Enterolab results: finally willing to try to make a change

[aginternist]

I did the enterolab test back in early 2023 after being diagnosed with lymphocytic MC in 2020 via colonoscopy. I've pretty much just tried diet modification here and there and just did what I wanted, and have had mostly daily diarrhea, with some days without it. Here are my results.

What do you recommend that I do? I feel that the gluten-sensitivity hype is overblown -will it really make a difference?

What should I eat and what should I avoid based on these results? Some antigenictiy values are on the lower side.

I NEED protein and plenty of it. I do heavy weight lifting and I'm very active in other sports. I also refuse to not eat vegetables and miss out on vitamins and minerals. I want to eat a whole food diet.


RESULTS:

Fecal Anti-gliadin IgA 11 Units (Normal Range is less than 10 Units)

Fecal Anti-Oat IgA 22 Units (Normal Range is less than 10 Units)

Fecal Anti-tissue Transglutaminase IgA 8 Units (Normal Range is less than 10 Units)

Fecal Anti-Saccharomyces cerevisiae (dietary yeast) IgA 1 Units (Normal Range is less than 10 Units)

Mean Value 11 Antigenic Foods 12 Units (Normal Range is less than 10 Units)

While all of the foods tested can be immune-stimulating, the hierarchy of reactions detected were as follows:
Food to which there was no significant immunological reactivity: Food to which there was some immunological reactivity (1+): Food to which there was moderate immunological reactivity (2+): Food to which there was significant and/or the most immunological reactivity (3+):
Rice
White potato
Garbonzo Bean
Sesame Seed
Soy
Corn
Almond
Walnut
Egg
Milk
Cashew


Within each class of foods to which you displayed multiple reactions, the hierarchy of those reactions detected were as follows:

Nuts:
Nut toward which you displayed the most immunologic reactivity: Cashew
Nut toward which you displayed intermediate immunologic reactivity: Almond
Nut toward which you displayed the least immunologic reactivity: Walnut

C-3) Antigenic Meat Panel

Beef 14.3 Units (Normal Range is less than 10 Units)

Chicken 26.4 Units (Normal Range is less than 10 Units)

Pork 28.1 Units (Normal Range is less than 10 Units)

Tuna 12.5 Units (Normal Range is less than 10 Units)

Mean Value # Antigenic Foods 20 Units (Normal Range is less than 10 Units)

Gluten Sensitivity Gene Test

HLA-DQB1 Molecular analysis, Allele 1* 06:09

HLA-DQB1 Molecular analysis, Allele 2* 03:01

Serologic equivalent: HLA-DQ 1,3 (Subtype 6,7)

*Molecular HLA results are now being reported utilizing the latest official WHO/ASHI/ESI HLA-nomenclature which inserts a colon (:) between the first two digits and the last two digits (e.g., 05:01 rather than 0501). Result interpretation is the same as they have been in the past when results were expressed without the colon.



TEST INTERPRETATION(S):

Interpretation of Fecal Anti-gliadin IgA: The level of intestinal anti-gliadin IgA antibody was elevated, indicative of active dietary gluten sensitivity. For optimal health; resolution or improvement of gluten-induced syndromes (mainly falling into six categories abbreviated as NAAAGS – neuropsychiatric, autoimmune, asthma, abdominal, glandular deficiencies/hyperactivity or skin diseases); resolution of symptoms known to be associated with gluten sensitivity (such as abdominal symptoms - pain, cramping, bloating, gas, diarrhea and/or constipation, chronic headaches, chronic sinus congestion, depression, arthritis, chronic skin problems/rashes, fibromyalgia, and/or chronic fatigue); and prevention of small intestinal damage and malnutrition, osteoporosis, and damage to other tissues (like nerves, brain, joints, muscles, thyroid, pancreas, other glands, skin, liver, spleen, among others), it is recommended that you follow a strict and permanent gluten free diet. As gluten sensitivity is a genetic syndrome, you may want to have your relatives screened as well.

For additional information on result interpretation, as well as educational information on the subject of gluten sensitivity, please see the "FAQ Result Interpretation," "FAQ Gluten/Food Sensitivity," and "Research & Education" links on our EnteroLab.com website.

Interpretation of Fecal Anti-Oat IgA: Level of fecal IgA antibody to oat proteins was greater than or equal to 10 Units, indicative of an immune reaction, and hence immunologic “sensitivity” to oats. It is recommended that for any elevated fecal antibody level to a highly antigenic food such as oats, that it be removed from your diet. You should avoid all oats, even those claiming to be gluten-free (which merely means they certify there is minimal to no contamination with wheat gluten). It is estimated that 40-50% of gluten-sensitive people are oat sensitive as well; you are among this 40-50%. Studies claiming oats are tolerated by all gluten sensitive people, and that consequently conclude that oat gluten is non-toxic, by design, inherently select study patients from the 50-60% of gluten-sensitive people who can tolerate oats. (This is because if a person could not tolerate oats they could not be in a study asking them to eat oats regularly for long periods of time.) The original research by Dr. Willem Karel Dicke finding that gluten was the cause of celiac disease identified wheat, barley, rye, and oats as the offending grains.

Interpretation of Fecal Anti-tissue Transglutaminase IgA: The level of intestinal IgA antibodies to the human enzyme tissue transglutaminase was below the upper limit of normal. Hence, there is no evidence of a gluten-induced autoimmune reaction to this enzyme.

Interpretation of Fecal Anti-Saccharomyces cerevisiae (dietary yeast) IgA: The level of intestinal Anti-Saccharomyces cerevisiae (dietary yeast) IgA antibody was below the upper limit of normal, indicating that the main immunologic reaction specific to the diagnosis of Crohn’s disease is absent. This stool test alone cannot rule out Crohn’s disease however. Further gastroenterological and/or serological testing is warranted if you have any of the following symptoms chronically: moderate to severe abdominal pain; blood, mucus, or pus in stools; diarrhea; partial or complete intestinal obstruction at any time; and/or signs of ongoing chronic systemic inflammation such as fever, weight loss, arthritis, or fatigue. Furthermore, some immunocompetent people can still have clinically significant reactions to a food antigen despite the lack of a significant antibody reaction (because the reactions primarily involve T cells), if there are any suspicious symptoms or signs of Crohn’s disease consult your health care practitioner for further diagnostic testing. And if you think you may be immunologically sensitive to dietary yeast even without these symptoms, we recommend avoiding foods and beverages with added Saccharomyces cerevisiae yeast (i.e., foods/beverages made with baker’s or brewer’s yeast) or high concentrations of this yeast naturally (like wine).

Interpretation of Mean Value 11 Antigenic Foods: With respect to the mean value of the 11 foods tested, overall, there was only a modest amount of immunological reactivity detected to these antigenic foods in terms of fecal IgA production.

Many foods besides gluten, milk, egg, and soy are antigenic in their own right; the main classes of which include other grains, meats, nuts, and nightshades (potatoes being the primary food eaten from this latter class). Minimizing exposure to antigenic foods is an important component of an anti-inflammatory lifestyle to optimize immune system health. This is especially important for those with chronic abdominal symptoms and/or chronic immune/autoimmune syndromes, or for those who want to prevent them.

For immunologic food sensitivity testing, the actual numeric value (in Units) for any given food or for the overall average of a group of foods is important mainly for determining: 1) if the immune reaction is present or absent, and 2) the immune reaction in relative terms to different foods tested in a given individual at a given point in time. It is not a score, per se, to be interpreted as a measure of clinical or immunological severity for that individual or between individuals. This is because the amount of IgA antibody made by a given person is particular for the immune function of that person. Furthermore, sometimes a person can display what can be viewed as immunological and nutritional “exhaustion,” whereby a more significant and symptomatic immunologic food sensitivity is accompanied by a lower positive measured anti-food antibody value (rather than a higher positive). In such an instance, following clinical improvement and improved nutritional status (while the suspect antigenic foods are withdrawn), values can actually be higher for a time before finally falling into the negative range after several years.

Thus, the overall average food sensitivity antibody value for this panel is an assessment of your overall humoral immunologic food reactivity, which can help determine if dietary elimination trials may help you. If the mean value is less than 10 Units, the humoral immune reactions can be considered clinically insignificant (negative); if greater than or equal to 10 Units, they can be considered clinically significant (positive). Rather than reporting the absolute value of a positive result for each individual food, since it cannot be considered as an assessment of severity, the results are reported in semi-quantitative terms between the foods tested (1+, 2+, or 3+). This provides you with the knowledge of which foods are stimulating the most immune response which, in turn, is indeed the most practically applied information to dietary elimination trials.

Dietary Recommendation Based on Test Results to Individual Foods:

This test panel was designed to guide your choices when building a new more healthful, less antigenic dietary plan. The results are delivered in such a way that you are not left with “nothing to eat,” but instead they should guide you in avoiding the foods to which the highest or most immunologic reaction was detected (and hence, are most stimulating to your immune system). We discourage dietary changes that involve removing too many foods at once. This can lead you to feel too hungry too often, especially if adequate healthful replacement foods are not readily available. Dietary elimination (beyond gluten-free, dairy-free, and soy-free) is best approached over a period of weeks to months and sometimes years, removing one or two additional foods at a time, rather than removing many foods at once.

If you reacted to more than one of the grains, meats, or nuts, we recommend that you first eliminate from your diet the one food from that class you reacted to most strongly, while keeping in your diet the ones you reacted to less strongly. When you want to try and eliminate additional foods, do so in the order of the strength of reaction from highest, intermediate, to least. In the case of potato, you may want to eliminate it if you reacted positively to it.

If you have an autoimmune or chronic inflammatory syndrome, or just want to pursue an optimally healthy diet and lifestyle, avoiding all grains, meats, and nightshades can optimize an anti-inflammatory diet (despite a negative result on food testing). As nuts and seeds are a very healthful source of vegetarian protein and heart-protective oils and minerals, rather than avoiding all nuts and seeds, you can render nuts and seeds less antigenic, more digestible, and more easily tolerated by choosing the few that you seem to best tolerate overall, soaking a one-day supply in a glass jar filled with clean water for 4-8 hours (or for ease, overnight), and pouring off the water and rinsing before eating. The resultant soaked nuts or seeds can be eaten as is (alone or with fresh or dried fruit), blended into nut butters (by adding some water), or added to “smoothies.”

Interpretation of Beef: Not yet categorized

Interpretation of Chicken: Not yet categorized

Interpretation of Pork: Not yet categorized

Interpretation of Tuna: Not yet categorized

Interpretation of Mean Value # Antigenic Foods: Not yet categorized

Interpretation of HLA-DQ Testing: Although you do not possess the HLA-DQB1 genes predisposing to celiac disease (HLA-DQ2 or HLA-DQ8), HLA gene analysis reveals that you have two copies of a gene that predisposes to non-celiac gluten sensitivity, in your case HLA-DQB1*06:09 and HLA-DQB1*03:01. Having two copies of a gluten sensitive gene means that each of your parents and all of your children (if you have them) will possess at least one copy of the gene. Two copies also means there is an even stronger predisposition to gluten sensitivity than having one gene, and the resultant immunologic gluten sensitivity may be more severe. This test was developed and its performance characteristics determined by the Kashi Clinical Laboratories. It has not been cleared or approved by the U.S. Food and Drug Administration.

[tex]

What do you recommend that I do? I feel that the gluten-sensitivity hype is overblown -will it really make a difference?

First, you'll need to overcome that opinion of gluten, or you'll almost surely never be able to reach remission. Gluten sensitivity is a fact of life that all MC patients have to deal with, if they intend to control their symptoms by diet alone. Please note that the medical community has absolutely no way to officially diagnose non-celiac gluten sensitivity. Consequently, a negative result on a celiac screening test performed by a conventional medical lab is meaningless/invalid. Therefore, gluten must be eliminated 100% from our diet, if we intend to control our symptoms by diet. Hit or miss gluten avoidance for a few days, or a few weeks, won't work. Due to the 120 day half-life of gluten (anti-gliadin) antibodies, it usually takes 6 to 8 weeks for most of us to get the gluten antibodies to decline to a level where they no longer provoke an immune system response.

Your test results are posted with inconsistencies, so that I really can't tell what your primary food sensitivities might be. Most of us, for example, are sensitive to soy, and all dairy products, and many of us are sensitive to chicken eggs. Without clear test results, I would avoid all of those foods while following a recovery diet.

For guidance on selecting foods for recovery diet, please read the newsletter published by the Microscopic Colitis Foundation about a year ago, regarding food selection. For your convenience. As a direct link where you can either read or download a copy of that newsletter:

https://www.microscopiccolitisfoundatio ... 479987.pdf

What should I eat and what should I avoid based on these results? Some antigenictiy values are on the lower side.

Some of your test results do seem strangely low. If you weren't taking a corticosteroid, it's possible that you have selective IGA deficiency

I NEED protein and plenty of it. I do heavy weight lifting and I'm very active in other sports. I also refuse to not eat vegetables and miss out on vitamins and minerals. I want to eat a whole food diet.

It takes plenty of protein to heal the damage done to our intestines by gluten sensitivity. Just make sure you're eating safe proteins, such as Turkey, Lamb, venison, wild type meats in general (not pork, beef, chicken, etc.). There's nothing wrong with eating vegetables, just make sure they are peeled, and overcooked, because we have to minimize the fiber in foods, and certain vegetables contain a lot of fiber, especially in their skin/paracarp. After we reach remission, we're usually able to slowly add fiber back into our diet, without any ill effects. Overcooking vegetables, while we're recovering, makes them easier to digest, and less likely to provoke a reaction. After were in remission, overcooking is no longer necessary, and raw vegetables can again be eaten.

This should get you started on the right track to recovery.

Tex

[aginternist]

Thanks, Tex. So I can never have gluten again?

Will I be able to introduce all of the other foods?

Why can't I have chicken or eggs? I definitely need a lot of protein and I don't want to eat lunch meat. Venison can be hard to come by where I am and I don't want to eat too much red meat. Can I continue with an ultra-filtered whey protein isolate to supplement my weight training? What about fish?

I'll repaste this here, since it didn't copy well:

Food to which there
was no significant
immunological
reactivity:

Rice
White potato
Garbonzo Bean
Sesame Seed
Soy
Corn

Food to which there
was some
immunological
reactivity (1+):

Almond
Walnut
Egg

Food to which there
was moderate
immunological
reactivity (2+):

Milk

Food to which there was
significant and/or the
most immunological
reactivity (3+):

Cashew

C-3) Antigenic Meat Panel
Beef 14.3 Units (Normal Range is less than 10 Units)
Chicken 26.4 Units (Normal Range is less than 10 Units)
Pork 28.1 Units (Normal Range is less than 10 Units)
Tuna 12.5 Units (Normal Range is less than 10 Units)

[Gabes-Apg]

the main reason we encourage 'wild' or 'game' meats is that they flourish on free range grass fed based feeding

those animals do not do so well on grain based feeds, which are full of gluten, soy and sugar and other 'crap' not good enough for processed food supply
(40 years ago these animals were not eating this level of crap, the food supply chain these days is more about profit not quality)

do some research, there will be distributors that can send you product from interstate that has been cyrofreezed etc

this also applies to commercially distributed eggs - the chickens are fed cheap crappy food high in gluten.
Some here that reacted to chicken eggs can tolerate things like duck eggs, goose eggs, quail eggs. same as above, those animals do not flourish on grain feed so their output does not have secondary gluten.



Gluten
gluten is highly inflammatory to digestion for ALL people. once you have auto immune illness then continuing to eat food items that trigger immune action is doing multiple things
a) continuing inflammation cycle
b) damaging your gut (which means you are not absorbing nutrients from food as you should)
c) putting stress on your immune system which will drain key nutrients like Zinc, VitC, Vit D etc that your body needs for health and muscle

why would you knowingly eat something that is like a poison to your system?? especially when you are so health focussed?
the best way to manage and heal from inflammation is to avoid major triggers.


if the whey protein is dairy free - continue it.
check the other ingredients of the product ie for Oats or any of the other ingredients you showed reactions to in the results above.
Also suggest you use raw or non flavoured version. Chemical sugars can be a trigger for MC.

[tex]

Gabes covered this pretty well, but in response to your questions:

Thanks, Tex. So I can never have gluten again

?

Correct. Once it develops, gluten sensitivity is permanent. Some people stop reacting to gluten (even some celiacs become asymptomatic), but although this stops the clinical symptoms, it does not stop the continuation of intestinal damage due to gluten exposure.

Will I be able to introduce all of the other foods?

Probably, but that's not chiseled in stone. It depends on how well your digestive system heals, and the older we get the longer it takes to heal. Kids can heal in less than a year or two, but it takes those of us who are considered senior citizens at least 5 to 10 years to completely heal, and some of us never heal completely. Reintroducing new foods is easier, and works better if that's delayed until about a year or more after your reach remission, and the foods are introduced one at a time, and slowly, watching for any reactions.

Why can't I have chicken or eggs? I definitely need a lot of protein and I don't want to eat lunch meat. Venison can be hard to come by where I am and I don't want to eat too much red meat. Can I continue with an ultra-filtered whey protein isolate to supplement my weight training? What about fish?

You showed a relatively high EnteroLab result for chicken (26.4), which probably means that you will also react to eggs, so they are best avoided until you reach stable remission, and then you might try reintroducing them. Tuna also showed a reaction, implying that other fish might cause problems. It's possible that some fish (some freshwater fish for example) might be safe, but then again, they might not be. These are uncharted waters. The point is, if we don't avoid all of our food sensitivities while we are recovering, we may never be able to suppress the inflammation enough to be able to reach full remission, and complete intestinal healing. So it's very important to reach remission, before experimenting with the reintroduction of foods.

I hope this helps.

Tex