Celiac Disease and Non-Celiac Gluten Sensitivity
Celiac disease is an inflammatory immune disorder that occurs when genetically susceptible individuals eat gluten, a protein in wheat, barley, and rye. The immune system damages the lining of the small intestine, which can cause nutrient malabsorption and symptoms ranging from diarrhea and constipation to skin rashes and depression.
After adopting a gluten-free diet, there are natural interventions that can help replenish deficiencies caused by celiac disease, like supplementing with iron, magnesium, vitamin D, and digestive enzymes.
Differences between Wheat Allergy, Celiac Disease, and Non-Celiac Gluten Sensitivity
Wheat allergy, celiac disease, and non-celiac gluten sensitivity can be confused with each other but are actually three separate conditions:
- A wheat allergy involves the reaction of a certain type of antibody (immunoglobulin E) to wheat, resulting in the release of histamine and other inflammatory substances. This can cause symptoms such as skin eruptions, runny nose, itching, and in rare cases, anaphylaxis and even death.
- Celiac disease is an autoimmune disease, not an allergy. Autoimmune disease reactions are enduring and highly destructive, whereas allergic reactions can appear and disappear within minutes to hours after contact with an allergen.
- When wheat allergy and celiac disease have been ruled out (see Diagnosis of Celiac Disease), having a beneficial response to dietary elimination of gluten-containing foods is considered non-celiac gluten sensitivity. In some people, it may actually be poorly-absorbed carbohydrates called FODMAPs that contribute to sensitivity reactions.
Signs and Symptoms of Celiac Disease
- Pain, bloating, gas
- Constipation and/or diarrhea
- Loss of appetite
- Nausea, vomiting
Brain and nervous system:
- Recurring headaches
- Decreased sensation in peripheral nerves
- Anxiety, panic attacks
Other systems of the body:
- Itchy skin rash (dermatitis herpetiformis)
- Unexplained infertility and miscarriage
- Iron-deficiency anemia and other nutritional deficiencies
Diagnosis of Celiac Disease
- Gold standard for diagnosis is a biopsy of the small intestine
- A more simple “four-out-of-five” guideline has been proposed:
- Typical symptoms of celiac disease (see Signs and Symptoms of Celiac Disease)
- Celiac disease immunoglobulin A antibodies are strongly positive in the serum
- HLA DQ2 and/or HLA DQ8 genes are present
- Characteristic changes are evident on small intestine biopsy
- Positive clinical response to a gluten-free diet
Dietary and Lifestyle Changes
- Maintaining a gluten-free diet for life is essential for those with celiac disease.
- The gluten-free diet is considered the primary treatment for non-celiac gluten sensitivity (though some researchers advocate avoidance of FODMAPs as opposed to gluten).
- Minerals: Iron, calcium, magnesium, zinc, and selenium are some of the minerals that can become deficient in people with celiac disease, generally due to malabsorption. Screening for deficiency and supplementing as necessary is important.
- Vitamins: B vitamins and the fat-soluble vitamins A, D, E, and K can also become deficient due to malabsorption. Supplementation with these vitamins has been shown to improve bone status and neurological health in celiac patients with deficiencies in these vitamins.
- Probiotics: In a three-week randomized controlled trial, supplementation with a particular Bifidobacterium infantis strain in untreated celiac disease patients resulted in improvements in indigestion, constipation, and acid reflux.
- Digestive Enzymes: Pancreatic exocrine insufficiency may inhibit the ability of the pancreas to secrete digestive enzymes, a condition relatively common in celiac patients. Ninety percent of patients treated with digestive enzymes experienced a reduction in symptoms like diarrhea.
- L-carnitine: In a randomized controlled trial, supplementation with L-carnitine for six months resulted in significant improvement in reported fatigue in adults with celiac disease.