Celiac Disease

Gluten and the gluten-free craze has been a big topic as of late. Most people have seen the amount of gluten-free items in the grocery store go from a few products on the shelves here and there to entire sections dedicated to these products. Different eating styles from the Paleo diet to straight gluten-free diets have surged in popularity. When asked in polls, many people do not even know why they may want or need to adopt a gluten-free diet, but said they would (or do) just because of the perception that it is “healthier”.  While it certainly can be a benefit for someone trying to lose weight or manage their blood sugars by limiting carbohydrate-rich foods containing gluten such as breads, pasta, tortillas and cereals, other individuals actually NEED to keep gluten out of their bodies to avoid the development or exacerbation of certain health conditions. Most notable of these would be a wheat allergy, Non-Celiac Gluten Sensitivity (NCGS) and Celiac Disease, which to most people are a source of confusion as they all appear to cause similar problems in the body. However, if you do find that you experience some type of intolerance to gluten, it is imperative that you know what condition you have. Since it is the most serious of the three, we’ll start by discussing celiac disease here today.

Celiac disease is an inflammatory autoimmune disorder that can occur in genetically predisposed people where the ingestion of gluten leads to damage in the small intestine.  It is estimated to affect 1 in 100 people worldwide and that two and one-half million Americans are undiagnosed and are at risk for long-term health complications, which is why addressing and properly identifying a gluten sensitivity issue as soon as possible is so important. Because it is an autoimmune disorder, this means that the body’s immune system is overreacting to some type of stimulus and attacking its own cells in a particular organ or system. In the case of celiac disease, the body attacks the epithelial cells in the small intestine, which are essentially the “inner lining” of the intestines. These cells have small finger-like protrusions off them called villi that allow for the absorption of nutrients from the food we eat to pass into the bloodstream to be used for energy, healing and all other necessary functions. If the body attacks these cells, it destroys these villi leaving the cells unable to absorb the critical nutrients. So not only does a patient who has celiac disease have to worry about the gastrointestinal issues, but also about varying degrees of malnutrition that can lead to vitamin deficiencies and anemia.

But before you assume that you automatically have celiac disease based on just the symptoms, remember that there are 3 criteria that would have to be met in order for you to be diagnosed as such. First, you must have had exposure to gluten in some form in order for the body to react to it. Second, you must also have a condition known as “leaky gut” syndrome. Normally those epithelial cells that line the inner intestinal walls are stacked close together forming “tight junctions” that only allow small, properly digested particles of food through to the bloodstream. In gluten, there are certain protein components that are harder to break down for some people and these indigestible fragments cause the cells to release a protein called zonulin that loosens the tight junctions. Now the gluten fragments get through to the bloodstream where they have the potential to begin a damaging cascade. This process can occur in many individuals with the other types of gluten sensitivities, but it is the third component that will identify the condition definitively as celiac disease. A suspected individual must be a carrier of a gene for one or more of two proteins called HLA-DQ2 or HLA-DQ8. It is these two proteins that, when gluten fragments enter the bloodstream, will display the fragments to certain immune system cells which will then initiate a series of biochemical reactions that stimulate the body’s immune system to (incorrectly) start attacking the intestinal cells, destroying their ability to absorb nutrients.

Now remember, all 3 conditions would need to be met to develop celiac disease. Some people may be carriers of the genes, but if they don’t expose themselves to gluten and/or don’t allow themselves to develop a leaky gut, there would be much less chance of ever developing the condition in the first place. Also, in individuals who do have celiac disease, by the same order of logic, they can reduce the symptoms and progression of the disease by eliminating gluten from their diet and healing the gastrointestinal tract so that a leaky gut is no longer a contributing factor. If you or someone you know is suffering from the symptoms associated with celiac disease, it would be wise to have an evaluation done to determine if you actually do have it or one of the other gluten sensitivity conditions. In future posts, we will discuss these other conditions in more depth as well.

In Health, 

Dr. Brad Niewierowski