Even though I have changed the test service, I have decided to continue to offer the Cyrex tests as they are SO important and needed. They are not easy for you to get in any other way and I couldn’t bear the thought of you not getting what would truly help you!
Unsure if you need a Gluten Test?
Check the Gluten Illness section in the A-Z – there are several pages in the menu. Read them all through – they will probably amaze you and make you have a few aha moments!
OK, convinced gluten might be an issue, let’s see what we can find out then.
NOTE: do not just stop gluten as you can’t test once it’s out of your system and is is FAR better to get something on paper and a diagnosis if you can so you know what you’re dealing with and how to target treatment/future diet, prescriptions, supplements etc.
Strap yourself in; this can get complicated – it is NOT just about standard coeliac testing or ‘gluten’ foods, trust me!
In general, my advice is to do a Cyrex 3x if you want to confirm a gluten reactivity and what type that might be – you have to be eating wheat, rye or barley regularly. For why to do this rather than a standard coeliac test, see below. Don’t forget to do a total antibody GAM Test (PHC) test to make sure your results are viable if you think your immune system might be low – see more on that later. Then, if positive or negative, check your cross-reactive foods with a Cyrex 4 or FIT 132 (RG). Next, consider any other issues such as leaky gut, leaky blood-brain barrier, autoimmunity and triggers of that such as chemicals, environmental toxins and pathogens (bacteria, viruses etc) as described below. Use Cyrex 14 to start with for that.
This medical field is evolving so fast it is sometimes hard to keep up! What we do know now is that there is a whole spectrum of gluten illnesses, not just coeliac disease (CD). CD is the most studied and is related to an autoimmune reaction in the gut, on the villi specifically, triggered by gliadin, one of the peptides in gluten grains. So far, so good.
We know that many people are misdiagnosed or undiagnosed coeliacs, but we also now know that you can have other gluten related disorders (GRDs). In fact, gluten or gliadin IgE allergy, IgG delayed intolerance and non-coeliac gluten-sensitivity, which affects the neurological systems more than the gut, are probably much more prevalent.
Testing these disorders is also evolving, but we do now have a strategy for finding most of the hidden coeliacs and GRD sufferers previously told they had no problem with gluten and it was all in their heads!
Before giving up gluten….
First, before giving up gluten, you need to test for coeliac disease to rule it in or out. This is often negative because mainstream tends to look for gliadin 33-mer and transglutaminase 2 antibodies linked to villi autoimmunity only. We know of plenty of others now and it seems daft to only look for the well-known ones.
I recommend you do Cyrex 3x testing as a minimum now to look for as many of the peptides and transglutaminases as you can. This is not perfect but this is so much better than what we’ve had up to now. I generally pick up most problems with it – and many who show nothing on the mainstream test! Many gluten experts – and, in fact, recent medical advice for doctors (2020) – believe that just one positive gluten antibody is enough to confer a gluten illness diagnosis. That may not be coeliac, there are other types as I have explained above.
You can view all of the Cyrex tests here and the Cyrex FAQ here and a sample report here – they all look like this one but with the different analytes tested. Note: equivocal is taken as a weaker positive, not borderline.
I can do a standard 33-mer gliadin and transglutaminase test if you wish via the Coeliac Profile (RG), but I find myself constantly saying: ‘yes, but now test Cyrex 3 before you believe a negative!’
The Cyrex tests are ordered via the UK lab and drop-shipped for you to the US. The samples need centrifuging – pls see the FAQ for more on how to do this. Please also note: you must write your date of birth on the vials as we would do it normally in the UK/Europe as in 11/4/1987 for 11th April 1987 or your samples will be rejected. I have no idea why, but this is now Cyrex policy.
Measuring total immunoglobulins first….
The Cyrex tests measure a mix of IgA and IgG antibodies. Be aware that some people can have low levels of these antibodies if the immune system is not brilliant. If doing an important – and often expensive – food intolerance/sensitivity test, it is wise to do a quick check on your totals.
You would use a GAM Test (PHC) which will show you if any of your IgG, IgA or IgM antibody levels are low. If, say, your IgA was low in total ie. you’re not producing much, then any further testing that measures IgA might show allergen reactions are lower than they really are. It’s not that you can’t have those tests done; more that you have to factor that in when looking at your results. In that scenario, you’d think: ‘Aha, this IgA test result for beef is borderline, but I know my IgA is low so it is probably more likely higher than that and positive.’ Do you see?
If you’ve already stopped eating gluten…
You can still do Cyrex 3x if you’ve not been off long. See the tips below for specific timings etc. I do NOT recommend reintroducing gluten for testing – and neither do most of the experts I speak to – because of the potential for causing more damage.
OK, let’s stop for a little moment of calm before we continue….
OK, better? Onward…
Cross-Reactive Gluten Foods Testing: The Healing Diet
The standard coeliac diet suggests that you avoid ‘gluten’ in wheat, rye and barley. However, that is a misnomer in that what you are actually avoiding is ‘gliadin’. Gluten is a much more complex molecule. The use of the term gluten has caused a lot of confusion. Just know that the standard coeliac testing and diet involved gliadin because that’s what they originally isolated as the villi-attacker in CD. There are a LOT more types of gluten that people may be having a problem with.
It is now believed by some, including me from personal and clinical experience, that many coeliacs and indeed GRDs generally, are not healing because they are reacting to other foods that cross-react with gluten/gliadin.
The body gets confused and reacts in the same as it would to the gluten. Dairy and other grains are the most common. Cyrex 4 has been designed specifically to help you find if you have antibodies to the cross-reactive foods and, usefully, also to some of the most common GF diet substitute foods. However the FIT 132 (RG) test includes all those and many other foods too so I would generally say do that.
Food sensitivity testing is a really complex field. Have a look at the Allergy & Intolerance Testing page here for how to do it right. Essentially, the summary says do a FIT 132 (RG) as a brilliant starter.
If you can take the pressure off your body by removing the key ‘inflamers,’ as I call them; you will heal much more effectively.
Gluten Illness Treatment
Apart from the diet – all-important that you remove the key allergens – not just gluten, as explained above – there are other things you can be doing to help yourself heal. Note that most GRDs are NOT going to get gluten back, but you can help your villi heal, offset the possible malabsorption and investigate and eliminate/prevent future autoimmune issues.
You need an idea of what your specific GRD is up to in the body so you can devise a way to combat it.
You can read a lot more about this in my Gluten Plan – I wrote it all down as I was researching it for you – it took me two years.
Mucosal Immune Test: Array 14
This is a salivary SIgA test which is looking for triggers and causes of loss of tolerance to foods, autoimmune triggers etc. It’s a fab all-rounder test. You might find you want to start with this one first. See my post on SIgA testing and the Array 14 here.
Leaky Gut or Blood-Brain Barrier
For more info on leaky gut generally, see the Leaky Gut Factsheet here.
You can check the damage gluten has done to your gut with a gut test that includes zonulin, such as Cyrex 2, or the Advanced Intestinal Barrier Test (RG), which also includes DAO and Histamine. See the Gut Tests bit about Leaky Gut here. Gluten is known to affect the functioning of the tight junctions in the gut wall, which makes you hyper-permeable or ‘leaky’ in common parlance.
I think if you have sensitivities to other stuff as well as gluten, you can possibly assume and treat this without testing, although it can give some useful targeting info on whether the leakiness is more about food or bacterial infection. It also gives you a progress marker you can monitor.
Similarly, you can test now for a leaky blood-brain barrier using Cyrex 20. We know that most GRDS are actually affecting the brain and nervous system (think: brain fog, movement disorders, migraine, anxiety, ataxia, depression etc). Sometimes, seeing this leakyness on paper answers a lot of questions. Again, it can act as a progress monitor. I don’t find it that often, but it absolutely vital to identify and deal with it if it is there.
You can also now check for evidence of leaky gut and SIBO in the small intestine with Cyrex 22. This is very different to the breath test in that it is looking for antibodies to bacterial cytotoxins released in SIBO rather than the gases we produce. It also looks for evidence to see if the cytotoxins have caused a leaky gut. You can see more info on this sheet here.
We know that gluten is the only common denominator found so far in autoimmune disorders, which is really exciting info! Coeliac disease is an autoimmunity attack on the absorptive villi in the gut, hence the problems that come with CD illness. But that is what we know and have studied. Other people have autoimmune thyroid or adrenal issues, ovarian attack (infertility is common in GRDs), skin diseases, reactive arthritis, psoriasis etc etc. The list goes on.
First, check if autoimmune disease markers are present. Use Cyrex 5 for a really comprehensive autoimmune screen (you can see an interpretation table of what each antibody means etc here), Cyrex 6 for diabetes, Cyrex 7 or 7X for the neurological autoimmunity screen, Cyrex 8 for joint autoimmunity and Cyrex 20 for blood-brain. All of those separate tests are included in the Cyrex 5.
Pathogens and Other Triggers
Next, consider if pathogens are causing your issues. Cyrex 12 assesses IgG immune reactivity to pathogens that are documented triggers or exacerbators of autoimmunity and chronic disease.
The test looks for IgG antibodies to various pathogens including oral pathogens, gastrointestinal parasites, bacterial and stealth pathogens, environmental moulds (molds), viral pathogens and tick-borne pathogens – you can see all of them here. If an IgG antibody is present, it doesn’t show a current infection, but it suggests there is a hidden or latent pathogenic problem that may well be causing you problems or acting as a trigger.
It can also be a good idea to consider levels of known toxic chemicals in your system. Could you have a high levels of something like glyphosate (Round Up) in your system that is triggering cross-reactivity to organs and tissues maybe or messing about with your gut flora, hormones etc?
To check the presence of toxins in your system, use the Glyphosate Test (RG), GPL-TOX Test (RG) which looks for 172 different environmental pollutants and/or the GPL-Mycotox (PHC) which looks for the most common moulds (molds for our US friends). You can also check Cyrex 11 for any clues that you are immunologically reacting to any of the most common ones. In other words, you can now check for presence and immune reaction to them.
For much more on this whole complex field, do read much more in the Gluten Plan here.
Meantime, here’s a lovely calming picture to enjoy before we get to the Testing Tips, of which there are many…
In general, my advice is to do a Cyrex 3x if you want to confirm a gluten reactivity and what type that might be – you have to be eating wheat, rye or barley regularly. For why to do this rather than a standard coeliac test, see below. Don’t forget to do a total antibody GAM Test (PHC) test to make sure your results are viable if you think your immune system might be low – see more on that later. Then, if positive or negative, check your cross-reactive foods with a Cyrex 4 or FIT 132 (RG). Next, consider any other issues such as leaky gut, leaky blood-brain barrier, autoimmunity and triggers of that such as chemicals, environmental toxins and pathogens (bacteria, viruses etc) as described above. Use Cyrex 14 to start with for that.
Q: Do the Cyrex samples need centrifuging?
Q: If I have one Cyrex test done, can I have another one done on the same blood sample?
A: Yes, you can. You can add on multiple tests within the first 21 days. They then freeze your blood sample for 90 days, so between 21 and 90 days you can add on other tests once only and they will be done once the sample has thawed. This is most commonly done, for example, if you have done Cyrex 3, found a problem and then want to test the cross-reactive foods with Cyrex 4 and/or the predictive autoimmune antibodies Cyrex 5. We just ask them to use the same sample. I wish all the labs would do this!
Q: Can I do the Cyrex tests if I am off gluten?
A: If you have been off it for more than a few months or even years, doing the test can actually show you if you are still producing antibodies and therefore if your diet is good enough to heal. If you find something, it means you are likely still consuming some gluten hidden somewhere or a cross-reactive food. That is crucial knowledge for healing. Generally, though, this test would be done BEFORE you give up gluten if you are trying to confirm a GRD. No gluten in your system = no antibody production so the test won’t find anything.
Q: Can I do the Cross-Reactive Foods test, Array 4, or the Food Screen, Array 10, if I am off some of the foods?
A: For antibody tests, you need to be eating the food or have done recently.
Q: Can I continue or go back onto the foods safely if the antibody tests are negative?
A: For gluten, you need more tests to know whether that is safe. The most common reaction is an antibody one but there is a possibility that you have a different mechanism. If all antibodies for gluten are negative, that’s a great sign. For the cross-reactive foods, you may not yet be as far as producing an antibody, so I advise an elimination diet as a double-check to be certain. Also, these can trigger at any time so keep your eye on these foods in future and re-test as appropriate.
Q: Can children do Cyrex tests?
A: Yes, it is fine for under 16s. For small children, the lab says: “No restriction on age. If they are old enough to be eating gluten, they can be tested. The difficulty is generally taking the blood.”
Q: I have got saliva and blood vials in my test kit. Is that right?
A: Yes, there is one test kit for all the tests so just use the one you need and discard the other, or keep it for later in case you need a blood test further on. The UK doesn’t do the Cyrex saliva test.
Q: Will I need follow-up tests?
A: The best way of finding out your progress is to repeat your test so you know you are on the right diet, protocol and path to heal.
Q: Is there any logic to sequential testing with the Arrays? Do the results of one test provide direction for the other tests?
A: Yes. There are logical sequences to testing. Ideally we recommend ordering Arrays 2, 3, 4 and 5. Another option is to start with Arrays 2 and 3 and depending on your results, add Array 4 and 5 if necessary. The lab will freeze your blood and you can order additional test(s) within 90 days. I have added a combination test of the most frequent food screen now – arrays, 3, 4 and 10.
Q: Are there any medications, foods, conditions, or other factors that could interfere with the results of a Cyrex test?
A: Yes. While Cyrex is unable to provide an exhaustive answer to this question due to the interactive complexities and varieties of medications and patient circumstances, the following has been noted:
Immunosuppressant and corticosteroid drugs can reduce antibody production and cause false negative results. Inhalers specifically can affect the results of Cyrex’s oral fluid testing (Array 1). Wait two weeks after completion of inhalant dosages before collecting the specimen. If you are on steroid treatment, it doesn’t necessarily mean you can’t have the Cyrex tests, but you need to bear in mind that any scores might be lower than they would be without the steroids so that could mean they look OK or low level when they are not. If in doubt, talk with your health professional and/or Cyrex for advice.
Limited assessments on the effects of aspirin, acetaminophen, and antipsychotics on Arrays 2-4 have been performed. No noticeable effects were observed.
Unknown cross-reactive epitopes from foods and microorganisms may stimulate the antibody production in the absence of a true antigen. Cyrex has already developed Array 4 in order to recognize the most common antigens in this regard.
A gluten-free diet can cause false negative results on gluten protein/peptide tests.
Certain conditions, such as ileal pouch surgery, may cause a false positive celiac serology.
Q: How soon after finishing steroids can a patient do Cyrex testing?
A: 60 days. It takes this period of time for the medication to clear the system and allow the normalized production of antibodies, required for immune testing, to resume.
Q: How long does it take to see reductions in the antibodies to the lipopolysaccharides, actomyosin, or occludin/zonulin after the gut barrier is restored?
A: Antibody levels decrease on a curve and not in a line. Based on patient populations, initial significant decreases—after no exposure—can be seen in two weeks for IgA, four weeks for IgM, and six weeks for IgG. Lower levels can remain longer after this initial reduction. IgG can be found in some patients up to one year after exposure.
Q: If someone recently had an infectious gastroenteritis, would this temporarily cause a leaky gut and give a positive result to the Array 2?
A: In a person with infectious gastroenteritis, you may detect leaky gut. It is recommended to wait at least four weeks after completion of treatment before ordering Array 2.
Q: What if rye, barley, and Polish wheat don’t show up as cross-reactive even though they contain gluten?
A: The gluten-sensitive patient should abstain from all gluten-containing grains, whether or not the four gluten-containing grains on Array 4 result positive. The patient may not respond to those grains due to the fact that we are testing the whole grain molecule, which is made up of multiple proteins. The proportion of the gluten proteins may not be enough to elicit an immune reaction in all gluten-sensitive patients. However, if the patient consumes the grain, during the digestive process, the gluten proteins of rye, barley, spelt, and Polish wheat will cause an immune response.
Q: I don’t see sugar listed on Array 4, but I have heard that sugar can be as reactive as dairy.
A: Sugar by itself is too small to elicit an immune response. However, if sugar combines with a protein to form a complex, the body could react to the complex. The number of possible complexes is nearly endless, and therefore, we cannot add it to our panel.
Q: What kind of chocolate do you test…milk or semi-sweet?
A: Milk chocolate
Q: What kind of potato do you test?
A: White potato
Q: What kind of rice do you test?
A: Regular white rice
Q: What kind of yeast do you test?
A: A combination of brewer’s and baker’s yeasts
Q: Is espresso the same as coffee?
A: Yes, espresso comes from a coffee bean. It is roasted, ground, and brewed a bit differently than coffee, however.
Q: Can a gluten-free patient who tests positive for dairy-sensitivity on Array 4 consume whey?
A: No. Whey is a milk product.
Q: For the out-of-range items, what is the recommended procedure? Specifically, should these items be completely avoided for 6 months, 12 months, etc.? Should I re-test after a certain length of time, and then slowly reintroduce those foods if the re-test shows they are okay?
A: The cross-reactive foods must be avoided for life, just like wheat. If the patient is gluten sensitive, then the gluten-containing grains should also be avoided for life. Patients who test positive for all other foods can be slowly reintroduced to the foods on a rotation diet only after the gut has been healed. Retesting of Array 4 can take place a few months after the reintroduction has been implemented. If any of the foods are still positive, the patient should be instructed to avoid the food for life.
Q: I tested positive for many of the foods on Array 4, but my Array 2 leaky gut results were normal; is this right?
A: It is unusual but not impossible for a patient to have multiple food sensitivities with an intact intestinal barrier. [Ed: I would also note that there are several other mechanisms at play in leaky gut, see my Gut Tests page.]
Q: If I do the cross-reactive foods array and something (or multiple things) comes back as reactive, then can we assume that I am gluten sensitive?
A: No. A positive result may represent a sensitivity response or gluten cross-reactivity. Therefore, one may not assume gluten sensitivity based on positive results. Confirming gluten sensitivity requires a direct method of testing. Furthermore, wheat is made up of more than the gliadin (gluten) proteins and peptides. Some patients are sensitive to other components of wheat, such as wheat germ agglutinin or gluteomorphin. These are not gliadin and therefore not technically gluten. These patients would be considered wheat sensitive. For these patients, the gluten-containing grains on Array 4 may not elicit an immune response.
Q: Why doesn’t Cyrex offer genetic testing for celiac disease and gluten sensitivity?
A: The clinical application of genetic testing is specifically ruling out Celiac Disease in high-risk individuals. It is not appropriate for the broad-spectrum immune response against gluten. There is value in the genetic testing of the celiac genes (HLA typing for DQ2 (DQA1*05; DQB1*02) and DQ8 (DQA1*03; DQB1*0302), but it is not a first-tier test. There is a strong correlation with certain other conditions and celiac disease such as diabetes type 1, Down’s syndrome, a family history of celiac disease, Williams syndrome, etc… The genetic testing is required with these conditions if the celiac serology is negative. Even with negative celiac serology, a patient on the spectrum of gluten sensitivity may be positive to other gluten peptides (Array 3).
When negative for these genes, the patient’s likelihood of developing celiac disease is very small. But that patient may still be at risk for nonceliac gluten sensitivity. When positive for these genes, a patient’s risk of developing full-blown celiac disease is only about 2%. These patients require ongoing monitoring of an immune reaction to the peptides of gluten.
Q: Do I have to fast before my Cyrex test?
A: Detailed specimen collection instructions regarding fasting are included in each Specimen Collection Kit, which must be read before collecting any specimens. Blood testing has no fasting requirements or collection restrictions. However, eating a high fat meal prior to your blood draw can cause your serum specimen to be lipemic. Lipemic specimens are rejected by Cyrex Labs.