needs to be done is the IgA Levels/Deficiency Test (often called "Total IGA") because some people are naturally IGA deficient, and if this is the case, then certain blood tests for celiac disease might be false-negative, and other types of tests need to be done to make an accurate diagnosis. The article includes the "Mayo Clinic Protocol," which is the best overall protocol for results to be ~98% accurate.

 

Quote

The sensitivity of the DGP-IgG test is reported to range from 75% to 85%, which means it can correctly identify individuals with the condition in about 75% to 85% of cases. The specificity of the DGP-IgG test is reported to range from 75% to 95%, which means it can correctly identify individuals without the condition in about 75% to 95% of cases. 

 

[Milo Milo]

They did test for tTG-IgA and it was undetectable (<1.0) but my total IgA was also undetectable (<5) and flagged as low. They stated that I have selective IgA deficiency.  There were 5 thing measured in total on the panel, tTG-IgA, total IgA, tTG-IgG (1.0, <15 is normal), Gliaden IgA, Gliaden IgG

Gliaden IgG was flagged as high, total IgA flagged as low, the other 3 normal/undetectable/negative.

My HLA test put me in the 1:210 probability bucket. That's the number that my GI's disagree about being positive/negative. I've decided to proceed with the endoscopy due to having the symptoms of celiac disease for 6 months now with no other explanation so far despite plenty of testing to rule out other explanations.

Another random thought... I had been eating a bunch of Cheerios a week or two ago. Like 6 bowls at a time to try to combat weight loss. So like 12 bowls a day each bowl probably being like 2 servings. Even though it's labelled gluten free maybe it adds up? I hadn't thought about that but I'm wondering if 1 serving is gluten free and 2+ is not?

[Milo Milo]

13 hours ago, Scott Adams said:

 

I'm actually shocked that these percentages are that high. I would have guessed more like 15% accuracy give or take based on the impressions I've gotten chatting with doctors and researching stuff. I suppose the chances that I have celiac disease are a lot higher than I thought. I'm looking forward to the results of this endoscopy though a bit scared of the gluten challenge which I will begin Monday.

[Scott Adams]

Oats naturally contain a protein called avenin, which is similar to the gluten proteins found in wheat, barley, and rye. While avenin is generally considered safe for most people with celiac disease, some individuals, around 5-10% of celiacs, may also have sensitivity to avenin, leading to symptoms similar to gluten exposure.

You may fall into this category, and eliminating them is the best way to figure this out. Some people substitute gluten-free quinoa flakes for oats if they want a hot cereal substitute.

If you are interested in summaries of scientific publications on the topic of oats and celiac disease, we have an entire category dedicated to it which is here:

https://www.celiac.com/celiac-disease/oats-and-celiac-disease-are-they-gluten-free/ 

 

[Scott Adams]

Here is more info about how to do a gluten challenge for a celiac disease blood panel, or for an endoscopy:

Quote

"...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."

• 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;

and this recent study recommends 4-6 slices of wheat bread per day:

 

 

[Milo Milo]

Wow, fascinating that some can't eat oats. Could that explain my current high DGP-IgG levels? Or does avenin not trigger DPG-IgG or something that looks like it? Or is that a separate test?

[Scott Adams]

Yes, for people with celiac disease who are also intolerant to oat avenin, eating gluten-free oats could potentially trigger higher antibody results for a deamidated gliadin peptide (DPG-IgG) test. In those who are sensitive to avenin, consuming oats can lead to an immune response similar to the response triggered by gluten. This immune response can result in elevated levels of antibodies, including deamidated gliadin peptide IgG (DPG-IgG). Therefore, if someone with celiac disease is also intolerant to oat avenin, consuming gluten-free oats could result in higher DPG-IgG antibody levels, misleadingly suggesting gluten exposure.