I believe that people are becoming increasingly aware that gluten is not the best food ingredient for us – it can be very difficult to digest, and can promote significant inflammation both in the gut and in the body as a whole, resulting in chronic pain, fatigue, brain fog, skin irritation, mood imbalances and more. There are a variety of labs that offer testing for gluten intolerance- in fact, all the big commercial labs offer the tests. I have found, however, that sometimes those blood tests are not as sensitive as some others. In my view, the best test for gluten intolerance is a stool test offered by a lab called Enterolab.

The markers that are tested for gluten intolerance are anti-gliadin antibodies and anti-tissue transglutaminase antibodies. Both are looking for auto-immune reactions in the body that are caused by the ingestion of gluten. These are the markers that are assessed in blood testing too.

Enterolab uses a stool sample to look for those markers. I have found this to be a more sensitive test than standard blood tests (one of the ways I know this is that a rep from one of those big labs offered 10 of my patients free testing with their lab to be able to compare the results with Enterolabs results (samples taken on the same day). In several of those cases, the bloodwork showed negative where the stool results showed positive. Can we rule out false positives 100%? No, we can’t, but I can say that the results were reflective of the health issues of those patients, and all those patients felt better when adopting a gluten-free diet.

One can be gluten intolerant without having Celiac disease. Celiac is the most severe form of gluten intolerance, where damage is at the extent of causing erosion of the villi of the small intestine. Celiac is typically diagnosed by a biopsy. Gluten intolerance can be much subtler in its presentation, but can also be insidious and cause many quite serious health issues.

I also think the stool test is ideal for kids – sparing them a blood draw. I’m getting ready to do the test on my daughter, because while I am gluten free, and we are gluten free at home, I don’t restrict her outside of the house. Recently, however, we’ve been noticing that when she eats wheat, she gets these anger outbursts that happen 10 minutes or so after ingestion, and only last a few minutes. It’s so out of character for her that I started observing what was happening around the time they occurred, and sure enough, eating wheat seemed to be the trigger. I talked with her about it and she can actually see the connection too. Even at age 4, kids know when something makes them feel bad and how uncomfortable it can be.

Getting the sample isn’t so hard either – an adult can simply put a clean container in the toilet bowl. I have found that that can be off putting for kids, so I advise parents to put saran wrap inside the bowl, allowing some length so that the sample call “fall in”, so to speak. It secures quite well around the rim of the toilet, then when you put the seat down it’s barely visible.

Enterolab is a lab that does not even require a doctor’s order – you could feasibly order a kit yourself, they ship it to you, you take the collection and send it in.

They also offer cheek swab testing for the genetic markers that predispose to gluten intolerance – that’s pretty cool too, especially for people who are going to have children to get an indication of whether their kids will have that gene too and subsequently be predisposed to gluten intolerance.

You want to have eaten gluten fairly recently to see an accurate result. If you’ve been gluten free for months or years, it may not show up. I took this task very seriously when I was testing myself – I was on holiday in Sydney at Easter time, and I ate Hot Cross Bun after Hot Cross Bun – at least one every day for a week! I felt pretty sick by the end of it mind you!

The panel I recommend with Enterolab is B1: Gluten Sensitivity Stool Panel.  If you’re interested in the genetic test, you would also order the Gluten Sensitivity Gene Test, which is a molecular HLA-DQB1 analysis).  They also offer more extensive panels to include other food intolerances, but the ones I’ve listed as the specific gluten ones.

I have rarely come across a person who didn’t feel better on a gluten-free diet. But some of us need to see the results of a lab test to motivate us to make dietary changes. If that’s you, then this test would be ideal.