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Celiac

Designed for a 60-second scan in primary care. Use this to explain why this theory fits, what would weaken it, and which tests are most worth discussing.

Why this still fits

I think my brain fog might be connected to gluten. I want to get tested before I change my diet so the results are accurate.

What would weaken it

  • -Negative celiac testing with adequate gluten exposure and no GI, skin, or deficiency pattern supporting it.
  • -No relationship to gluten exposure and no broader signs of malabsorption or autoimmune overlap.
  • -Food sensitivity, SIBO, histamine, or another gut explanation fits the pattern better than celiac disease does.

Key points to communicate

  • •I want to know whether this is true celiac disease, non-celiac gluten issues, or another gut pattern entirely.
  • •Please tell me what testing needs to happen before I remove gluten and muddy the diagnosis.
  • •If celiac isn't the answer, I want to know what still explains the gut-plus-fog pattern.

Bring this to the visit

  • •Any prior celiac panel results: tTG-IgA, total IgA, EMA, DGP.
  • •A food diary showing gluten exposure patterns and symptom timing.
  • •Family history of celiac disease, autoimmune conditions, or type 1 diabetes.
  • •A list of GI and non-GI symptoms: bloating, diarrhea, joint pain, dermatitis, anemia.

Useful screening structure

  • -tTG-IgA with total IgA (to rule out IgA deficiency causing false negatives).
  • -DGP-IgG as backup if IgA is deficient.
  • -Endoscopy with duodenal biopsy remains the gold standard for confirmation.

Tests and measurements to discuss

Celiac Testing (tTG-IgA + total IgA)

What this helps clarify: Celiac disease screening - gluten triggers neuroinflammation

Range context

Negative (<4 U/mL)

How to use the result

Save the result with date and symptoms from the same week.

Nutrient Status (iron/ferritin, B12, folate, vitamin D, calcium, zinc)

What this helps clarify: Severe deficiency doubles dementia risk

Range context

40–60 ng/mL

How to use the result

Save the result with date and symptoms from the same week.

HLA-DQ2/DQ8 Genetic Testing (if already GF or serology equivocal)

Questions to ask directly

  • •I have been eating gluten-free already - do I need to do a gluten challenge for accurate testing?
  • •Could I have celiac with negative serology? When is biopsy warranted anyway?
  • •What co-occurring deficiencies should we check: iron, B12, folate, vitamin D, zinc?
  • •If I am strict GF but still foggy, what else should we investigate?

Functional impact snapshot

  • -Track fog severity relative to confirmed or suspected gluten exposures.
  • -Note the timeline: how many hours after exposure does fog start, and how long does it last?
  • -Rate whether cognitive function improves progressively over months of strict GF adherence.

Escalate instead of self-managing if

  • •Severe malnutrition, significant unintentional weight loss, or refractory symptoms despite strict GF diet.
  • •Progressive neurological symptoms: ataxia, peripheral neuropathy, or seizures.
  • •Persistent or worsening symptoms after 6-12 months of strict gluten-free diet - consider refractory celiac.

Peer-reviewed references

  1. 1. Rubio-Tapia A et al. ACG Guidelines Update: Diagnosis and Management of Celiac Disease. Am J Gastroenterol. 2023;118(1):59-76. PMID: 36602836 [DOI]
  2. 2. Lebwohl B, Sanders DS, Green PHR. Coeliac disease. Lancet. 2018;391(10115):70-81. PMID: 28766137 [DOI]
  3. 3. HTTPS://WWW.NICE.ORG.UK/GUIDANCE/NG20 [DOI]