Written and medically reviewed by Dr. Dan Wool, NMD

Arizona-licensed Naturopathic Doctor and Gastroenterology Specialist

Originally published: December 9, 2024

Updated: October 19, 2026



Gluten and Diagnosing Celiac Disease



[video transcript] Diagnosing celiac disease presents a unique challenge, often referred to as the gluten-free conundrum.


The gold standard, obviously, is to get an endoscopy and get a biopsy. Usually, when gastroenterologists are in there, they see the telltale signs.


If somebody's eating gluten and they have celiac disease, you have these microvilli. They actually look like these little palm fronds, and they are where your nutrients get absorbed.


With celiac, they look like a haystack that has been bombed out – that's a telltale sign for diagnosing celiac disease.


Now, the gluten-free conundrum is that in this day and age, gluten-free diets are... popular.


It's a pretty good go-to when people have unexplained gut health issues.


And so somebody with celiac disease will go on a gluten-free diet, and then you can't test them because in order to see those telltale signs on endoscopy, you need to be eating gluten.


The same goes for blood labs. There are things called tissue transglutaminases that we can check in the blood to see if somebody is positive for celiac disease.


Same thing though: if you are not eating gluten, it's not going to show up as a positive.


It actually, as a medical doctor, is unethical to even test those [knowing the patient is gluten-free].


So if you have a doctor who hasn't asked you about your gluten diet or gluten-free diet, that should be the first question they're asking when they're running tissue transglutaminases to try to diagnose celiac.



Understanding Genetic Markers for Celiac Disease (HLA DQ8 & DQ2)


The other celiac tests we need to be aware of are HLA, specifically HLA DQ8 and HLA DQ2.


These are genetic markers that just tell us whether or not you are predisposed to having celiac disease.


Now, if both of those show up as positive, as it did for one of my patients the other day, in the absence of tissue transglutaminase positive or other findings on endoscopy and other tests that we can run, well, that only tells us that you are predisposed to getting celiac.


It doesn't mean you are celiac. [These] are some things that we have to consider.


The Real Challenge: Diagnosing Celiac on a Gluten-Free Diet


So then how do you diagnose celiac disease when you have a gluten-free diet?... Honestly, it's really difficult.

One backdoor way, no pun intended, is a stool test.


When we run something like a GI Map from Diagnostic Solutions or a Gut Zoomer from Vibrant [Wellness], we can actually see anti-gliadin IgA.


That's one of the other IgA markers we can run, and we can see if that is elevated and whether there's damage occurring and kind of trickling down into the stool.


But it also runs into that gluten-free conundrum, times two, [which] can mean that you have something called non-celiac gluten sensitivity.


So someone could be sensitive to gluten, not necessarily celiac, but if you're eating a gluten-free diet, you're going to have to trial off gluten for some time and, unfortunately, be sick.


That's the conundrum.


Go back to being ill and then get your endoscopy, your tissue transglutaminases, your anti-gliadin IgA, and that is the conundrum.


You could either go back to being sick, being on gluten, and test all these things and get an official diagnosis.


Or you could just continue to be gluten-free and know that every time you add gluten back in the diet, you're a complete wreck, and fingers crossed that is celiac disease.


So those are some things to consider when diagnosing celiac disease.


Seek a Holistic Approach for Your Celiac Disease (from a doctor who has it!)


If you want a holistic approach to celiac disease, you should get in touch.


For starters, I have celiac disease and have a special empathy for patients like us!  


I really encourage you to check out my website, drdanwool.com. Find me at @DrDanWool on all the socials. Please comment below; I'd love to hear from you and answer your questions here on the YouTube channel. And in the meantime, it's fix your gut, solve your health.



Oh...one more thing

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