7 Ways to Help Monitor Adherence to a Gluten-Free Diet

As the prevalence of celiac disease and other gluten-related intolerances continues to grow, people are beginning to realize gluten can have a profound impact on their overall health. There is currently only one treatment for celiac disease which is a lifelong gluten-free diet; meanwhile, those with non-celiac gluten sensitivities may also need to follow a gluten-free diet for a period. These individuals often face great challenges trying to avoid gluten due to a range of factors such as cross-contamination, food and product mislabeling, and simply giving in to the pressures of society while facing resistance from those around them. Fortunately, there are now many ways to help monitor adherence to a gluten-free diet and identify unintentional consumption.

7 Ways to Help Monitor Adherence to a Gluten-free Diet

Here is a summary of seven different methods, what they can offer people, as well as potential drawbacks.

An ELISA Test that Detects Gluten

There are ELISA tests that can detect trace amounts of gluten in a stool sample to help monitor adherence to a gluten-free diet and provide insight into whether an individual may have consumed gluten unintentionally.

Pros of Gluten ELISA Test

• The test is minimally invasive, requiring a stool sample about the size of a teaspoon.
• Highly informative for physicians so they can help make decisions about an individual’s health and diet.
• Results are obtained accurately in a lab setting with minimal risk for false-positive or false-negative results.
• The results from the ELISA test are quantitative in nature.

Cons of Gluten ELISA Test

• This test must be ordered by a physician.
• Sample must be collected within 4 days of suspected gluten contamination/consumption.

Rapid Tests that Detect Gluten

A gluten rapid test only requires a urine sample. Results are qualitative and will read either positive or negative for the detection of gluten. This test is most effective for detecting gluten consumption in the previous 24 hours.

Pros of Gluten Rapid Test

• The test can deliver a definitive result in as little as 15 minutes.
• Can be ordered online and shipped directly to the individual so the test can be performed in their own home.
• Affordable and non-invasive.

Cons of Gluten Rapid Test

• Since this test is performed at home, there is a chance that if the instructions are not followed exactly as written, the test may be falsely negative.
• The test results are qualitative rather than quantitative.
• Due to the short window of time, this test may not be effective for determining long-term gluten-free diet adherence.¹

Endoscopic Biopsy

Typically, to confirm an initial diagnosis or monitor the progression of celiac disease the physician may order an endoscopy biopsy. This procedure involves the individual being sedated for a tube to be passed down their throat to retrieve intestinal tissue samples for a biopsy test. This allows the physician to get an inside look at any potential damage caused by a gluten-rich diet.

Pros of Endoscopic Biopsy

• The physician can view the inside of the intestine and assess the extent of potential damage caused by gluten consumption.
• Biopsy results can be helpful in the diagnosis of celiac disease.
• Endoscopy results are often available quickly after the procedure. However, biopsy results may take a little longer to process.

Cons of Endoscopic Biopsy

• This is an expensive, highly invasive procedure and usually involves taking a sample of intestinal tissue.
• Endoscopic biopsies must be performed at a medical center or doctor’s office.
• There is a degree of subjective judgment to the performance of this test, as the physician must use their own professional judgment when looking at any potential damage related to gluten consumption.²

Everlywell Food Sensitivity Test

The Everlywell food sensitivity test can be performed by the individual from the comfort of home by using a finger stick blood sample. This test checks for the presence or absence of IgG antibodies in order to inform which foods to eliminate in a two-step process. Once completed, the test includes a shipping label that allows the recipient to ship the sample back to the lab to be analyzed.

Pros of the Everlywell Food Sensitivity Test

• The test can be ordered online and shipped directly to someone’s home. 
• After the test is complete, the results are sent in the mail back to the lab to be tested. 
• Results are recorded and saved in the corresponding app.

Cons of the Everlywell Food Sensitivity Test

• Everlywell Food Sensitivity Test can be a little pricey at around $100.  
• Some people may be uncomfortable pricking their own fingers and drawing the blood sample needed to test.
• It is imperative that the blood from the sample soaks through to the back of the card so that it can be analyzed once it arrives at the laboratory.
• Not designed to monitor accidental gluten consumption.³

Serology Testing

Some may opt for a serological test to help monitor adherence to a gluten-free diet. This test requires blood to be extracted from the subject and evaluated in a laboratory.

Pros of Serology Testing

• This test is less invasive than endoscopy and can usually be done in a doctor’s office.
• Great for determining the performance of long-term adherence to a gluten-free diet and useful to help identify celiac disease.
• This test also checks for the presence of antibodies like IgA, which are commonly present in those with celiac who have been exposed to gluten.

Cons of Serology Testing

• This test may be a little uncomfortable for anyone who fears needles.
• Serology testing is not effective in evaluating minor deviations from a gluten-free diet.
• There is still a chance for false-negative results of IgA antibodies.⁴

Personal Survey to Evaluate Gluten Consumption

Often when following up with someone with celiac disease, physicians will give them a survey to fill out individually. This is a quick, effortless way of simply asking the individual to recall where they may have consumed gluten either willingly or accidentally.

Pros of Personal Survey

• No advanced and or expensive technology necessary.
• May prompt subjects to think more critically about their habits to determine where dietary improvements can be made.
• Offers the physician insight into the individual’s perspective in terms of following the diet.

Cons of Personal Survey

• Responders may feel a lot of pressure and answer the survey questions dishonestly to avoid disappointing a medical professional.
• They may also be unaware of instances where they have accidentally consumed gluten, as it is possible to be asymptomatic and still have celiac disease.
• Individuals may lack a general understanding of which products are likely to contain gluten which can also make this test an invalid assessment.

Nima Food Sensor

People suffering from celiac disease may also turn to tools that can help them avoid accidental gluten consumption, allowing them to have a better idea if they are following their diets before ingesting food or using a consumer product. 

Nima is a sensor that allows people concerned about gluten intake to test foods they are about to eat to ensure they are, in fact, gluten-free. Using a test strip, a sample of the food can be taken. The strip is then inserted into the sensor for analysis. In a matter of minutes, the sensor can determine if the food that has been sampled is safe for consumption.

Pros of Nima Food Sensor

• Portable and easily taken from place to place in a travel case.
• Samples are analyzed in a matter of minutes.
• Allows for the testing of foods when gluten content is unknown to help avoid the consumption of contaminated foods.

Cons of Nima Food Sensor

• Nima can be an expensive choice for many who already must buy special gluten-free foods for their diets. Additionally, users must continue to buy test strips in order to sample and analyze uncertain foods and products.
• The user must make sure that all parts of the food or dish are tested to achieve accurate results.
• False-negative results are a possibility because the test is qualitative and does not quantify the amount of gluten in a product.⁵

Monitoring Adherence to a Gluten-free Diet

It can be extremely difficult to adhere to a gluten-free diet due to challenges such as improper food labeling, cross-contamination, a general lack of information and understanding, and giving in to social pressures. However, individuals with celiac disease and other gluten-related sensitivities have more options available to them now to help monitor adherence to a gluten-free diet and identify unintentional consumption.

Have you tried any of these methods or others not mentioned here to monitor gluten consumption? Leave a comment below to share your experience.

No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

References

1. “Celiac Disease Tests.” National Institute of Diabetes and Digestive and Kidney Diseases, U.S. Department of Health and Human Services, 22 Feb. 2021, https://www.niddk.nih.gov/health-information/professionals/clinical-tools-patient-management/digestive-diseases/celiac-disease-health-care-professionals.
2. “Endoscopic Biopsy.” Beyond Celiac.org, Beyond Celiac, 8 Feb. 2021, https://www.beyondceliac.org/celiac-disease/diagnostic-endoscopy/.
3. Everlywell Staff. “At-Home Food Sensitivity Test.” Everlywell.com, Everlywell, 2022, https://www.everlywell.com/products/food-sensitivity/.
4. Nima Partners. “A Gluten-Free Lifestyle Made Easier.” Nima Partners, Nima, 2022, https://nimapartners.com/.
5. Ratner, Amy. “At-Home Urine and Stool Tests That Detect Gluten Now Available.” Beyond Celiac.org, Beyond Celiac, 23 May 2019, https://www.beyondceliac.org/research-news/at-home-urine-and-stool-tests-that-detect-gluten-now-available/.