Gluten Challenge - How Long? How Much?

Fidissimus · Joined: 17 Mar 2006 Posts: 1569 Location: Portland, OR.

How long do I need to be eating gluten before I am tested for celiac disease?

This is not an easy question to answer. Most people believe, or are told that they need to eat gluten for a few days (or up to a week) before a blood test or a biopsy, and this is incorrect. The true answer depends on how long the individual has been avoiding gluten. How much gluten to eat depends on the age of the individual who is being tested. The information provided here is a general rule, there are many specifics that come into play, so its best to talk with a knowledgable physician about your particular situation.

First: If a patient has avoided gluten for six to 12 months (or more) it is advisable to consider an HLA gene test before a gluten challenge. The HLA gene test will help determine if the patient is even in the risk group for celiac disease. (Only 1/3 of the US population have the genes for celiac disease.) After 6-12 months, it can be difficult to obtain a diagnosis of celiac disease after a gluten challenge, which is why this step is advisable.

Patients who have been on a gluten free diet for less than six months can consider a gluten challenge under a physician's supervision. A challenge would typically require an adult or a child to eat some gluten for four to eight weeks. For some, a twelve week challenge could be required but no challenge should last more than 12 weeks in children. The patient would eat a specified amount of gluten every day.

Many patients are concerned about participating in a challenge. Medical research shows that a limited challenge of this sort provides a greater medical benefit when it leads to a correct diagnosis of celiac disease. The challenge would need to be maintained if a positive antibody test result is received, because the biopsy procedure also depends on the presence of an autoimmune response.

For children, eating a saltine cracker each day would be enough gluten to conduct a challenge and for adults, a slice of bread a day would be adequate. The challenge would need to occur for six to eight weeks before the test in order for it to be accurate. Accordingly, we will not be able to register individuals for the screening who cannot meet this criteria, should they wish to be tested after following the diet.

Source: http://www.celiacdisease.net/GreatQuestion/tabid/125/Default.aspx
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Cheers!
Jenn

GF BD: Feb. 2001
Free of wheat, barley, rye, oats, dairy, eggs, almonds, pineapple and brewers yeast.
http://graindamaged.blogspot.com/

aklap · Joined: 02 Oct 2004 Posts: 8607 Location: WI, USA

Thanks Jenn!! Great info!!
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Al

“We cannot all do great things, but we can do small things with great love.” Mother Teresa

ostrich · Joined: 30 Mar 2006 Posts: 4162 Location: Nebraska

Woah, good stuff Jenn! Thanks! I'll have to do some more research into that gene test.
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Ostrich :>--O==={

I lie below, you float above
In the pretty white ships that I am dreaming of

~Flawed Design~ · Joined: 05 Feb 2007 Posts: 30

Yay! Thank you so much for the link. I feel so much better about going into my biopsy tomorrow.

My gastroenterologist, told me just 20 days of gluten challenge would be enough, didn't specify amount. Then I read somewhere you need to eat .3 g for every kg of your body weight, a 100 kg person would then have to eat 30 grams of wheat protein!!! That's too large an amount, and I was getting concerned. Also I read just a molecule of gluten would trigger the auto immune response that causes the damage. . .the information you've posted just reaffirms that, thank you so much.
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Suspected Celiac since 2-2-2007.

babyface nelson · Joined: 22 May 2007 Posts: 4

Ok. I am really confused. I just saw my gastro today, and she told me that if I have been avoiding gluten, the serology will come back normal, but the biopsy will still be valid. She then scheduled an endoscopy for the end of the month and told me not to worry about the diet either way until then.

Do I need to eat gluten before my endoscopy or not?

cruelshoes · Joined: 23 Sep 2005 Posts: 2546 Location: Washington State

Yes. You must be eating gluten to have a better chance at an accurate result. The human digestive tract is something line 27 feet long. Every day you are not eating gluten (if you have CD, that is) is a day of healing. Many physicians only want to take a few samples and damage can be patchy anyway, so the more healing you do, the less likely you are to show damage.

If it were me, I would eat as much gluten as I could until the endoscopy and then pester the doctor to make sure she is taking at least 10 - 12 samples in the endoscopy.
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-Colleen
Dx 8/05 via bloodwork/biopsy
10-YO son Dx 11/05 via bloodwork/biopsy
Daughters (12 and 2) have neg. bloodwork

A woman is like a tea bag-you never know how strong she is until she gets in hot water. - Eleanor Roosevelt

aklap · Joined: 02 Oct 2004 Posts: 8607 Location: WI, USA

bump
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Al

“We cannot all do great things, but we can do small things with great love.” Mother Teresa

aklap · Joined: 02 Oct 2004 Posts: 8607 Location: WI, USA

bump for Asif
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Al

“We cannot all do great things, but we can do small things with great love.” Mother Teresa

aklap · Joined: 02 Oct 2004 Posts: 8607 Location: WI, USA

back top the top
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Al

“We cannot all do great things, but we can do small things with great love.” Mother Teresa

aklap · Joined: 02 Oct 2004 Posts: 8607 Location: WI, USA

bump for katiejack
_________________
Al

“We cannot all do great things, but we can do small things with great love.” Mother Teresa

gfjhawk · Joined: 31 Jan 2008 Posts: 3

I'm about to start eating gluten again in preparation for a biopsy. I was told I needed to eat gluten for a week beforehand (I've been gf for about two months now). In this situation, would a slice of bread a day still be enough to produce an accurate result? I have a hard time forcing myself to eat the stuff, and don't want to consume any more than necessary. Wink

cruelshoes · Joined: 23 Sep 2005 Posts: 2546 Location: Washington State

In 2 months, I think it is possible that you could have had significant healing. Thre is really no way to know for sure. A week really isn't enough time. I think the last book I read said that healing can be aparent in the villi within a week. 2 months GF is a lot of healing time. Your biopsy may or may not be accurate, and may or may not show you have villi damage.

I can tell you about my situation, however. I had a follow up biopsy 6 months after I went GF. I still had significant damage that was visible to the naked eye. My villi were completely gone when I got my diagnosis, though. I think if you have less damage than I had, your results might be a bit murkier.

Good luck on your challenge.
_________________
-Colleen
Dx 8/05 via bloodwork/biopsy
10-YO son Dx 11/05 via bloodwork/biopsy
Daughters (12 and 2) have neg. bloodwork

A woman is like a tea bag-you never know how strong she is until she gets in hot water. - Eleanor Roosevelt

gfjhawk · Joined: 31 Jan 2008 Posts: 3

aklap · Joined: 02 Oct 2004 Posts: 8607 Location: WI, USA

aklap · Joined: 02 Oct 2004 Posts: 8607 Location: WI, USA