Celiac Disease affects currently 1% of the population and is on the rise. It doubles in prevalence every twenty years.
It is a serious autoimmune disease but is often thought of like being a simple lactose intolerance.
How is celiac disease defined? It is an “Autoimmune disease characterized by aberrant response to gluten in genetically susceptible individuals.” 1
If you are new here, you may ask-- what is an autoimmune disease? In simple terms, an autoimmune diseases is where the body’s immune system attacks its own healthy cells.
If you know someone with an autoimmune disease, you know they are terrible. Some of the mechanisms that are meant to protect us get broken down and healthy tissue gets destroyed whether it is kidneys, lungs, stomach, etc.
The study we reference in this newsletter is titled, “Celiac Disease and Non-celiac Wheat Sensitivity: State of Art of Non-dietary Therapies” an open access article from Frontiers of Nutrition. 1
- Celiac disease is specifically triggered by the consumption of gluten in any form: wheat, rye, barley, Brewer’s yeast, malt, spelt, etc.
- Celiac disease has a strong hereditary component.
- Most of our food in America is processed and contains gluten. Gluten is in most foods that we consume.
- Celiac is different from gluten sensitivity, in that with celiac, the immune system starts to kill off the small intestines called enteropathy. There can also be other manifestations of celiac that can be joint related, or even neurological.
Celiac Disease affects currently 1% of the population and is on the rise. It actually doubles in prevalence every twenty years! Many doctors believe this is due to changes in the microbiota of our guts.
Why is celiac more common now than ever?
Changes in our guts may be due to medications we take, substances in our water supply, changes in how our food is produced, the rise of antibiotic use, etc. These individually can lead to changes in the microbiome. (It is worth noting that autoimmune diseases in general are on the rise, not just celiac.)
How does celiac disease develop?
Gluten is known to be a tough molecule for the gut to break down and it is thought to be tougher now than it used to be. This is possibly due to more pesticides being sprayed on wheat as farmers attempt to yield a larger and more abundant harvest. Additionally, wheat has been hybridized, (not genetically modified) which has probably also contributed to it’s change.
“First, gluten must be eaten and digested in the stomach and small intestine. Since gliadin is hard to digest, small peptides remain in the intestine. These peptides then cross the epithelium (cell layer) into the mucosa. Researchers are still trying to understand how this happens. Certain proteins, such as zonulin, may make the cell layer more permeable, so peptides can pass through to the underlying mucosal layer.
Once the gliadin peptides get to the mucosal layer, they become modified by tissue transglutaminase (tTG) to fit better within the grooves of the MHC class II proteins on antigen presenting cells. Only antigen presenting cells with HLA-DQ2 or HLA-DQ8 haplotypes are able to present deamidated gliadin peptides and activate CD4+ T cells.
Once the CD4+ T cells are activated, they produce Th1 helper T cells, which make cytokines that recruit and activate other innate immune cells and CD8+ intraepithelial lymphocytes (IELs). Th17 cells, which play a role in many autoimmune diseases, are also involved in celiac disease. Activated Th2 cells may help to activate B cells that recognize tTG, resulting in the production of antibodies against tTG.
Together, the Th1 CD4+ T cells, IELs, innate immune cells, and antibodies cause inflammation and damage to the cells of the intestine.
Gluten is the trigger for this entire process—if it is removed from the diet, there is no immune response and the intestine is able to heal.” 2
Symptoms of celiac versus non-celiac gluten sensitivity:
Basically non-celiac sensitivity is when someone eats gluten and they don’t feel well. The way it is diagnosed is to stop eating gluten for 4-6 weeks and if you feel better, you have a non-celiac gluten sensitivity. Some non-celiac gluten sensitivity will have antibodies to gluten but will not have the diagnostic findings of celiac disease in terms of the positive tissue transglutaminase antibodies, endomysial antibodies, and the duodenal biopsy features.
Symptoms of classical clinical celiac presentation include “Gastrointestinal symptoms such as diarrhea, malabsorptive manifestations, constipation, and abdominal pain. In addition, extra intestinal symptoms such as...neurological symptoms, dermatitis and arthritis may be present as well, in particular among adult patients.” 1
We also know now that those diagnosed in childhood are more likely to have intestinal symptoms while adults are more often experience neurological problems when they are diagnosed with celiac. Around 30% of adults present with neurological problems, not necessarily gastrointestinal problems, so just because you don’t experience GI symptoms, does not mean that you don’t have celiac disease as an adult.
What tests determine celiac and is it misdiagnosed?
The tests used to determine celiac:
Blood tests- tissue transglutaminase antibodies, endomysial antibodies, gliadin antibodies may or may not be positive. You can also have blood tests to test for the genetic predisposition.
The golden standard workup also includes a duodenal biopsy. With the biopsy, they go in and take out a small piece of the small intestine and they look at it under a microscope because they are looking for characteristic features. These features include: increased intraepithelial lymphocytes, villous atrophy (the finger like projections of these enterocytes are called villi) and increased depths in the intestinal crypt.
The Marsh Criteria determines how the villi have atrophied and how bad the intestinal depths are. How much intraepithelial lymphocytes you have...that will constitute these different levels of the Marsh Criteria and thus how bad the celiac disease truly is.
Some illustrations and images of the March Criteria:
Image of healthy villi versus celiac disease.
What are the common treatments for celiac?
The treatment for celiac disease is to eat strictly gluten free. Unfortunately, researchers have shown that “Adherence to a gluten free diet can be low, as low as 36-45%.”
This is one autoimmune disease where we can specifically point to a trigger and cause and the treatment is to avoid it, but only around a third of those diagnosed are doing so. Basically the excuses for not being gluten free are “limited availability, high cost of gluten free products and social isolation…”
This is an issue we see daily within our office and patient population. We hear “I’m not really on the diet” or “I cheated this week.” The word and understanding of the word “diet” have an overall bad connotation in our society and there is something about the psychology of the word “diet” that makes us not want to adhere to it even when it is for our own good.
All of that being said, there is a type of Celiac disease called Refractory Celiac Disease. Refractory Celiac Disease is when an a person may be on a gluten free diet and still not feel well- this is not completely uncommon. There are two types of refractory Celiac Disease and one is basically if you stay on the gluten free diet, by five years you will be healed. Type two refractory disease can take five years and only half of those individuals will feel better. Dr. Gates argues that those cases probably have other food sensitivities and you probably want to really be working to heal your intestinal permeability.
Are gluten free products actually gluten free?
Most of the time they are. There is a plethora of content about this online but there is also misinformation out there. If a product is certified gluten free, they have gone through inspections and are trustworthy. If it is not certified, proceed at your own risk.
Can a celiac disease patient ever eat gluten again?
There is much research dedicated to developing medications, enzymes, immune therapies, nanoparticles, genetically modified wheat, probiotics, a vaccine, and even a parasite to help the celiac population heal or be able to eat gluten again.
Here are some of the solutions researchers are testing:
-Endopeptidases are molecules designed to break down gluten and are being used basically as an enzyme to break down the gluten molecules.
-Medications to help the zonulin occludin complex stay together to prevent leaky gut.
-Medications that target other inflammatory immune cells in our system.
-Hookworms to try to get the immune system to fight the parasite rather than the intestines.
-Biologics (Enbrel, Ocrevus, and Humera are probably the most popular biologics monoclonal antibodies out there and so now they are looking at biologics for celiac disease.) Biologics are expensive but if only ⅓ of the celiac population is adhering to the gluten-free diet, then this will lead to the rationale as to why patients should be on these expensive treatments to control their symptoms instead of worrying about ingesting gluten. There is the huge potential for these companies to make a lot of money.
-Probiotics may help the symptoms of celiac disease, but it does not fix the problem.
This is not a complete list of the research and trials that are going on for celiac but none of these treatments have really shown to lead to what one would consider a cure or significant change.
So...can a celiac patient ever eat gluten again?
The answer is no but why would you want to? Gluten causes your intestines to die, it makes your immune system eat away at your peripheral nerves, and causes the degeneration of your cerebellum. It isn’t just that the stomach is affected, it can also affect your skin (dermatitis or pediformis), cause joint pain and has been associated with depression. This is why celiac patients should never eat gluten.
Why is gluten that important to us? Why are we so unwilling to part with a food product that causes so much damage? Why do we struggle with finding something new to love that will actually benefit our bodies and overall well-being?
Going gluten free is certainly difficult but we can do difficult things and difficult things get easier as time goes on.
Are you ready to let us cheer you on as you walk your healing journey? Are you ready to find out how Gates Brain Health can help you reduce inflammation, clear your skin, minimize stomach discomfort, brain fog, fatigue, arthritis, leaky gut, and allergies? Schedule your free consultation today!
This Article by Gemma Ward based on information shared by Dr. Gates here.
1. Serena G, D'Avino P and Fasano A (2020) Celiac Disease and Non-celiac Wheat Sensitivity: State of Art of Non-dietary Therapies. Front. Nutr. 7:152. doi: 10.3389/fnut.2020.00152