So my EnteroLab result was inconclusive, due to low IgA levels in my digestive tract. Even though my serum IgA was 136 (in a range of 44-441), my salivary and my fecal IgA are low. Salivary was 16, with a normal range of 25-60 on a DiagnosTechs test, while fecal was 4 with a range of 5-161. The fecal IgA was done 18 months ago, and I have tried to bring the level up since then.
What I want to discern / decide:
1) Can I use the EnteroLab result in some way?
2) Perhaps I have gliadin cross-reaction?
3) Should I design an elimination diet?
4) Or should I pursue other types of testing?
Here are the results:
Mean Value of 11 Antigenic Foods: 6 Units
Hierarchy of reactions (all 11 foods fell within the lowest category - no significant immunological reaction):
Corn
Oat
Rice
Beef
Chicken
Pork
Tuna
Almond
Walnut
Cashew
White Potato
Fecal Anti-gliadin IgA: 21 units (normal range is less than 10 units)
Fecal Anti-casein (cow's milk) IgA: 7 units (normal <10)
Fecal Anti-ovalbumin (chicken egg) IgA: 6 units (normal <10)
Fecal Anti-soy IgA: 6 units (normal <10)
Perhaps the test is still useful - I'm assuming the 11 foods are listed in order of reactivity, with corn being the highest and potato the lowest. I could try avoiding the top several foods, along with dairy, egg & soy.
In 2001, I tested positive for anti-gliadin antibodies, and have avoided gluten since. It was the one food category I was avoiding prior to the test! Why is it elevated? I do monitor this occasionally through other labs - the most recent was 18 months ago, and it was not elevated then. Three possibilities come to mind: 1) I'm now being unwittingly exposed to gluten, 2) I was still reacting to the small flour tortilla I accidentally ate 3.5 months earlier (thinking it was a corn tortilla), or 3) I am now cross-reacting to non-gluten foods which raise my anti-gliadin level (I've been learning that this can happen - I can provide weblinks). My D has gotten worse in the last year, which is why I did this EnteroLab test. Any thoughts here?
Since the test, I found that I have a histamine issue. In addressing it, I improved, but am still having problems. I then cut dairy, all cruciferous, fructose, and other aspects of the FODMAPs diet (oligos & polyols) but that hasn't brought further improvements.
So then I wonder about doing an elimination diet. I did read post #732 (mentioned in the book). Are there other posts I should read? The last alternative I can think of is to pursue other testing, like the MRT or Cyrex (for the gliadin cross-reactivity). I am leaning towards the elimination diet (for several reasons), but I want to know others' thoughts.
thank you very much,
Genie
Enterlab Results (low sIgA): now what?
Moderators: Rosie, JFR, Gabes-Apg, grannyh, Gloria, Mars, starfire, Polly, Joefnh
Hi Genie,
I've never heard of fecal or saliva IgA testing (to establish your ability to produce intestinal IgA antibodies), so I had to look that up. I would be very suspicious of those test results, and any doctor who recommended the tests. Here's why: Our body has only one immune system. If our body is capable of producing IgA antibodies in the blood, then trust me, it is capable of producing IgA antibodies in the mucosal tissues of the mouth (saliva), and the intestines, and any other epithelial tissues found in or on the body (such as the skin).
Your blood test result clearly shows that you are capable of producing normal amounts of immunoglobulin A, so unless you were taking a corticosteroid, or some other immune system suppressant when you submitted a sample to EnteroLab, then the test results that you received from them should be accurate and reliable.
Here's a possible hitch though — the tests that they use are very specific (in order to be accurate and reliable) and they test for the most common antigens found in the foods tested. It's possible that you might not be sensitive to those particular antigens, but you react to other proteins in the foods. For example, rather than being sensitive to the type A casein that the lab tests for in cow's milk, you might be sensitive to one of the less prominent proteins, or you might be sensitive to one of the whey proteins.
Or maybe you are not sensitive to any of them (except gluten), as the EnteroLab test results indicate.
IMO, the problem lies in the following quote:
You say that your D has become worse during the past year. That suggests that the past year or 2 is the most likely time frame when gluten cross-contamination in your diet became bad enough to begin triggering symptoms.
Do you eat any processed foods? If so, they may contain traces of gluten. Do you eat away from home? For those of us who are very sensitive to gluten, it's almost impossible to eat out without being exposed to gluten. Does anyone in your home use wheat flour for baking (or anything else)? If there is a bag of flour in your home, then that is almost surely a source of cross-contamination, no matter how careful you or anyone else might be with using it.
I'm speaking from experience, because a couple of years ago, I had the same problem with symptoms showing up, and slowly becoming worse over time. I did an EnteroLab test and found that my anti-gliadin antibody test level was 62.
Since our antibody level continues to climb as long as we continue to ingest an antigen, that means that I had probably been getting traces of gluten in my diet for years. It didn't take me long to figure out that the cross-contamination was coming from someone else in the house using flour for their own cooking. When a bag of flour is opened, or flour is poured, dipped, or whatever, flour dust floats out and settles everywhere in the house, and preventing cross-contamination is virtually impossible IMO, if there is any wheat flour in the house.
But you can get the same small dosage from processed foods, or eating out. Gluten-Free processed foods are not actually gluten-free — they are actually low-gluten foods. And most employees at restaurants (except for some of the top-level restaurants), do not understand how meticulously they must prepare food, in order to avoid cross-contamination with gluten. Unless the restaurant has a dedicated area for preparing gluten-free meals, where no gluten is ever allowed, and only a few specially-trained individuals are allowed in that area to prepare the food, the risk of cross-contamination is always present.
It's certainly possible that you might have a histamine issue, because many of us do, but as long as you are producing anti-gliadin antibodies, the source of gluten contamination in your diet must be eliminated before there is any point in trying to determine whether you have a histamine problem, IMO. And after you find the source of gluten and eliminate it, you may not need to be concerned about histamines.
The bottom line is that for those of us who are extremely sensitive to gluten, avoiding it is far, far more difficult than most people realize.
Tex
I've never heard of fecal or saliva IgA testing (to establish your ability to produce intestinal IgA antibodies), so I had to look that up. I would be very suspicious of those test results, and any doctor who recommended the tests. Here's why: Our body has only one immune system. If our body is capable of producing IgA antibodies in the blood, then trust me, it is capable of producing IgA antibodies in the mucosal tissues of the mouth (saliva), and the intestines, and any other epithelial tissues found in or on the body (such as the skin).
Your blood test result clearly shows that you are capable of producing normal amounts of immunoglobulin A, so unless you were taking a corticosteroid, or some other immune system suppressant when you submitted a sample to EnteroLab, then the test results that you received from them should be accurate and reliable.
Here's a possible hitch though — the tests that they use are very specific (in order to be accurate and reliable) and they test for the most common antigens found in the foods tested. It's possible that you might not be sensitive to those particular antigens, but you react to other proteins in the foods. For example, rather than being sensitive to the type A casein that the lab tests for in cow's milk, you might be sensitive to one of the less prominent proteins, or you might be sensitive to one of the whey proteins.
Or maybe you are not sensitive to any of them (except gluten), as the EnteroLab test results indicate.
While it's true that they are probably listed in order of reactivity, with an overall score of "6" for all 11 foods (as noted in the quote below, from your post), you could not be producing significant amounts of antibodies to any of them. Therefore, I doubt that avoiding any of those foods will make any difference. Obviously I could be wrong though, based on my explanation above.Genie wrote:Perhaps the test is still useful - I'm assuming the 11 foods are listed in order of reactivity, with corn being the highest and potato the lowest. I could try avoiding the top several foods, along with dairy, egg & soy.
Hierarchy of reactions (all 11 foods fell within the lowest category - no significant immunological reaction):
IMO, the problem lies in the following quote:
It's elevated because you are still producing antibodies to gluten. If you have been gluten-free since 2001, then you could not possibly have a test result that high, without a somewhat regular exposure to gluten . Your diet is clearly cross-contaminated on a regular basis, by small (possibly even trace) amounts of gluten. And that, IMO, is why you are still reacting.Genie wrote:In 2001, I tested positive for anti-gliadin antibodies, and have avoided gluten since. It was the one food category I was avoiding prior to the test! Why is it elevated?
You say that your D has become worse during the past year. That suggests that the past year or 2 is the most likely time frame when gluten cross-contamination in your diet became bad enough to begin triggering symptoms.
Do you eat any processed foods? If so, they may contain traces of gluten. Do you eat away from home? For those of us who are very sensitive to gluten, it's almost impossible to eat out without being exposed to gluten. Does anyone in your home use wheat flour for baking (or anything else)? If there is a bag of flour in your home, then that is almost surely a source of cross-contamination, no matter how careful you or anyone else might be with using it.
I'm speaking from experience, because a couple of years ago, I had the same problem with symptoms showing up, and slowly becoming worse over time. I did an EnteroLab test and found that my anti-gliadin antibody test level was 62.
Since our antibody level continues to climb as long as we continue to ingest an antigen, that means that I had probably been getting traces of gluten in my diet for years. It didn't take me long to figure out that the cross-contamination was coming from someone else in the house using flour for their own cooking. When a bag of flour is opened, or flour is poured, dipped, or whatever, flour dust floats out and settles everywhere in the house, and preventing cross-contamination is virtually impossible IMO, if there is any wheat flour in the house.But you can get the same small dosage from processed foods, or eating out. Gluten-Free processed foods are not actually gluten-free — they are actually low-gluten foods. And most employees at restaurants (except for some of the top-level restaurants), do not understand how meticulously they must prepare food, in order to avoid cross-contamination with gluten. Unless the restaurant has a dedicated area for preparing gluten-free meals, where no gluten is ever allowed, and only a few specially-trained individuals are allowed in that area to prepare the food, the risk of cross-contamination is always present.
It's certainly possible that you might have a histamine issue, because many of us do, but as long as you are producing anti-gliadin antibodies, the source of gluten contamination in your diet must be eliminated before there is any point in trying to determine whether you have a histamine problem, IMO. And after you find the source of gluten and eliminate it, you may not need to be concerned about histamines.
The bottom line is that for those of us who are extremely sensitive to gluten, avoiding it is far, far more difficult than most people realize.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
Hi Tex,
I apologize to be so delayed in my response.
I learned some things after your reply. Since there are two different types of IgA--one that is primarily in the mucosa (Secretory or SIgA) & one primarily in the blood--I did find out from Phyllis & from calling my local lab, that the blood test does measure the mucosal kind (of which a small amount is in the blood).
So in essence the serum IgA does apply to the stool test. And since my measure is within normal range, I now realize my Enterolab test does accurately indicate that I don't have sensitivities to those particular proteins (except gliadin).
I've decided to follow a very strict elimination diet, which I've been on for a week now. I'm not seeing any improvement yet.
I just learned about SIBO & actually "attended" the first ever SIBO conference remotely (via internet teleconference). I'll be posting about that in the future - I learned a ton!
And I will be even more careful about gluten now.
Thanks for all your help,
Genie
I apologize to be so delayed in my response.
I learned some things after your reply. Since there are two different types of IgA--one that is primarily in the mucosa (Secretory or SIgA) & one primarily in the blood--I did find out from Phyllis & from calling my local lab, that the blood test does measure the mucosal kind (of which a small amount is in the blood).
So in essence the serum IgA does apply to the stool test. And since my measure is within normal range, I now realize my Enterolab test does accurately indicate that I don't have sensitivities to those particular proteins (except gliadin).
I've decided to follow a very strict elimination diet, which I've been on for a week now. I'm not seeing any improvement yet.
I just learned about SIBO & actually "attended" the first ever SIBO conference remotely (via internet teleconference). I'll be posting about that in the future - I learned a ton!
And I will be even more careful about gluten now.
Thanks for all your help,
Genie