Gluten Challenge for Celiac Testing

The gluten challenge for celiac testing is required. If your already gluten-free trying to get an official celiac diagnosis, the gluten challenge is probably short of your worst nightmare.

Every week I am asked on Instagram about the gluten challenge, if it’s required for testing, and what to do if you can’t do it. I’m writing this post because I am asked about it so often that I think a resource on it is important

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What is a Gluten Challenge For Celiac Testing?

The gluten challenge is where you have to eat gluten for a specific amount of time before celiac testing. Your doctor will tell you how much and for how long before testing to consume gluten.

In general, most gluten challenges involve eating 10 grams of gluten/day for around 8 weeks. 10 grams of gluten/day ends up working out to be 2 pieces of bread/day.

Terrified? I completely understand. Eating this much gluten for 8 weeks is scary if it causes painful symptoms for you. It’s also required for accurate celiac test results.

The celiac gluten challenge is important because if you’re not eating gluten, there’s not celiac-related inflammation for the celiac tests to measure. Meaning there is no reaction for them to check for if you’re already living gluten-free.

Because luckily, if you have a gluten-related disorder, you can manage that disorder by living gluten-free.

Gluten Challenge Symptoms

If you’re already gluten-free and needing to do the gluten challenge, the symptoms you’ll endure will likely be the ones you experienced before going gluten-free.

The symptoms can include:

  • Pain
  • Bloating
  • Constipation
  • Heartburn
  • GI Distress
  • Fatigue
  • Stomachache
  • Vomiting
  • Headaches/Migraines
  • Depression
  • Anxiety
  • Nutrient deficiencies (like low vitamin D, calcium, and iron deficiency anemia)
  • Malabsorption
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Gluten Challenge Diet

The gluten challenge diet involves eating 3-10g of gluten a day for a set amount of time as determined by your doctor. Basically, the gluten challenge diet is where you eat gluten temporarily for the purposes of accurate celiac disease testing.

Gluten Challenge Food List

Below are some approximations of how much gluten is in different types of food you may eat on a gluten challenge diet for celiac:

  • 1 piece of bread = 3g of gluten
  • A slice of cake = 3g of gluten
  • 1 cupcake = 3g of gluten
  • A serving of wheat-based cereal (like shredded wheat) = 3g of gluten
  • ½ cup dried pasta = 3g of gluten

As a reminder, this is not an all-inclusive list or a completely accurate list but it is to help give you an idea of how much gluten to eat a day on the gluten challenge.

Gluten Challenge For Celiac Testing

You must eat gluten before any celiac testing if you’re already gluten-free. It is normal to have to do a gluten challenge before a blood test or endoscopy. Typically you do the gluten challenge before the blood test and you keep consuming gluten until the endoscopy but everyone’s timeline and diagnosis procedure is different.

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Is the Gluten Challenge Worth it?

Now that we know the importance of the gluten challenge and celiac, let’s talk about if it’s worth it.

Obviously, if you’re already gluten-free, it’s for a reason. You’ve likely noticed gluten does not sit well in your body so eating it feels scary.

First, I want you to know, you’re not alone. Many people find themselves in this spot of weighing the pros and cons of an official diagnosis. And many people find themselves horrified at the thought of eating gluten just to see if they have celiac disease or non-celiac gluten sensitivity.

So know, you are not alone.

Second, reading this blog post should not take the place of consulting your health care team on making a decision about getting an official diagnosis and how to go about that. If you have questions, concerns, etc. always bring them up with your healthcare provider. This post is just to help weigh your options.

So, is the gluten challenge worth it? It’s entirely up to you and your doctor. Below are something to consider when deciding if you should eat gluten for a celiac diagnosis.

Why You Need a Celiac Diagnosis

The gluten challenge for celiac testing can be worth it for a variety of reasons.

First off, the biggest difference between celiac and gluten intolerance is that celiac is life long. Gluten intolerance however, can be temporary. Knowing you can grow out of a gluten sensitivity, ask yourself “am I willing to be gluten-free for the rest of my life, no matter what?”

Another key difference is that for celiac, you have to be strictly gluten-free at all times. This means no cross-contact ever. Even if you don’t think you’re reacting. With gluten sensitivity, cross-contact can be tolerated.  Ask yourself, “am I willing to act as if I have celiac for the rest of my life without an official diagnosis?”

Additionally, an official celiac diagnosis means you’ll be eligible for celiac treatment and cures as they become available. Ask yourself, “will I be okay waiting to get an official diagnosis to access new celiac treatments/cures as they become available?”

Furthermore, getting an official diagnosis starts or continues the line of family health history. If you get an official celiac disease diagnosis, you’re paving the pay for your family to get screened in the future, potentially catching the cause of GI woes sooner.

Moreover, you will be able to access work and school accommodations. An official diagnosis allows your child to have a 504 plan. It also allows you certain accommodations protected by the ADA.

Most importantly, an official celiac diagnosis will allow you to monitor your celiac progress. It also will help insurance cover certain tests for celiac monitoring. Test like bone density scans, nutrition status monitoring, and more.

More Questions to Ask Yourself

Determine if eating gluten for a celiac diagnosis is the right step for you by discussing the following questions with yourself and your doctor:

  • How will a celiac diagnosis change your current situation?
  • If your celiac disease testing comes back negative, will you still stay gluten-free for the rest of you life?
  • Do you have the resources to be glutened for the next ~8 weeks?
  • Do you have the emotional and physical capacity to be glutened for the next ~8 weeks?
  • How can your doctor support you if you don’t follow through with official testing procedures?
  • What will it mean for your own self-care if you don’t get tested?
  • What are you looking for in an official diagnosis?

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