Understanding Celiac Disease

Understanding Celiac Disease (from diagnosis to natural management)

Celiac disease is often misunderstood and underestimated due to its invisible nature. It is not a mere dietary preference or a lifestyle choice; it is a legitimate medical condition that requires strict adherence to a gluten-free diet.

To know more about this condition, read on

What is Celiac Disease?

Celiac disease is an autoimmune disorder that primarily affects your small intestine. It’s typically triggered when you eat gluten, a wheat, barley, and rye protein.

When someone with this disease consumes gluten, their immune system reacts by damaging the villi in the small intestine or those small, finger-like projections. Once damaged, your body’s ability to absorb nutrients from the food you eat decreases.

Wheat Allergy: A Snapshot

A wheat allergy is an immune reaction to wheat proteins, and it's usually driven by antibodies known as IgE. Gliadin, a component of gluten, is often the trigger for the allergic response. This places wheat in the top 10 food allergens. The allergic reaction is typically diagnosed through skin prick testing, but be aware - there can be false negatives because gliadins are not soluble in water.

The symptoms of a wheat allergy can show up within minutes to hours and may include issues with the respiratory system, gastrointestinal system, skin, and even anaphylaxis in severe cases. While it's common in infancy or toddler years, it's less common in adolescents and adults. The best treatment? Avoiding wheat, while barley, rye, and oats are usually safe.

Celiac Disease: A Deeper Dive

Unlike wheat allergy, celiac disease is an immune response triggered by gluten ingestion in genetically predisposed individuals. Gluten is found in wheat, rye, barley, and oats, each grain containing a unique protein that resists digestion in the upper gastrointestinal tract.

This condition affects around 1.4% of the global population, with varying prevalence in different countries. It's not that we've become better at diagnosing it; the increase in prevalence could be due to factors like early introduction of gluten, changes in wheat varieties, growing techniques, and food preparation methods.

Causes of Celiac Disease 

The exact cause of celiac disease isn’t fully understood. However, research suggests that it happens due to genetic and environmental factors. 

Here’s a more detailed explanation of these causes:

Causes of Celiac Disease
  • Genetic factors

    Certain genetic factors play a significant role in the development of celiac disease. The presence of specific genes, particularly the human leukocyte antigen (HLA) genes HLA-DQ2 and HLA-DQ8, is strongly associated with an increased risk of developing the condition, 

    Gluten Consumption

    Gluten is the main environmental trigger for celiac disease.

    When individuals with a genetic predisposition to the disease consume gluten, their immune system reacts by producing antibodies that attack the small intestine's lining. 

    Over time, this immune response damage the villi and impairs the absorption of nutrients.

    Environmental Factors

    While genetics predispose individuals to celiac disease, environmental factors are believed to play a role in triggering the condition. Some factors that have been suggested as factors that haven suggested as potential triggers include:

Infant Feeding Practice: The introduction of gluten to an infant’s diet, especially while they are still being breastfed, may influence the development of celiac disease. The timing amount of gluten introduced can impact the risk, the evidence suggests that introducing gluten too early (before 4-6 months of age) or too late (after 12 months) may increase the risk.

Gastrointestinal infection: Some studies have suggested that a certain viral or bacterial infection in the gastrointestinal tract could trigger the onset of Celiac disease or exacerbate existing symptoms. The theory is that these infections might induce an immune response that affects how gluten is processed in the body.

Gut Microbiota: The composition of the gut microbiota, the collections of microorganisms living in the digestive tract, has been linked to celiac disease. An imbalance in the gut microbiota may contribute to the development of the condition or influence its severity. However, more research is needed to fully understand this relationship.

It’s important to note that the exact interplay between genetic and environmental factors in celiac disease development is still not fully understood. Researchers are actively investigating these factors to gain more insights into the causes and mechanisms of the disease.

The Symptoms of Celiac Disease

Celiac disease can present with a wide range of symptoms that can vary from person to person. Some individuals may experience classic gastrointestinal symptoms, while others may have non-gastrointestinal manifestations.

Here’s an elaboration on the symptoms commonly associated with celiac disease: (add infographics)

Gastrointestinal Symptoms.png
Non-Gastrointestinal Symptoms

Important to note that not everyone with celiac disease will experience noticeable symptoms. Some individuals may have “silent” or “asymptomatic” celiac disease, meaning they have intestinal damage without apparent symptoms; these individuals are still at risk for long-term complications if the disease goes undiagnosed and untreated.

How Is Celiac Disease Diagnosed?

The diagnosis of celiac disease typically involves a combination of blood tests and a small intestine biopsy. 

Here’s a detailed  explanation of the diagnostic process:

Blood Tests

Serology Tests: Blood tests are usually the first step in diagnosing celiac disease. The primary blood test is the tissue transglutaminase antibody (tTG-IgA) test. Elevated levels of these antibodies indicate an immune response to gluten. If an IgA deficiency can occur in a small percentage of individuals, an IgG-based test may be used instead.

Total serum IgA: This test is conducted to determine if an individual has sufficient immunoglobulin A (IgA) antibodies for the accuracy of the tTG-IgA test. In people with selective IgA deficiency, alternative testing methods may be necessary.

Endomysial Antibody (EMA) test: If the tTG-IgA is positive, this test is often performed as a confirmatory test. EMA antibodies are highly specific to celiac disease and indicate an immune reaction to gluten.

Small Intestine Biopsy

If the blood test suggests celiac disease, a small intestine biopsy is usually performed to confirm the diagnosis. This procedure involves the removal of small tissue samples from the lining small intestine. It is typically done via endoscopy, where a flexible tube with a camera is passed through the mouth and into the small intestine.

During the endoscopy, the doctor will examine the small intestine and take multiple biopsy samples from different areas. The samples are then examined under a microscope for characteristic changes in the small intestinal lining, such as villous atrophy, increased lymphocytes, and damage to the villi.

Additional Tests 

Genetic Testing: While not used for definitive diagnosis, genetic testing can help identify if an individual has the HLA-DQ2 or HLA-DQ8 genes associated with an increased risk of developing celiac disease. However, since many individuals with these genes do not develop the disease, genetic testing alone cannot confirm or rule out celiac disease.

Follow-up Tests: After the diagnosis of celiac disease, additional blood tests may be conducted to monitor the response gluten-free diet and assess for nutrient deficiencies that may require supplementation.

It’s important to note that to obtain accurate results from blood tests and biopsies, individuals should continue to consume gluten-containing foods leading up to the diagnostic testing. Going on a gluten-free diet before testing can lead to false negative results and hinder an accurate diagnosis.

Its recommended to work closely with a healthcare professional experienced in celiac disease diagnosis to ensure appropriate testing and interpretation of results.

Treatment for Celiac Disease

The primary treatment for celiac disease is strict adherence to a lifelong gluten-free diet. The complete elimination of gluten from the diet is essential to manage the symptoms, promote intestinal healing, and prevent long-term complications. Here’s an elaboration on the treatment and management of celiac disease:

Gluten-free Diet

Avoiding gluten-containing foods: This includes wheat, barley, rye, and their derivatives. Common sources of gluten include bread, pasta, cereal, baked goods, sauces, and processed foods. It’s crucial to carefully read food labels and be aware of hidden sources of gluten.

Switching to gluten-free alternatives: There are many gluten-free alternatives available, such as rice, corn, quinoa, amaranth, and gluten-free flours made from nuts, legumes, or grains like rice or corn.

The Cyrex array 4 test is an excellent option to assess if you are also reacting to other non-gluten grains, this is commonly called cross reactivity.

Be cautious of cross-contamination: Avoiding cross-contamination with gluten-containing foods during preparation, cooking, and serving is essential. This involves using separate utensils and cooking surfaces and avoiding shared toasters or deep fryers.

Education and support: Working with a registered dietician specializing in celiac disease can guide you on following a gluten-free diet, help with meal planning, and identify safe food options. Support groups and online communities can also offer valuable support and information.

Nutritional Management

Nutrient deficiencies: Celiac disease can lead to malabsorption of nutrients, so it’s essential to address any deficiencies. Supplements may be prescribed, especially for iron, calcium, vitamin D, vitamin B12, or folate deficiencies.

Diet assessment: A dietician can help evaluate the nutritional adequacy of the gluten-free diet, identify the potential sources of hidden gluten, and ensure a balanced intake of macronutrients and micronutrients.


Ongoing Monitoring and Follow-Up

Regular medical check-ups: Periodic follow-up visits with a healthcare professional are essential to monitor the response to the gluten-free diet, assess nutrient levels, and evaluate overall health.

Repeat testing: Blood tests like tTG-IgA and EMA antibodies may be repeated to assess antibody levels and confirm disease management. This is usually done 6 to 12 months after initiating a gluten-free diet.

Biopsy: In some cases, repeat intestinal biopsy may be recommended to evaluate the healing of the small intestine and assess the effectiveness of the gluten-free diet.

It’s crucial to emphasize that strict adherence to a gluten-free diet is necessary even without symptoms, as continued exposure to gluten can lead to intestinal damage, increased risk of complications (such as osteoporosis, infertility, or certain cancers), and persistent symptoms.

Living with celiac disease requires ongoing education, vigilance in food choices, and a supportive environment. Working closely with healthcare professionals, dieticians, and support networks is essential to ensure proper management and a healthy lifestyle.

About the Author Michael

Michael is head consultant at Planet Naturopath - Functional Medicine and Nutrition Solutions. He is a registered naturopath with the Australian Natural Therapists Association (ANTA) and works with clients from all over the world via video or phone consultations. He is a degree qualified naturopath from the Endeavour College of Natural Medicine in Australia with 18 years of experience. He uses advanced testing methods, nutritional medicine, herbal medicine, and lifestyle advice to help you stay healthy. He is a Kalish Method-trained practitioner that keeps updating his education with Chris Kresser. Michael completed Dr. Terry Wahls practitioner training program, a 12-month program with ongoing training that helps understand the underlying cause and treatment of MS and autoimmune conditions. He keeps up to date with the latest research into health and natural medicine through the Metabolic Fitness Pro course with Dr. Bryan Walsh.

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