Chris Kresser: Next question is from Ariel that was sent in, and I think this is also the question on the live call here, “Could you identify simple rules of thumb for when Cyrex Array 3 and 4 results cause you to suspect autoimmune pathology and, therefore, order the Cyrex 5 test [as] a follow-up? You mentioned that testing positive for alpha-gliadin plus negative transglutaminase 2 is a cause to suspect autoimmunity. Could you please explain the reason for that suspicion?”
Actually, we might’ve had a miscommunication there. Alpha-gliadin plus transglutaminase positive and transglutaminase negative would actually suggest that there isn’t an autoimmune cause. If transglutaminase is positive, that would suggest autoimmunity because transglutaminases are enzymes in the body that if you see antibodies to those, that means the body is attacking itself. Anytime you see the transglutaminase is elevated, then that’s certainly one thing that will lead you to suspect autoimmunity. If you see that the gliadin transglutaminase complex [is] elevated, that’s another thing that might cause suspicion for autoimmunity because that is a complex of gluten or gliadins plus transglutaminase linked together, that there’s antibody production forward. Those are probably the main ones, but also if you just see a huge what we call polyreactive antibody presentation where you see just everything is elevated, those people also are often autoimmune.