A reader with celiac disease recently wrote to ask whether her adult children should be tested for celiac disease even if they have no symptoms. Two doctors have told her yes, and two others told her “Why bother?”

She’s also gotten conflicting advice from her doctors about whether she herself will need further blood tests for celiac antibodies now that her second blood test was negative.

It’s not unusual to get different opinions from different health care providers. Often, the differences are due to the fact that there’s no single right answer to the problem.

But for the doctors who don’t know why our reader's kids should be tested, there is an answer: First-degree relatives of people with celiac disease (children, parents, and siblings) have a 1 in 22 chance of developing celiac disease in their lifetimes. Furthermore, the prevalence of celiac disease in children of celiac patients is approximately 15%. If her children have the genes for celiac disease -- or if they don't know whether they have the genes -- they should have blood tests at regular intervals to see whether celiac disease has developed, even if they have no obvious symptoms. (The sooner it’s diagnosed, the lower their risk of serious complications!)

As for follow-up testing, the best practice is somewhat less clear. Here’s what the University of Chicago Celiac Center says on its fact sheet (available online): “New celiacs should receive follow-up testing twice in the first year after their diagnosis…After that, a celiac should receive follow-up testing on a yearly basis.” Dr. Peter Green, director of the Celiac Disease Center at Columbia University, cautions in his book Celiac Disease: A Hidden Epidemic, co-authored with Rory Jones, that blood tests are not very accurate indicators of intestinal damage, and the best way to assess a celiac patient’s success on the gluten-free diet is to perform a repeat endoscopy and biopsy after several years.

To learn more about testing for celiac disease, read the following articles:

• If my relative has celiac disease, what are my chances of having it?
• Genetic Tests for Celiac Disease
• Celiac Disease Diagnosis with Blood Tests and Biopsy

Starbucks might soon be offering its customers more gluten-free options, and in fact the company says it’s already “doing some operational testing” of this idea in a few cities. On the Ideas in Action blog on the Starbucks website, the Starbucks Food Team writes, “Before we continue moving forward, we would love some feedback from you about what you want to see in gluten-free offerings.”

Here are their questions. Visit the Starbucks site to give them your feedback.

• What specific gluten-free products would you like to see in our stores?
• Would you prefer to see it individually packaged or unpackaged?
• How would you like to learn we have gluten-free products? For example, would you like to see it on a sign or would you prefer the barista tell you?
• Where would you like to see gluten-free products in the store; in the pastry case or placed elsewhere?
• The ingredient costs of gluten-free products tend to be higher, so would you understand if we charged more for the gluten-free version?

Anyone who's looking for a low-carb substitute for gluten-free pasta should try some shirataki noodles (also called konjac noodles). They’re made from the root of the Amorphophallus konjac plant, which grows in Asia. They have no fat, sugar, starch, or protein. They do contain a beneficial water soluble fiber known as glucomannan.

Especially if you’re concerned about weight gain (like me and the others who’ve been discussing this problem in the forum), these noodles could be a great addition to your diet. Laura Dolson, About.com’s Guide to Low Carb Diets, has posted an interesting article about shirataki noodles, with instructions for preparing them.

Yesterday, the New York Times reported that a major laboratory services company in the U.S. -- Quest Diagnostics, Inc. -- has “provided possibly erroneous results to thousands of people who had their vitamin D levels tested in the last two years.”

In most cases, the test result was too high, meaning that people who needed vitamin D supplements would not have realized it. In some case, however, the test result was too low, leading doctors to prescribe doses that were too high.

People with celiac disease often have low levels of vitamin D, particularly when they’re still eating gluten and are suffering from malabsorption of nutrients. Many of us continue to have low vitamin D levels after we start the gluten-free diet, in part because most commercial gluten-free products are not enriched with extra vitamins.

Quest Diagnostics has sent letters to thousands of doctors whose patients may have been given incorrect test results. If you’ve had your blood levels of vitamin D checked in the last two years and you used a Quest laboratory, check with your doctor.

You can read more about vitamin D and celiac disease in the following articles:

Complications of Untreated Celiac Disease
Side Effects of the Gluten-Free Diet
Osteoporosis and Celiac Disease