The Horticulturalist
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I just posted this on an IBS forum but wanted to post here too as I know that gluten is at least part of the problem for me, but not sure that it's the only problem. If anyone has similar symptoms I'd love to know, I can't find any stories online that sound like mine and am really at my wits end
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Almost 2yrs ago our family had a D&V illness that was doing the rounds that winter, I had diarrhea only, the others were all vomiting. We all recovered normally it seemed at the time. 3 months later in March 2010 I had a similar diarrhea episode that was so severe that I assumed it was food poisoning, I took immodium and it stopped within 1 - 2hrs. I had another 'episode' in May 2010, then again in August 2010. Following the August episode I started to have these episodes on average every week.
A typical diarrhea episode would start with me feeling hot, flushed and generally unwell about 30 mins before the diarrhea starts, I did not have a fever though. Once the diarrhea starts it would very quickly become watery and often foul smelling, like rotten fish. I would be very weak, shivering, teeth chattering and barely able to hold my head up. I usually would lie on the cold bathroom floor near to the toilet as I was too weak to move very far. At no time did I ever have abdominal pain or cramping. Within 1 to 1.5hrs of diarrhea starting the medication would start to become effective and the diarrhea would stop and I would go to bed. The severe episodes have *only* ever happened in the evening, almost always after my evening meal, only once I think it happened just before we sat down to eat.
Despite eating and drinking as normal the next day, I would be very weak and extremely fatigued, much more than I would expect after only an hour of diarrhea. I would usually spend most of the next day and the following day in bed and unable to do normal things around the house. I would be far too weak to attempt to drive. It takes days for me to feel fully back to normal. In between these episodes my bowel movements are totally normal, no diarrhea or constipation. I have lost weight, usually 1 - 2lbs after each episode of diarrhea. My weight 1 year ago was about 125lbs, It
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If someone knows the toll free hotline number can you please post it? I found a number on their website but I don't think that's it. thanks!
I called them, they returned my call in about 2 - 3 days. Most of the time it's an answering machine, but they do call back. I then emailed with the lady I talked to, she was very nice. The Dr did review the labs for me at the time.
I found them very helpful, can't say enough good things about them.
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Hello,
I will be having additional tests for Celiac and I'd like to go to a different lab. (First time was Santa Ynez Cottage.)
Is it true Quest Diagnostics is a good lab for these tests? Any other ones?
Thanks!
Sonja
Quest, LabCorp or Prometheus are all good. Prometheus is good is you are going for the genetic tests in addition to the celiac panel.
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Oh, please, please help. I had an EGI done in September that showed the cracked river bed appearance, scalloping, and the biopsy turned up atrophy of the villi. My GI then ordered the Prometheus genetic tests, which just came back negative. She called to tell me that I definitely DO NOT have Celiac Disease, just IBS with gluten intolerance. I asked her about the atrophy to the villi. She said a virus can cause it? She said it was good news because I could have a slice of cake if I wanted to. I told her that I baked a cake for my husband and ended up extremely nauseous, even though I didn't eat any. I was even diligent about washing my hands and the kitchen surfaces. I am very confused. She went on to say that she and the rest of the medical community agree that the genetic test is conclusive because it is 99.9% accurate. At the end of our 15 minute phone conversation, she said it was possible I was in that .1%. I am really confused. Where on earth do I go from here?
Did you have other celiac bloodwork done, and if yes what did it say? I would ask for a review of all your notes and biopsy slides from another gastroenterologist, preferably one more knowledgeable in the diagnosis of celiac disease, perhaps at one of the celiac centers.
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Thank you for all of these tips! I called U of C for DD's basket. She will be so excited to get a "gift" in the mail. I am now totally in love with the blog and can't wait to try some of the recipes (especially for goldfish crackers)! I am hoping to be able to do the Once a Month Mom cooking once we are a bit more settle in. Maybe a good thing to attempt when I am off over the holidays. It sure would make life simpler.
It's a big shift in thinking and planning that's for sure!!
My philosophy is that my son's Celiac diagnosis is infinitely preferable to a missed diagnosis and all the potential complications that can go with that.I've sent my husband off to Sam's Club today to get a bunch of food for my once a month cooking attempt, I'd better go get organised before he gets back!
There are a ton of gluten-free blogs out there, most blogs have links to other blogs so you could spend all day looking at them. Google 'a year of slow cooking', I was reading that blog for the year before I was gluten free and hadn't noticed that it was gluten free, you'll find lots of easy family friendly meals there.
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I posted our story about 2-3 weeks ago. Long story short, my 4-year-old son has had BM issues from the start; chronic diarrhea into chronic constipation, as well as a distended belly, eczema, mood swings and irritablity, and trouble sleeping. I forgot to mention in the first post that his pre-k teacher noticed he has motor strength weakness as well. Now, I have noticed in the last week that his eyes have been red, watery, and itchy, as in seasonal allergy symptoms, which he has never had up to this point.
I just received his test results in the mail that I requested. I am unsure how to read them, but they all seem to be negative. I will list them so I can get some assistance on what I am really looking at:
Antigliadin ABS, IGA ABN RESULT: 0.2 NRML RANGE: 0.0-10.0 U/mL
Antigliadin ABS, IGG ABN RESULT: 0.5 NRML RANGE: 0.0-10.0 U/mL
T-Transglutaminase IGA ABN RESULT: 1 NRML RANGE: 0-3 U/mL
States: Tissue Transglutaminase (tTG) has been identified as the endomysial antigen. Studies have demonstrated that endomysial IgA antibodies have over 99% specificity for gluten sensitive enteropathy.
T-Transglutaminase IGG ABN RESULT: 1 NRML RANGE: 0-5 U/mL
ENDOMYSIAL ANTIBODY IGA ABN RESULT: NEG NRML RANGE: NEG
IMMUNOGLOBULIN A L ABN RESULT: 16 NRMAL RANGE: 20-100 mg/dL
Please feel free to share your thoughts on what I am looking at. All comments are welcome!
Thank You!
Just a thought, but is it possible that the eczema could be dermatitis herpeteformis?
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I posted our story about 2-3 weeks ago. Long story short, my 4-year-old son has had BM issues from the start; chronic diarrhea into chronic constipation, as well as a distended belly, eczema, mood swings and irritablity, and trouble sleeping. I forgot to mention in the first post that his pre-k teacher noticed he has motor strength weakness as well. Now, I have noticed in the last week that his eyes have been red, watery, and itchy, as in seasonal allergy symptoms, which he has never had up to this point.
I just received his test results in the mail that I requested. I am unsure how to read them, but they all seem to be negative. I will list them so I can get some assistance on what I am really looking at:
Antigliadin ABS, IGA ABN RESULT: 0.2 NRML RANGE: 0.0-10.0 U/mL
Antigliadin ABS, IGG ABN RESULT: 0.5 NRML RANGE: 0.0-10.0 U/mL
T-Transglutaminase IGA ABN RESULT: 1 NRML RANGE: 0-3 U/mL
States: Tissue Transglutaminase (tTG) has been identified as the endomysial antigen. Studies have demonstrated that endomysial IgA antibodies have over 99% specificity for gluten sensitive enteropathy.
T-Transglutaminase IGG ABN RESULT: 1 NRML RANGE: 0-5 U/mL
ENDOMYSIAL ANTIBODY IGA ABN RESULT: NEG NRML RANGE: NEG
IMMUNOGLOBULIN A L ABN RESULT: 16 NRMAL RANGE: 20-100 mg/dL
Please feel free to share your thoughts on what I am looking at. All comments are welcome!
Thank You!
If I'm reading this correctly, it looks like he may be IGA deficient, the last test listed there looks like the normal range is 20 - 100 and his result is 16, am I reading that correctly?
Low IGA is not uncommon in celiacs, it would render the other tests potentially as false negatives.
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I just wanted to say hi. My daughter is 4.5 years old and received her biopsy results on Friday evening this past week so we are on day 4 of her gluten free diet. We are struggling through the first shopping trips and trying to get the school on board. I am trying to remain positive and matter-of-fact with her but on the inside I am sad. Don't get me wrong- I understand that this can be managed and could have been worse but life is hard enough. As a parent I think we all wish that our kids don't have any more struggles in life than they have too.
Same story here, just received biopsy results this morning for my son and he has celiac. I have been gluten free for a year so it's not too much of a challenge for me in terms of cooking, but it will require a good deal more organization on my part!
I have been in touch with the University of Chigago Celiac center, they have been so helpful and have some great resources. I have asked about getting their care package for my son, which is basically a basket of gluten-free goodies, see here: Open Original Shared Link If you are on Facebook 'like' their link here: Open Original Shared Link you can see a picture of a little girl on there getting her package.
Check out some of the gluten free blogs out there, I have found them to be an invaluable resource. Heidi has some great recipes and also some helpful info on dealing with schools, I'm sure if you contacted her she would point you to some resources she has used (you can also 'like' her page on facebook)Open Original Shared Link
I just signed up for Once a Month Mom, they have a gluten free and Dairy Free menu option and it's GREAT!! It's free, so definitely worth a look.
It IS overwhelming and takes a while to get used to the change, don't be too hard on yourself, you're doing great already!
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Previous thread here
We had the biopsy on Monday, it went well. the surgeon saw "patchy moderate erythematous mucosa without active bleeding in the duodenal bulb" He said it was highly suggestive of celiac, or as the report said "high likelihood of duodenitis."
He gave us a copy of the endoscopy report to take home, it had photos on it (which I will post if I can figure out how to do upload them) of the duodenal bulb, you could see the red patchy spots in that area, the duodenum beyond that looked normal, he biopsied that also.
Just had a phone call from the clinic and he has celiac, it was Marsh 3a.I have asked her to fax me the report so that I can see the details. They are also going to fax me an order for his brother to have celiac bloods checked, that will save me a trip to the pediatrician at least.
Very pleased with the care we received, thankfully very different to the debacle I had to endure.
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We are in Atlanta (came from MS) for consultation today with Dr Jeffrey Lewis of the Children's Center for Digestive Health in Atlanta, he was recommended by the Atlanta area celiac support group.
He was VERY thorough in going through all the details with me. He told me where they would take biopsies from, and he said that he had a very experienced pathologist who uses the Marsh criteria. We go in Monday for the endoscopy, we get the biopsy results back the following day so I will report back then.
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Well now I'm kind of confused.
My blood test showed a low positive. The biopsy came back positive for Celiac. The blood test they want to send me for is this:
PROMETHEUS
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Congrats on the diagnosis! There is so much associated with celiac and he probably wants to see where your vitamin counts and antibodies, all of that are at. My doc had me do a test for diabetes after I was diagnosed. Good thing is you are on the right track. Are you taking anything for the GERD. One thing I can say to keep in mind is do what it takes to heal your system. GERD really tears your stomach up.
Duhlina,
I missed that you got your test results back before I posted, glad that you have a definitive answer and can start to feel better. Consider cutting out or reducing your dairy if you continue to have symptoms, it can cause problems for many celiacs, especially in the first year.
I would ask them to test your Vit D levels, it seems that a high percentage of the general population is low for this anyway, but I think you'll feel better if you can get it up a bit. I got Bio-D-Mulsion Forte liquid VitD form Amazon as the tablets were huge and I had trouble swallowing them, this is just a tiny drop a day and it raised my levels from 26 - 36 which I think is just at the lower end of normal now. I'd also ask for B12 and ask them to check your iron levels, I just read this on the UofC Celiac Facebook page:
"The most common sign of celiac disease in adults is iron deficiency anemia that does not respond to iron therapy."
I didn't know that until yesterday, so I'd definitely add that blood test to the list.
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My blood tests were a "low positive". In other words the cut off to be positive for Celiac was like an 8 and I tested a 7. The gastro says I didn't test an 8, so I don't have it.
I don't know how many biopsies he did. I'm getting ready to call and see what the results were and will ask when I speak with them.
My son (7) had a weak positive about 6 weeks ago on the Ttg, it was repeated along with the EMA (which was +ve) a couple of weeks ago and it was positive this time, so don't let them fob you off with that one. You may not have celiac, but you could have it.
I recently went in to my Drs office and asked for copies of the biopsy results that I had a year ago and the doctors report from the colonoscopy. That was an enlightening experience because he did not mention celiac at all on the report or suggest it as a possibility to the pathologist, he also did not take any small bowel biopsies, only large bowel biopsies. I am now gluten free and so can't be tested, but I was told at the time I didn't have celiac so I went gluten free anyway, I didn't have enough knowledge at the time to realise that he should have taken small bowel biopsies and that the ideal test would really ought to have been an endoscopy.
So, if I were you I'd absolutely get copies of the tests. I would also consider seeing someone else if you feel that he has not been thorough before you start the gluten-free diet if you think you might repeat the test. The Open Original Shared Linkwill review your labs and test results for you I think if you fax email them,they looked at my sons labs recently for me and had their senior Dr review them.
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Have been gluten and dairy free for a year or so, tried lactose free but the GI symptoms were just the same.
Having been unable to find anything online about this I thought I'd ask here if anyone who was once casein intolerant in the past is now able to eat it, and how long did this take?
I can leave the gluten behind, but I'd love to think that I'd be able to enjoy cheese again in the future.
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These are from memory and while I think I have it all correct, I am not 100% sure, I may be off by a few points in either direction.
Original ttg (per the endocrinologist)- 148
GI Doc ttg- 152
GI Doc #2 ttg- 146
6 months gluten-free- 48
12 months gluten-free- 38
(For all this blood work, anything greater than 13 was considered POSITIVE)
So we are STILL not "normal" yet. His diet is VERY VERY VERY specialized. He does NOT EVER get food we don't provide. At school we have a strict NOTHING that doesn't come from home rule d/t his Celiac and server life threatening allergies. So after a ton more phone calls and theories, we got some gluten test strips. There were only 2-3 things he was eating that weren't either labeled gluten-free or I hadn't called to confirm they were gluten-free. So we tested his mustard (he used it 2-4 times a week I would guess) and found out it DID contain gluten. So we obviously pulled that from his diet.
The other thing we were wondering was if there was an issue at school. We were going to test him right before he went back to school but figured he was only out for 2 1/2 months and it was a really slim possibility that was the issue and he already gets SO MANY blood draws. So we will see again in December (6 months after his last GI appt) what he's at. If his levels STILL are not down, we are considering a trip to Baltimore to see Dr. Fassano cause if this isn't it, I am at a total loss!
HTH!
Out of interest,can you tell us what kind of mustard you were using?
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So sorry you've had to endure this with your son, I hope you get some answers soon!
Could you post the test results here along with the reference ranges? It could be celiac, but it could be a myriad of other things. I would encourage you not to go gluten free with him until you rule out celiac, he must be eating gluten to get an accurate endoscopy.
Which part of the country are you in? If you are near one of the celiac centers I would go there to be seen with him if possible.
I have been helped a lot by the University of Chicago Celiac Center, they have a number you can call for free advice, they will call you back if you leave a message. I told them my sons history, faxed them his lab results and that was reviewed by their Doctor. Though his bloods were inconclusive (first time, they are now +ve) their Doctor said he would do an endoscopy based on his symptoms alone, which were very mild and infrequent, other paed GI's I contacted were unwilling to do the scope without a +ve blood test.
Here's the link: Open Original Shared Link
They were so good in dealing with me we gave serious consideration to making the 13hr drive there for him to be seen by Dr Guandalini, I have since found a good Dr closer we are planning to see now.
Everyone's case is different. I have no family history of celiac, but I have an aunt and a 1st cousin on the same side of the family with Rheumatoid arthritis. My son has just had a +ve celiac panel, we're awaiting an endoscopy appointment for him.
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I was diagnosed with Celiac Disease 7 weeks ago today. I'm still working on the diet issues as I am an American living in Poland and working with food labels in a foreign language! It has been an adventure.
I'm mostly sticking to simple meals of chicken, turkey, cooked veggies, rice, potatoes, some fruits (bananas, pears, cooked apples)...100% apple juice and water, lots of water. Yogurt was making me feel bleh so I am not eating that any longer but I do occasionally have a small piece of hard Cheddar cheese. This seems to be helping as my pain issues have decreased, I am finally gaining weight back (lost more than 20+ pounds in less than 6 weeks which finally made the doctors think it wasn't all just in my head which was the previous diagnosis!) and my mental fog has cleared slightly. Still have fatigue but not as extreme as prior to starting the diet.
I have noticed some problems (mostly increased pain) when eating items that the doctors said I should: nuts, legumes (I picked through the dry beans and washed them thoroughly prior to cooking), corn, raw veggies, raw apples. After I eat them I start to feel miserable...I'm thinking perhaps my system is just not healed enough to handle digesting them at this point? Has anyone else had this experience?
I'm cleaned out my kitchen, replaced my pots and pan, am manic about wiping down surfaces and am washing my hands prior to prepping food or eating. I think the chance of cc is slight...
Does anyone have any ideas?
Babs, I had a very similar experience to you though I'll never know now if I have celiac as I had -ve bloods and my GI did a colonoscopy and only took large bowel biopsies, which is pretty useless for a small bowel disease! I cannot tolerate gluten at all (severe diarrhea, like food poisoning)and went gluten free after that test. One year on I have just discovered that my youngest son (7) has celiac, he has +ve bloods and we are waiting for endoscopy.
So, like you I have found that I cannot easily tolerate some foods in addition to the gluten, this is still an issue one year on. I stopped dairy as it gave me similar, though not nearly so severe, symptoms. I cannot easily digest lots of raw food,high fiber food. I tend to get reflux and or heartburn. I have the same issues with legumes, so I just don't bother with them any more. I have severly cut back on carbs and sugar and that helps a lot.
I have found white rice easy to digest, but I don't want to eat a lot of it. Also, I bought a juicer recently that juices whole unpeeled fruit and veg. Lots of my friends are into green smoothies, but I know that all that fibre would be a disaster for me, so the juice is much much better for me. The first time it did kind of clear me out though! I have one green juice a day and for the first time I have much more energy and feel much better than I have in a long time.
I've also been consciously trying to eat much much more fruits and vegetable in general, roasting them and so on, I'm sure that's helped too.
Can I make a suggestion? I know you are in Poland, but if you are able to give a call to the Celiac Hotline at the University of Chicago, they would be delighted to answer your questions. If you get the answering machine I suggest that you leave your email address as well as your phone number and they might be willing to correspond with you that way, or perhaps arrange a time that you could call when someone would be there to answer the phone. I can't say enough good things about them,they have been so helpful to me with my sons diagnosis.
Open Original Shared Link
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Kudos on double checking on this! One of those tests is very celiac specific - it's really good you caught it early.
One thing to know, now, although the center will likely tell you the same: you probably want to test everyone now. You and your spouse, and any other children. If one person is a celiac in the family, everyone 1 degree separate (parents, children, and siblings) jumps from 1 in 133 category to 1 in 22 category, in terms of having the disease. It's recommended to test everyone.
We did that and found out we didn't have 1, but 4 celiacs in the family, so I'm always pro-blood testing now when it pops up in the family.
We have one other son, and of course my husband to be tested. I'm sure the insurance company will not cover it until we have the definite diagnosis via endoscopy, so we'll pursue it after we get those results.
T.H. Just out of interest, how many of the celiacs in your family had significant symptoms?
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I'm reposting this from further down the page, I added it onto the end of another thread a few days ago but it seems to have been missed. Please read the short thread here first to get the backstory, thanks!
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Skylark and the rest of the forum, here is an update to the story above.
Short version, my son has long standing nut allergies, I decided to see an allergy Dr in a nearby town about it, really just for some advice.
While there I asked if he would repeat the Celiac panel and include EMA, DGP and repeat the others.Plus the genetic work.
He called my pediatrician who ordered the first lot (Ttg and IgA only - a weak +ve on the Ttg) and then he was very amenable to having his nurse order the bloodwork, he even got the book out with the order codes to make sure that they could get all the tests I wanted.
They sent them to Prometheus - is that regarded as a good lab, I figured it was? No reference range was given for the EMA, it just said "positive" under the results list and had "negative" under the reference range
Here are the results:
Summary Interpretation
Results support a diagnosis of celiac disease
Serological markers for celiac disease detected
RESULTS REFERENCE RANGE
Deamidated Gliadin Peptide Antibody, IgG (DGP IgG) 1.6EU/ml - <4.9EU/ml
Deamidated Gliadin Peptide Antibody IgA (DGP IgA) 2.6EU/ml - <2.6EU/ml
Anti-Human Tissue Tansglutaminase IgA ELISA (TTG IGA) 13.0U/ml + <10.3 U/ml
Anti-Endomysial IgA IFA (EMA) Positive +
Total Serum IGA by Nephelometry (TOTAL IgA) 173mg/dl
Celiac Risk Genes Detected:
DQ8 (HLA DQA1 *03 DQB1 *0302) and other non risk aleles
relative risk MODERATE (I have the same gene)
Still reeling a little from the this, trying to get through to UofChicago Celiac Hotline and speak to the lady there that helped me.
Folks, his symptoms were so mild to almost non existent that I really didn't think they would show up anything, in my head I was simply ruling it out.We have no family history of celiac, but on my father's side there are numerous relatives with general GI problems, one with bowel cancer and two with Rheumatoid Arthritis.
Any ideas on the sharp jump in only a matter of weeks between the two Ttg tests? Do you think the lab makes a difference? He had been eating gluten all the time, perhaps some weeks less than others though.
I am waiting to get an appointment with this group in Atlanta, perhaps as early as Friday next week. they came highly recommended from the R.O.C.K. group person that I emailed with.
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Yes, emdomysial is EMA. That's a good list of tests. Is your son still eating gluten for the tests to work?
Skylark and the rest of the forum, here is an update to the story above.
Short version, my son has long standing nut allergies, I decided to see an allergy Dr in a nearby town about it, really just for some advice.
While there I asked if he would repeat the Celiac panel and include EMA, DGP and repeat the others.Plus the genetic work.
He called my pediatrician who ordered the first lot (Ttg and IgA only - a weak +ve on the Ttg) and then he was very amenable to having his nurse order the bloodwork, he even got the book out with the order codes to make sure that they could get all the tests I wanted.
They sent them to Prometheus - is that regarded as a good lab, I figured it was? No reference range was given for the EMA, it just said "positive" under the results list and had "negative" under the reference range
Here are the results:
RESULTS REFERENCE RANGE
Deamidated Gliadin Peptide Antibody, IgG (DGP IgG) 1.6EU/ml - <4.9EU/ml
Deamidated Gliadin Peptide Antibody IgA (DGP IgA) 2.6EU/ml - <2.6EU/ml
Anti-Human Tissue Tansglutaminase IgA ELISA (TTG IGA) 13.0U/ml + <10.3 U/ml
Anti-Endomysial IgA IFA (EMA) Positive +
Total Serum IGA by Nephelometry (TOTAL IgA) 173mg/dl
Celiac Risk Genes Detected:
DQ8 (HLA DQA1 *03 DQB1 *0302) and other non risk aleles
relative risk MODERATE
Still reeling a little from the this, trying to get through to UofChicago Celiac Hotline and speak to the lady there that helped me.
Folks, his symptoms were so mild to almost non existent that I really didn't think they would show up anything. Any ideas on the sharp jump in only a matter of weeks between the two Ttg tests? Do you think the lab makes a difference? He had been eating gluten all the time, perhaps some weeks less than others though.
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Yes, emdomysial is EMA. That's a good list of tests. Is your son still eating gluten for the tests to work?
Yes, I have not modified his diet.
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Can you help me out with translating this list of blood tests please? In speaking to a Dr nearer to home, before they would consider an endoscopy they have requested that I ask my pediatrician to order this blood panel and the HLA DQ tests from LabCorp:
Deamidated Gliadin
Endomysial IgA Antibodies
Tissue Transglutaminase
Total IgA
I'm not sure what the 2nd one is, is that the EMA or something else? They asked for a repeat of the Ttg and the IGa as I previously had them done (through a different lab) with the old reference range.
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I think your doctor is barking up the wrong tree and ill informed.
Call the hotline at the Celiac Disease Center at the University of Chicago, if you get the answering machine you can leave a message and they will call you back within a few days, they are very, very helpful and will be able to give you a much clearer picture of what you should do next.
Open Original Shared Link
I would call your insurance company and see if you're covered to get testing for 1st degree relatives, I know my BCBS covers it, but yours may not. Again the UofC Celiac Center may be able to give you an idea of whether most insurance policies typically cover this.
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I Live in north Mississippi and am looking for a pediatric GI that has some experience diagnosing celiac. I found this group online and I wondered if any forum members had used them?
Open Original Shared Link
Thanks!
Bimonthly Episodes Of Very Severe Diarrhea
in Celiac Disease Pre-Diagnosis, Testing & Symptoms
Posted
I am going to go through everything again, contamination is in theory possible and I have replaced the cutting boards and so on a while back. I am getting rid of the last traces of gluten in the house as my youngest son was diagnosed with celiac last week. I've always been very careful, but this has forced me to look again. I've also decided to not eat anything anyone else has prepared so that I can know for sure whether cross contamination is causing this.
I have accidentally eaten small amounts of gluten a couple of times in the last year and immediately realised I had done it, but I did not get sick on those occasions, so it's hard to know what is going on.