It seems strange, doesn’t it, that one of the most important substances in our diet – gluten – can actually make some of us quite ill? After all, we’ve been eating foods containing gluten for millennia. It forms an important part of the ‘staff of life’ – bread. Coeliac Disease (CD) is a little-understood auto-immune disease that can destroy the lining of the small intestine, causing a cascade of very unpleasant symptoms, as well as an increased risk of developing other auto-immune diseases, so I thought this blog post would help people have a better understanding of it, how it can impact overall health and wellbeing, and what can be done to prevent CD from affecting your quality of life.
What is Coeliac Disease?
Coeliac Disease is an auto-immune disease, where the immune system attacks the cells that line the small intestine. This can also cause a flattening of the villous, minute hair-like projections found in abundance covering the walls of the small intestine, and which are crucial in helping to absorb nutrients. If the villous are flattened, this affects their ability to absorb nutrients from food. This occurs in the presence of the gluten found in wheat, barley, rye, etc., thus eventually making nutrient absorption difficult, if not impossible.
Nutritional deficiencies are common in CD because of the destruction of the intestinal villi, of which there around 6,000 to 25,000 per square inch of small intestinal tissue. The consequences of this destruction can be devastating. Digestive health is impacted and, if left undiagnosed and untreated, the disease could lead to various other serious disorders, such as neurological problems, anaemia, osteoporosis, mood disorders, multiple vitamin deficiencies, or even infertility.
How is Coeliac Disease diagnosed?
Blood test
Your GP will take a blood sample and test it for antibodies usually present in the bloodstream of people with CD. You should include gluten in your diet for at least six weeks before the blood test is carried out because avoiding it could lead to an inaccurate result. If CD antibodies are found in your blood, your GP will refer you for a biopsy of your gut. However, it’s sometimes possible to have CD and not have these antibodies in your blood. If you continue to have CD-like symptoms despite having a negative blood test, your GP may still recommend you have a biopsy.
Biopsy
A biopsy is carried out in hospital, usually by a gastroenterologist. A biopsy can help confirm a diagnosis of CD. If you need to have a biopsy, an endoscope will be inserted into your mouth down into your small intestine.
Before the procedure, you will be given a local anaesthetic to numb your throat and perhaps a sedative to help you relax. The gastroenterologist will pass a tiny biopsy tool through the endoscope to take samples of the lining of your small intestine.
The sample will then be examined under a microscope for signs of CD including damage to the villi.
What are the symptoms of Coeliac Disease?
Interestingly, some people don’t experience noticeable symptoms early on, and even when signs emerge, these may not give accurate information about the disease and its severity so, as a consequence, many people are fobbed off with having ‘IBS’.
Unfortunately, there are many people living with CD who have either not been diagnosed or who are still struggling with chronic symptoms despite a strict gluten-free diet.
While there are possibly hundreds of associated symptoms, the most common ones typically are:
- Painful abdominal bloating
- Frequent diarrhoea or constipation
- Abnormal looking pale stools, with foul odour
- Unintentional weight loss
- Unexplained tiredness, weakness, or sleepiness
- An itchy rash
Tips to manage Coeliac Disease
- Consuming a strictly gluten-free diet is the foundation of disease management since the digestive system is unable to tolerate any amount of gluten. There are many gluten-free whole grains, such as millet, buckwheat, quinoa, brown rice, and amaranth to choose from as alternatives. This task may seem daunting and confusing at first, but it needn’t be. Today most grocery stores carry plenty of gluten-free options, making the transition relatively easy and pain-free. However, while there are many gluten-free food options available, many of these are processed foods, so simply swapping out gluten-based products for gluten-free ones won’t necessarily repair your immune system. Make careful, healthy choices; there are still gluten-free foods that are best avoided – for example, products made from white rice, which is often tainted with the toxin arsenic. For some healthy meal ideas, you can download my gluten-free recipes here (they’re also dairy-free and refined sugar-free).
- Healing the gut. While eliminating gluten and replacing it with nutritious food is already extremely beneficial for the gut, a couple of extra measures can be taken to ensure that the small intestine returns to its proper functioning order. Prebiotics and probiotics are a valuable part of the healing journey, along with food that contains gut-friendly bacteria (kefir, kombucha, full-fat Greek yoghurt)/ anti-inflammatory ingredients (garlic, ginger, turmeric, oily fish) and specific gut-healing nutrients (collagen, bone broth – you can download my bone broth recipe, full of natural collagen )
- Supplementation. One of the tools to help rebalance the gut microbiome and improve gut barrier function is the use of probiotics. In addition, digestive enzymes are also beneficial in the treatment and long-term management of CD, as well as helping with the absorption of essential nutrients from food. Check out the Just For Tummies Live Bacteria probiotic capsules and natural Digestive Enzyme tablets here. I recommend a Live Bacteria capsule before breakfast and before bed, with a small glass of water, and one Digestive Enzymes tablet just before lunch and one just before dinner.
Read how Clare Vine was able to manage her Coeliac Disease with a simple supplementation protocol:
“I found Linda and Just for Tummies about 2 months ago, at a point when I was not in a good way, having just been diagnosed with Coeliac Disease, as well as dealing with horrendous acid reflux, bloating and erratic toilet habits! On Linda’s advice, I started the Live Bacteria probiotic capsules twice a day and the Digestive Enzymes before lunch and evening meals. Two months in, and I’m really pleased with the results. I have little to no reflux or bloating, and for the first time in forever, I’m predictable in the toilet department.
“Linda has been really supportive and replies quickly to my messages. We have agreed that I am ready to change my dose to more of a ‘maintenance’ level.
“I can’t recommend Linda and her Just for Tummies supplements highly enough – her advice and support is fabulous, the products are delivered quickly, and most importantly, they really work.“
The treatment for CD wouldn’t be complete without your doctor regularly monitoring various essential vitamin levels, which may indicate the need for extra supplementation, in particular, Vitamin D. Vitamin D levels need to be checked, and if deficient, supplementation is recommended, especially for someone with an auto-immune disease like CD.
If your GP won’t test you, then you can purchase a test kit online for less than £30, like this one: www.vitamindtest.org.uk. It’s also critical to monitor for other auto-immune diseases which those with CD are highly at risk for (i.e, Hashimoto’s Disease, rheumatoid arthritis and diabetes).
- Stress management
It is important to keep in mind that CD (like many auto-immune diseases) is extremely responsive to stress, which, along with physical exhaustion, may induce the flare-up and aggravation of your symptoms. For this reason, proper stress management is crucial and can make a world of a difference in your quality of life over time.
- Eliminate the possibility of cross-reactivity to gluten if you are still experiencing symptoms even on a GF diet.
This can include other grains like oats (even gluten-free oats). You can test for cross-reactivity using a Cyrex Array test. Remember, even though the cross-reactive foods do not actually contain gluten, your body thinks they do, and they can cause just as much inflammation and damage as eating actual gluten. So you want to remove them entirely once you have detected any via the test.
It’s also important to avoid other sources of hidden gluten, such as the glue on envelopes, or lipsticks, which are often ingested. As well as other beauty products, such as hand cream (this can be a problem if hands are not washed before eating for example).
Underlying causes
There are a number of underlying causes of Coeliac Disease that you should be aware of. These are:
- Genetics
- Gut hyper-permeability syndrome, commonly known as ‘leaky’ gut
- Viral exposure, especially as a child (viruses can cause long-term damage to the immune system)
- Certain intestinal parasites have been linked to the development of CD
- Gut dysbiosis
Why avoiding gluten may not be enough …
Increased intestinal permeability has also been shown to persist even on a gluten-free diet, probably due to an imbalance in the gut microbiome, and this is where supplementation with probiotics is essential.
Avoiding gluten helps to reduce inflammation and intestinal permeability, but a gluten-free diet alone is typically not enough to restore balance to the gut microbiome. Unfortunately, this is not something commonly recognised and addressed in conventional medicine.
However, Functional Medicine and Nutritional Therapy are unique in the fact that they help people living with Coeliac Disease more comprehensively identify and address the underlying root-cause imbalances, which may be persisting even after the implementation of a gluten-free diet.
A functional stool test may be advisable to identify possible root causes of CD.
You can read more about functional gut testing in my blog post here.
Take-home message
Being strict with your diet is very important because recent research has shown that eating gluten (or gluten look-a-likes) can elevate your antibodies for up to three months, meaning that even if you only ate gluten or its cross-reactive foods four times a year, you would be in a state of inflammation all year round. And finally, get to the root cause of your diagnosis with functional testing so that you can heal your gut.
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