DR CABOT: Hello. This is Dr Sandra Cabot and naturopath Margaret Jasinska. Today talking to you about the genes that could predispose you to intolerance to gluten.

So, hi Margaret!

MARGARET: Hi, Dr Cabot. Thank you for having me on today.

DR CABOT: Now, a lot of people who come to our clinic or email us from our websites ask, “Should I give up gluten?” And they’ve usually got different symptoms, particularly digestive problems or fatigue or aches and pains, and they can’t find a reason for it. So, they look at their diet and it is very important to look for food intolerances, if you do have symptoms that are unexplained by conventional blood tests.

So, one test that I often do in people who could be intolerant to gluten is a gene test. And that is a gene called HLADQ. And we know that if you test positive for the mutation in the HLADQ gene – so that you’re positive for the DQ2 and the DQ8 – you are more likely to get celiac disease. And because genetic research is still in its early stages, you could be more likely to get other autoimmune diseases, if you eat a lot of gluten. This is still ongoing research, but it’s very helpful to know if you have this genetic predisposition to gluten intolerance. And this is a simple blood test that can be done for you. And it’s quite interesting, particularly if you have a family history of autoimmune diseases.

So, Margaret, we find that a lot of people do test positive for HLADQ abnormalities. And indeed, if you look at the US population, 40% of people will test positive, but only 1% of these people will develop celiac disease. But that doesn’t mean that gluten could not be causing other problems in their body.

So, it’s an interesting test. So, would you like to elaborate on that, Margaret?

MARGARET: So, sometimes we get patients who come to us and they already know that they’ve got celiac disease. So, they’ve already been diagnosed. But sometimes we get patients who have some kind of mysterious, unresolved health issues. Generally, their blood test results are good. They may have been to a gastroenterologist and no structural abnormalities were found. But the person may have gut problems, they may have low energy, they may have mood issues. And it’s often good to be able to see if gluten is negatively contributing to their health problems. And this is a way to do it.

What are the other tests for celiac disease? Well, there’s a blood test, but you have to be eating gluten for six weeks beforehand, like four pieces of wheat bread or equivalent for six weeks before having that blood test, called celiac serology. A lot of people can’t do that. A lot of patients have already been off gluten for some time because they’ve done some self-experimentation. And then their doctor may say, “Well, you’ve now got to go back onto gluten.” Some people vomit terribly just from a small ingestion of gluten. Some of them are hospitalized. Some of them get severe reactions from just a small intake of gluten. It’s not possible for them to eat it every day for six weeks.

DR CABOT: That’s right. A breakout in psoriasis, dermatitis.

MARGARET: Absolutely! Someone just can’t function. Who can just stay home in bed for six weeks? So, this gene test is a non-harmful test. It’s only a blood test.

And then the other test for celiac disease is the intestinal biopsy, where they snip some segments from your small intestine to have a look at them under the microscope and look for damage to the lining of the small intestine. That’s an invasive test. Depending on where you live, sometimes it’s a very expensive test. You may have to wait a long time to get that test. You may live in an isolated country town and just have very poor access to having it.

So, the blood test for the celiac genes really can be quite a useful test for our patients.

DR CABOT: Yes, that’s true. And it’s definitely not invasive and it’s not too expensive. It’s a general guide, whether you’re predisposed to celiac disease. And I believe also whether you’re generally predisposed to being intolerant to gluten, which means that if you eat gluten, it’ll cause inflammation in your body and that could manifest in different ways. You could get dermatitis, you could have psoriasis, you could have arthritis, whether it’s rheumatoid or osteoarthritis. You could just feel a bit down, a bit moody, a bit tired. So, if you’ve got general inflammation in your body, it can have wide ranging and rather vague symptoms.

So, the only way to prove if your HLADQ test being positive is relevant, is to go off gluten for six to twelve months – to totally eliminate it – and see the difference in your health. Because it does take time for the gluten protein to get out of your body. In other words, to stop affecting your genes.

MARGARET: Absolutely. Yes. Most people start to feel better within a couple of weeks, if they’ve been ingesting a lot of gluten. But it can take more than six months for the levels of inflammatory markers to come back down again, if they were raised, because eating gluten didn’t agree with your body and caused inflammation.

DR CABOT: That’s right. And some people who are gluten intolerant and they’ve been eating gluten for many, many years and they’re older, they may find it takes years for their gut to completely recover.

MARGARET: Well, sometimes it doesn’t. So, the research shows that sometimes it won’t fully repair itself. And it’s very interesting, as well. The symptoms of celiac disease or gluten intolerance can be so vague or even non-existent. There are patients who on intestinal biopsy may have severe damage to the lining of their small intestine. But if you question them, they get zero digestive discomfort. They were just diagnosed because they had anemia, or they developed osteoporosis early in life. So, even if you get zero gut symptoms or gut discomfort, you could still have a severe problem with gluten. It could still be scratching and causing abrasion and damage to the lining of your small intestine.

DR CABOT: That’s right. Those little villi, little hills that line your small intestine are very, very sensitive to proteins, but particularly gluten. If you have that genetic pattern of HLA-DQ2 and 8 positive genes, you’re more likely to get gut inflammation.

And the other thing, some patients find they can’t lose weight if they eat gluten. And when they go on a gluten-free and even better, a grain-free diet for a while, they’re able to lose weight for the first time in their life.

MARGARET: Yes, because inflammation can cause insulin resistance, it can be a cause of insulin resistance. You could be eating a healthy diet, you could be getting exercise. But if your body is highly inflamed, then insulin won’t work properly in your body and that can cause an inability to lose weight.

DR CABOT: Yes, it’s not just how much you eat, it’s what you eat. And gluten is generally found in high carbohydrate foods. But I think for people with mysterious illnesses that cannot be diagnosed accurately and no matter what age group they are, it’s worth having that genetic test, HLADQ, to see if you have the genes that predispose gluten intolerance or celiac disease.

So, thanks for listening and we hope you’ve enjoyed this podcast from the Weight Loss Detectives. Thank you, Margaret.

MARGARET: Thank you and bye-bye!