What is Celiac Disease
Celiac Disease, also known as Gluten-Sensitive Enteropathy or Celiac Sprue, is an intestinal absorption problem caused by sensitivity to the gluten/gliadin protein found in grains such as wheat, rye, and barley. It’s a unique autoimmune disorder because both the environmental trigger (gluten) and the auto-antigen (tissue transglutaminase found in the intestines) are known, which is not the case in other autoimmune disorders such as MS, Diabetes, or Lupus, where the triggers are unknown. In Celiac Disease, elimination of the environmental trigger, gluten, leads to a complete elimination of the disease.
How do you get Celiac Disease?
Symptoms typically begin within the first 3 years of life, after the introduction of cereal grains into the diet. Three factors play a role in the development of celiac disease: an environmental trigger, a genetic susceptibility, and an unusually permeable (“leaky”) gut. The environmental trigger may be an infection (HSV-1, mycoplasma, adenovirus, rubella), pregnancy, surgery, trauma, early grains and dairy introduction in babies, lack of breastfeeding, cancer, parasites, or a high gluten diet. Genetically susceptible individuals are those who are positive for either HLA DQ2 or HLA DQ8, or both. These genes give rise to proteins that display gluten fragments to immune cells, which then direct an attack on the intestinal lining. In celiac disease, the tight junctions between intestinal cells come apart, allowing a large amount of indigestible gluten fragments to seep into the underlying tissue and incite an immune system response.
Celiac affects the proximal small intestine, particularly the jejunum where atrophy of the finger-like villi occur. Increased numbers of eosinophils and mast cells are present. Mucosal enzymes are not made, which causes intestinal permeability leading to an antigen-antibody response. Several studies have indicated that early introduction to gluten increases the onset of celiac and that to reduce this risk, food introduction for infants should occur between 4-6 months and in smaller amounts. There are several types of Celiac Disease:
- 1) Typical/Classic: mostly GI signs/symptoms – diarrhea, weight loss, malabsorption (complete villous atrophy)
- 2) Atypical: majority of patients (60%) – may present with anything, gastrointestinal signs/symptoms are usually minimal or absent (normal mucosa or villous atrophy)
- 3) Silent: small intestine is damaged and serology is positive, but no symptoms exist. Discovered by chance. (complete villous atrophy)
- 4) Latent: positive/negative serology, positive genes, no mucosal damage (-) biopsy; may or may not be symptomatic (normal mucosa)
What is gluten?
Gluten is a component of the endosperm of grains like wheat, barley and rye and is composed of gliadin and glutenin. There are several gliadin fragments including alpha, beta, gamma, and omega. While only the alpha fragment is considered to be causative in Celiac Disease, more recent research is showing that these other fragments may be playing a role, particularly in non-celiac gluten sensitivity.
Classes of drugs commonly used to treat Celiac Disease
Currently there are no drugs to treat Celiac Disease and there is no cure. A strict, lifelong gluten free diet is the only treatment currently avoidable. Grains which contain gluten include wheat, rye, barley, spelt, kamut, triticale, and potentially oats due to cross contamination issues.
The drug, larazotide, is zonulin inhibitor that is currently being researched as a possible treatment. Zonulin is a protein in the gastrointestinal lining which regulates intestinal permeability via tight junctions.
Nutrients to consider in Celiac Disease
Patients with Celiac Disease are often deficient in many nutrients, due to intestinal damage and malabsorption, including iron, folate, B12, vitamins A, D, E & K, thiamine, niacin, B6, beta carotene, zinc, essential fatty acids.
DPP IV (or dipetidyl perptidase IV) is a protease enzyme which can assist in the complete breakdown of gluten and casein. Cross contamination of food in restaurants is a serious issue for Celiac patients and this enzyme may help prevent negative reactions to inadvertent exposures.
Nutrients that can promote repair of damage intestinal mucosa include
- L-glutamine – to repair intestinal tissue and maintain proper intestinal permeability
- Zinc carnosine – protective for mucosa
- MSM & Quercitin – anti inflammatory
- N-acetyl glucosamine – supports mucosal health and reduces intestinal permeability as it is a source of glycosaminoglycans
- DGL, slippery elm, marshmallow, chamomile, okra, cat’s claw – mucilaginous relaxing herbs, promotes healing of inflamed tissue
- Mucin – a glycoprotein normally secreted by intestinal cells which coats the intestinal linking and neutralizes antigens
Other conditions associated with Celiac Disease
There are several conditions that are commonly linked to to Celiac Disease such as Hashimoto’s Thyroiditis, Type I diabetes, psychiatric conditions such as Schizophrenia, Dermatitis Herpetiformis and Urticaria.
Diagnosis of Celiac Disease
An intestinal biopsy is currently the most definitive diagnostic procedure currently available. A positive test for anti-gliadin antibodies along with clinical. symptomatology may also be used.