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Why Celiac Disease Is More Than Going Gluten-Free

Celiac disease is more than simply going gluten-free.

It is estimated that 1 in 133 Americans, 1% of the United States population, has celiac disease, an autoimmune disorder triggered by the ingestion of gluten and characterized by the destruction of intestinal cells (villous atrophy). In celiac, the immune system attacks the enzyme that repairs the intestinal villi, and when that enzyme cannot do its job, intestinal damage occurs. There appears to be a genetic component to celiac disease as well as leaky gut or intestinal permeability. Your health care provider may suspect celiac disease when villous atrophy appears on a biopsy of the small intestine, and it is officially diagnosed when a person has positive celiac labs and the person gets better on a gluten-free diet.

But is it really that cut-and-dry? If you go on a gluten-free diet for the rest of your life, will everything be all right? The answer is no. Celiac disease is more than simply going gluten-free. Other key factors are critical to maintain health in someone with celiac disease, and addressing other aspects of the disease in addition to going gluten-free can improve your quality of life.

Being strict on being gluten-free

Right now the only recommended treatment for celiac is a gluten-free diet. Why? Because the gluten protein is the spark that lights the fire in the progression of the disease. There is “no pill to pop” and nothing needs to be surgically removed: you simply avoid foods with gluten. Some celiac patients are more sensitive than others—the slightest hint of gluten can send symptoms flaring—while others are affected in subtler ways. But gluten is sneaky, and if you are not properly educated on how to avoid it, your symptoms may not improve. Seek help: find a gluten-free group, work with a nutritionist, and talk to your naturopath. Gluten-free can be easy!

Fixing absorption

The damage that celiac causes in the small intestine affects nutrient and mineral absorption. Poor nutrient absorption leads directly to other conditions associated with the disease. For example, not properly absorbing vitamin D can lead to secondary hyperparathyroidism, which leads to bone loss and osteoporosis. To optimize nutrient absorption and reduce inflammation in the gut, treatment focuses on removing triggers (gluten and identifying other possible food allergies), repairing damage, and reintroducing good bacteria.

There are several therapies for healing the digestive tract. One is quercetin, a flavonoid found in fruits and vegetables, such as onions and apples. Quercetin supports the integrity of the cell walls of the intestine that may have become weakened in the celiac patient. The cell walls are held together by tight junction bonds that control the size of antigens and particles crossing from the digestive tract into the bloodstream. L-glutamine powder may also be used to reduce intestinal inflammation. Bone broth is another dietary addition that can promote healing and integrity of the gut. Bone broth soup is loaded with amino acids, such as glycine, and it provides collagen to heal and replenish the damaged cells.

Conditions associated with celiac

Several conditions are associated with celiac disease. The most common are Hashimoto’s thyroiditis, dermatitis herpetiformis (skin condition), osteoporosis, peripheral neuropathy, type 1 diabetes mellitus, liver disease, and lymphoma. Another associated condition that is not usually talked about is the link to depression (Lionetti, 2015). This condition should not be taken lightly: depression in the celiac population is common, possibly due to the nutrient deficiency that occurs with the disease.

Knowing the conditions associated with celiac are crucial for living with the disease. If you have been on a gluten-free diet for two years and still have symptoms, you may fall into the nonresponder category known as refractive celiac (www.UptoDate.com). Nonresponse is prevalent in 5% of celiac patients, and more treatment is required for nonresponders to keep their immune systems healthy. The common theme of treatment is to maintain a strict gluten-free diet, correct nutrient deficiency, and restore absorption.

Follow-up care

For some time before celiac awareness really hit, the standard of care was to simply place a patient on a gluten-free diet. But it’s just not as simple as “OK, here you go. Easy fix!” Going gluten-free is much easier nowadays, relatively speaking, than it was even a few years ago. But adopting a gluten-free diet without consulting your doctor is not a treatment plan. Follow-up is key! To correct nutrient deficiencies, patients need routine follow-up care to monitor nutrient levels, measure bone density one year after starting a gluten-free diet, and check antibody levels through routine lab work. Dealing with celiac disease causes stress, creates anxiety around food, and contributes to situational depression. Having a good support network, a life coach or counselor, and a stress management program in place is key for everyone, and that includes people with celiac disease.

 

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Dr. Ellie Heintze, ND, LAc is a licensed naturopathic doctor and acupuncturist practicing in Seattle, WA. She specializes in migraine treatment and digestive disorders. Her clinic provides people with a starting point to take control of their health and digestion. Visit her website at www.startingpointacupuncture.com.

Sources:

Beyond Celiac (www.beyondceliac.org)

Celiac Disease Foundation (www.celiac.org)

The Gluten-Intolerance Group of North America (www.gluten.org)

Lionetti, E., et al. (2015). Gluten psychosis: Confirmation of a new clinical entity. Nutrients, 7, 5532-5539.

UpToDate (www.UpToDate.com)

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