How many grams is there in one slice of wheat bread?

[Jack Common]

Hello!

I'm doing a gluten challenge now. I don't know how much bread to eat. There are 4-6 slices of bread a day suggested in most articles. But one slice of bread can be 25 grams or 40 grams. So when it's 25, six slices are just 150 grams. When it's 40 grams, six slices are 240 grams. The difference is huge in my opinion.

Can someone recommend the dosage?

[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:

 

 

[Jack Common]

Thank you for your answer.

Well, I'm going to eat at least 5 slices a day, each of them is 35 grams. I think I'll do blood tests again after four weeks. If the results are negative or not clear, I'll continue the challenge and repeat blood tests again after another four weeks.

[Scott Adams]

In case your tests turn out negative you may still want to try a gluten-free diet. Approximately 10x more people have non-celiac gluten sensitivity than have celiac disease, but there isn’t yet a test for NCGS. If your symptoms go away on a gluten-free diet it would likely signal NCGS.

[JA917]

On 12/5/2024 at 11:08 PM, Jack Common said:

Thank you for your answer.

Well, I'm going to eat at least 5 slices a day, each of them is 35 grams. I think I'll do blood tests again after four weeks. If the results are negative or not clear, I'll continue the challenge and repeat blood tests again after another four weeks.

If I'm not mistaken, you need to count by the grams of GLUTEN, not the gram weight of the bread.  So, instead of counting each slice of bread as 35 grams, it would be counted as 2 grams, so that's why the recommendation is 5 slices a day = 10 grams.  One of the moderators can correct me if I'm wrong on that!  

[Jack Common]

Hello!

I want to share my situation.

I had symptoms like some food intolerance, diarrhea, bloating, belching one year ago. I thought I could have celiac disease so I did the blood tests. The results were ambiguous for me so I saw the doctor and he said I needed to do tests to check whether I had any parasites as well. It turned out I had giardiasis. After treating it my symptoms didn't disappear immediately. And I decided to start a gluten free diet despite my doctor said I didn't have it. After some time symptoms disappeared but that time it wasn't unclear whether I'd had them because of eliminating gluten or that parasite. The symptoms for both are very similar. Giardiasis also damages the small intestine. The only way to check this was to start eating bread again as I thought.

Now about my results.

 

These are my first test results (almost a year ago) when I had symptoms:

The Tissue Transglutaminase IgA antibody - 0.5 U/ml (for the lab I did the tests 0.0 - 3.0 is normal)

The Tissue Transglutaminase IgG antibody - 6.6 U/ml (for the lab I did the tests 0.0 - 3.0 is normal)

Immunoglobulin A - 1.91 g/l (for the lab I did the tests 0.7 to 4 g/l is normal)

IgA Endomysial antibody (EMA) - < 1:10 titer (for the lab I did the tests < 1:10 titer is normal)

IgG Endomysial antibody (EMA) - < 1:10 titer (for the lab I did the tests < 1:10 titer is normal)

Deamidated gliadin peptide IgA - 0.3 U/ml (for the lab I did the tests 0.0 - 6.0 is normal)

Deamidated gliadin peptide IgG - 46.1 U/ml (for the lab I did the tests 0.0 - 6.0 is normal)

 

Then I didn't eat gluten for six months. Symptoms disappeared. And I started a gluten challenge.

Before the challenge I did some tests.

My results:

The Tissue Transglutaminase IgG antibody - 0.5 U/ml (for the lab I did the tests < 20 U/ml is normal))

Deamidated gliadin peptide IgG - 28 U/ml (for the lab I did the tests < 20 U/ml is normal)

 

During the challenge I ate 6 slices of wheat bread.

After the challenge my results are:

The Tissue Transglutaminase IgA antibody - 2.0 U/ml (for the lab I did the tests < 20 U/ml is normal)

The Tissue Transglutaminase IgG antibody - 2.0 U/ml (for the lab I did the tests < 20 U/ml is normal)

Immunoglobulin A - 1.31 g/l (for the lab I did the tests 0.7 to 4 g/l is normal)

Deamidated gliadin peptide IgA - 2.0 U/ml (for the lab I did the tests < 20 U/ml is normal)

Deamidated gliadin peptide IgG - 2.13 U/ml (for the lab I did the tests < 20 U/ml is normal)

 

To be sure I continued consuming gluten. I ate a lot each day. Two months after I did the tests again.

My results I got today are:

The Tissue Transglutaminase IgA antibody - 0.7 U/ml (for the lab I did the tests < 20 U/ml is normal)

Immunoglobulin A - 1.62 g/l (for the lab I did the tests 0.7 to 4 g/l is normal)

Deamidated gliadin peptide IgG - 25.6 U/ml (for the lab I did the tests < 20 U/ml is normal)

 

Nowadays I didn't have any symptoms except tiredness but I think it's just work. I think it was this parasite because two years ago, for example, and before I didn't have these symptoms and I always ate gluten food. But I'm still not sure especially because the Deamidated gliadin peptide IgG results are sometimes high.

What do you think?

@Scott Adams

[Scott Adams]

The first set of results show two positive results for celiac disease, so at the very least it looks like you could have it, or at the least NCGS.  

Approximately 10x more people have non-celiac gluten sensitivity than have celiac disease, but there isn’t yet a test for NCGS. If your symptoms go away on a gluten-free diet it would likely signal NCGS.

 

 

 

[Jack Common]

I don't have symptoms now. But this DGP IgG is high than normal. I read your article. Very nice by the way. Based on it I don't need to do DGP IgG because I don't have IgA deficiency. I did it first time because those days I didn't know the right procedure for blood tests so I did all.

What might you do if you was me? Just keep eating gluten and do tests again after some time? Biopsy is not available in my town.

I also read somewhere if a person has NCGS he doesn't have any blood tests high.

Very confusing situation.

[Scott Adams]

Your situation involves interpreting elevated Deamidated Gliadin Peptide (DGP) IgG levels, which can indeed be confusing without clear symptoms or additional diagnostic tools like a biopsy. Here’s a possible approach to help clarify your next steps:

Understanding DGP IgG: DGP IgG is a blood test often used to help diagnose celiac disease, particularly in individuals with IgA deficiency. However, since you’ve confirmed you don’t have IgA deficiency, the focus should shift to other celiac-specific tests, such as tissue transglutaminase IgA (tTG-IgA) and endomysial antibodies (EMA-IgA), which are more specific for celiac disease. Elevated DGP IgG alone is not diagnostic of celiac disease but may indicate gluten-related immune activity.

Non-Celiac Gluten Sensitivity (NCGS): You’re correct that NCGS does not typically show abnormalities in blood tests like celiac disease does. NCGS is diagnosed based on symptoms (e.g., bloating, fatigue, brain fog) that improve on a gluten-free diet, after celiac disease and wheat allergy have been ruled out. Since you don’t currently have symptoms, NCGS seems less likely in your case.

Possible Next Steps:

Monitor Symptoms: If you remain asymptomatic, it’s reasonable to continue eating gluten and retest after some time. This is because celiac disease can develop or become symptomatic later, and ongoing gluten consumption is necessary for accurate testing.

Repeat Testing: Consider repeating the tTG-IgA test, as it is the most sensitive and specific for celiac disease. If this is also elevated, it strengthens the case for further investigation.

Genetic Testing: If available, HLA-DQ2 and HLA-DQ8 genetic testing can help rule out celiac disease if negative, as nearly all celiac patients carry one or both of these genes. However, a positive result doesn’t confirm celiac disease, as these genes are common in the general population.

Dietary Trial: If testing remains inconclusive and you develop symptoms, a supervised gluten-free diet trial might provide clarity. However, this should only be done after thorough testing, as going gluten-free prematurely can interfere with accurate diagnosis.

Biopsy Limitation: Since a biopsy is not available in your town, you’ll need to rely on blood tests and clinical judgment. If your tests remain inconclusive but you develop symptoms, you may need to travel to a facility that can perform a biopsy for definitive diagnosis.

In summary, if I were in your position, I would continue consuming gluten, monitor for symptoms, and retest with more specific celiac markers (tTG-IgA and EMA-IgA) in a few months. If symptoms develop or tests remain ambiguous, consulting a gastroenterologist for further guidance would be advisable. Always work with a healthcare provider to interpret results and tailor next steps to your specific situation.