Celiac Disease: The Well-Disguised Gluten Intolerance

Celiac disease is a form of gluten intolerance – it can be detected, but is often difficult to identify. Here you can find out how you can tell if you have celiac disease and which natural measures can help.

Celiac disease is a gluten intolerance

Celiac disease – formerly also known as local sprue – is a chronic and usually lifelong autoimmune disease characterized by intolerance to gluten. In those affected, the consumption of foods containing gluten leads to inflammation of the intestinal mucosa, which causes the intestinal villi to shrink.

Intestinal villi are lined-up elevations or protuberances of the intestinal mucosa in the small intestine. They are responsible for absorbing the nutrients from our food. If they regress over time, fewer and fewer nutrients can be absorbed, which eventually leads to nutrient deficiencies.

What is gluten?

Gluten is a protein found in wheat and other grains such as rye, barley, spelled, unripe spelled, emmer, einkorn, Khorasan wheat (known as Kamut), and triticale (a cross between rye and wheat).

Gluten is widely used in food processing because it causes the flour to combine with water to form a sticky, elastic dough that holds together well. Due to these properties, gluten is also referred to as glue protein. Gluten is also used as a carrier for aromas and is therefore not only found in baked goods but can also be found in products that at first glance would not appear to contain gluten.

What is gluten made of?

Gluten is not a single substance, but a collective term for a mixture of linked amino acids. It consists of the storage proteins prolamin and glutelin, which make up about 70 to 80 percent of the protein in the grain and are located inside the grain (in the so-called endosperm). The remaining 20 to 30 percent of grain protein consists of the proteins albumin and globulin, which are found in the outer layers of the grain.

Why is gluten not tolerated by celiac disease?

The problem with digesting gluten (or prolamin) is that it is not properly broken down into individual amino acids in celiac disease. Like any protein, prolamin is made up of a long chain of linked amino acids. The prolamin chains of wheat and many other bowls of cereal are particularly high in proline (an amino acid). And it is precisely this proline that is the problem with celiac disease.

This is because the enzymes in the human digestive system are unable to break the bonds on either side of the proline that links proline to other amino acids in the protein chain. So there are always shorter amino acid chains left (they are called peptides). In healthy individuals, these undigested peptides stay within the gut and are simply excreted the next time you go to the toilet.

Unfortunately, this does not apply to people with celiac disease, because their immune system initiates an inflammatory reaction to defend themselves: the peptides pass through the intestinal mucosa undigested and accumulate behind it, whereupon the body releases the enzyme transglutaminase. This enzyme is also made in healthy people and actually helps repair damage to the gut lining.

In people with celiac disease, however, the transglutaminase reacts with the undigested gluten fragments, which falsely triggers an immune response and leads to inflammation of the intestinal mucosa. As a result, the intestinal villi, which are responsible for nutrient absorption, break down over time.

Why are oats often tolerated despite gluten?

Although oats contain gluten, oat-specific prolamin has a different composition than wheat prolamin. While the latter is high in proline (proline is an amino acid), oat prolamin is low in proline. The proline content of oats is even as low as that of millet and corn, which can ultimately be eaten very well on a gluten-free diet.

However, oats can be contaminated with other gluten-containing grains through neighboring fields, combine harvesters, and transport. That’s why you should use so-called gluten-free oats. Although this still contains the compatible oat gluten, it does not come into contact with other gluten-containing grains during harvesting and processing.

Nevertheless, to be on the safe side, some celiac disease societies advise eating only 50 to 70 g of oats per day (children: 20 to 25 g), since the long-term effects of avenin have so far been little researched. Excessive oat consumption could therefore lead to renewed symptoms.

Celiac disease – an autoimmune disease

Celiac disease is a special case among autoimmune diseases because it is the only autoimmune disease that can be switched on and off – namely by not eating gluten. The gluten ensures that antibodies are formed that attack your own body. If no gluten gets into the body, the antibodies break down again and as long as no new gluten is supplied, no new antibodies are formed.

What happens if celiac disease is not treated?

If the celiac disease remains undetected, there is a risk of progressive inflammation of the mucous membrane in the small intestine, followed by the consequences of this inflammation, namely intestinal problems, weight loss, and deficiency symptoms because nutrients are not being absorbed adequately.

The inflamed intestinal mucosa can also lead to other intolerances, such as lactose intolerance, which sometimes only occurs temporarily until the intestine has recovered.

In addition, the inflammation of the intestine can cause the so-called leaky gut syndrome (= permeable intestine), which means that bacteria or incompletely digested particles from the intestine can get into the bloodstream, which now leads to further diseases in the area of allergies and can lead to autoimmune diseases. Those affected also have a higher risk of colon cancer, and thyroid and liver diseases.

The diagnosis of celiac disease

In contrast to non-celiac gluten sensitivity, celiac disease can be diagnosed relatively easily.

No conversion to a gluten-free diet prior to diagnosis

Patients who suspect they may have celiac disease should consult a doctor before trying a gluten-free diet. If, on the other hand, you eat gluten-free for a while, this makes the diagnosis considerably more difficult because the specific gluten antibodies are broken down and the intestinal mucosa builds up again during the gluten-free period. The disease can then no longer be easily detected and you would first have to eat gluten again for a few days or weeks. Of course, this can be very uncomfortable, since the symptoms can then return.

However, it is important to clarify whether celiac disease is actually present or at most a gluten sensitivity or a wheat allergy because celiac disease can result in other serious diseases, as described above, and therefore requires an extremely strict diet without gluten. In the case of gluten sensitivity, on the other hand, a low-gluten diet is sometimes sufficient.

Which doctor should you see if you suspect celiac disease?

If you would like to have celiac disease clarified, you should first contact your family doctor or a gastroenterologist. Gastroenterologists deal with diseases of the gastrointestinal tract.

How is celiac disease diagnosed?

If celiac disease is suspected, a blood sample is first taken and analyzed for specific antibodies. If antibodies were detected in the blood sample, a small intestine biopsy follows. This is usually done by a gastroenterologist. A camera probe attached to a thin tube is pushed through the mouth, esophagus, and stomach into the small intestine under mild anesthesia.

Five to six samples are then taken from different areas of the duodenum to get a better overview of the overall condition of the intestinal mucosa.

Because with celiac disease, the changes in the intestinal mucosa are sometimes not evenly distributed. Rather, the inflammatory changes can occur in patches. With a single sample, there is always a risk of overlooking the disease.

This tissue sample can then be used to identify damage to the intestinal mucosa. The diagnosis of celiac disease is based on the antibodies in the blood, the small intestine biopsy, and the subsequent improvement in the symptoms with a gluten-free diet.

How does a celiac self-test work?

First of all: Self-tests for celiac disease cannot replace a diagnosis by a doctor, because only the presence of antibodies is measured – but the complete diagnosis also includes a small intestine biopsy.

The tests can be bought at drugstores, pharmacies, online, and sometimes even in supermarkets. A drop of blood is taken and mixed with a test liquid. Similar to a pregnancy test or a corona self-test, lines then appear that indicate whether antibodies are present in the blood or not.

As with the tests mentioned, however, a correct diagnosis must then be made – the self-test is therefore only an INDICATION of POSSIBLE celiac disease. The package leaflet, on the other hand, often suggests that you simply have to do without gluten and that the problems are solved – as written above, however, you should not do exactly that until you have received a reliable diagnosis from the doctor.

If you go to the doctor after a positive self-test, he will test for antibodies again anyway and also perform a small intestine biopsy. If your self-test comes back negative, that doesn’t mean you might not still have celiac disease, as self-tests are never 100 percent accurate.

These diseases with similar symptoms should be ruled out

The following diseases are similar to celiac disease and should be ruled out by thorough examinations:

  • Irritable bowel syndrome (in an irritable bowel there is no visible damage to the intestinal villi)
  • Chronic inflammatory bowel disease (eg, Crohn’s disease, Whipple’s disease, ulcerative colitis)
  • Food allergies and intolerances (e.g. lactose intolerance, wheat allergy, gluten sensitivity)
  • Other gastrointestinal diseases or infections of the intestinal tract
    pancreatic insufficiency
  • Immune defects and other autoimmune diseases

The treatment of celiac disease in conventional medicine

Although research into medicines and other treatment methods has been going on for years, a gluten-free diet has so far also been considered the most important measure for celiac disease in conventional medicine.

Enzyme preparations only as a supplement to a gluten-free diet

For a number of years, health food stores, pharmacies, and online retailers have been selling products with enzymes as dietary supplements that are said to help break down gluten in the body so that an immune reaction does not occur in the first place.

The enzymes are taken in the form of capsules with meals – if you take the enzymes after the meal, they can no longer develop their effect. However, the preparations cannot replace a gluten-free diet but only serve to render traces of gluten in already gluten-free foods harmless in the case of particularly sensitive sufferers.

Accordingly, the capsules are only taken as a supplement to a gluten-free diet, for example, to be on the safe side when eating out or when traveling. Treating yourself to a piece of cake containing gluten because you have taken enzymes is not an option.

The authors of a 2021 review that looked at various enzyme supplements also warn that people should by no means relax their gluten-free diet just because they are taking these supplements.

Because the composition of the food has an influence on the effectiveness of the enzymes and this factor has not been sufficiently researched so far – one cannot assume that one is protected by taking these preparations. In addition, the capsules are not equally suitable for every person, since not everyone is equally sensitive to gluten.

Possible therapies in the future

Meanwhile, several drugs against celiac disease are being researched that have not yet been approved. The mechanisms of action differ depending on the preparation: for example, they aim to make the intestine less permeable and thereby reduce the symptoms, or, similar to the enzyme preparations, they are intended to increase gluten tolerance or promote gluten digestion.

The active ingredient ZED1227, which was developed in Germany, has been the best researched so far. The active ingredient is currently (May 2022) in clinical study phase 2b. ZED1277 is said to inhibit the body’s own enzyme transglutaminase. This reacts with the undigested gluten fragments and triggers the immune response, which leads to inflammation of the intestinal mucosa.

However, these approaches are not aimed at replacing a gluten-free diet. This means that a gluten-free diet will remain the best treatment method for celiac disease even after these drugs are approved.

Naturopathic measures for celiac disease

In addition to a gluten-free lifestyle, the following naturopathic measures can also be used for celiac disease:

Probiotics could support the gut in celiac disease

Scientists are currently assuming a connection between the so-called intestinal flora – i.e. the composition of microorganisms in the digestive tract – and celiac disease. The microbiome is influenced by diet, medication, stress, and personal hygiene (washing affects the bacterial flora of the skin, which in turn affects the bacterial composition inside the body).

Furthermore, infectious, metabolic, and inflammatory diseases can permanently disrupt the microbiome. Apparently, the microbiome of people with celiac disease who are not yet on a gluten-free diet has fewer lactobacilli and bifidobacteria, but more E. coli bacteria, proteobacteria, and staphylococci than the microbiome of gluten-free celiac disease patients and healthy people – it is so imbalanced. However, it is not clear whether this imbalance is also a cause of celiac disease or rather a consequence of it.

Studies have been conducted in recent years that have tested the effects of probiotics in celiac disease patients. It has been shown that certain bifidobacilli and lactobacilli can inhibit the harmful effects of gluten in the gut by preventing gluten from making the gut lining more permeable. The most effective were those preparations that contained several different strains of bifidobacilli and lactobacilli.

Fermented foods, like miso, kimchi, kombucha, kefir, and sauerkraut, are considered natural probiotics. So, you could incorporate these foods into your gluten-free diet to support your gut. You could also take probiotic food supplements that promote the development of intestinal flora. Choose a preparation that is as contains different strains of bacteria.

A diet rich in fiber, vitamins, and minerals with lots of fruit, vegetables, and gluten-free whole grain products can also support the growth of good intestinal bacteria. On the other hand, sugar, salt, sweeteners, and other food additives (firming agents, humectants, etc.) can encourage the growth of bad gut bacteria.

Tips for a healthy gut

We have put together more tips for a healthy intestine under the previous link – including the following:

  • Massage your abdomen with the Abdominal Self-Massage
  • Eat well-tolerated fibers such as coconut flour, chia seeds, and barley grass powder. Since barley grass powder is made from barley grass and not barley grain, it is gluten-free.
  • Flea seed husk powder and bentonite can help normalize the consistency of the stool and also bind toxins.
  • Regular exercise or walks get the intestines going.
  • Drink at least 30 milliliters of water per kilogram of body weight daily.
  • Eat slowly and chew carefully.

Anti-inflammatory diet for the gut

Also eat a lot of different fruits and vegetables, such as broccoli, spinach, onions, and garlic, as well as berries, walnuts, herbs, and fresh spices such as turmeric and ginger, because the secondary plant substances contained have an anti-inflammatory effect. On the other hand, avoid sugar and highly processed foods such as salami and sausage, as these can promote inflammation.

Choose anti-inflammatory oils and fats whenever possible. These include in particular omega-3 fatty acids from linseed oil and hemp oil. You can find out how else you can take omega 3 here: Dosing omega-3 fatty acids correctly. Also make sure you have a healthy ratio between omega-6 and omega-3 fatty acids: a maximum ratio of 5: 1 or better 3: 1 (omega 6: omega 3) would be ideal. Because too many omega-6 fatty acids can in turn promote inflammation.

Optimize your nutrient supply

Celiac disease can lead to poor absorption of vitamin A, vitamin D, vitamin E, and vitamin K, as well as folic acid and iron since these vitamins, are primarily absorbed through the small intestine. (In the case of vitamin D, this only applies to the vitamin D that enters the body through food.) B vitamin deficiencies are also possible, although less common. Mineral deficiencies can also occur: magnesium, calcium, copper, zinc, and selenium are particularly affected.

You could consult a holistic nutritionist to help you create a customized nutrition plan and advise you on taking supplements. Because depending on how far the shrinkage of your intestinal villi has progressed, you will not be able to compensate for a vitamin or mineral deficiency through diet alone.

Is Celiac Disease Curable?

So far, it has been assumed that celiac disease cannot be cured – but after changing your diet to gluten-free foods, the disease can be symptom-free. Nevertheless, there are reports of alleged cures on the Internet, i.e. from people who suffer from celiac disease and then suddenly tolerate foods containing gluten again.

The treacherous thing about this is that the disease can sometimes be almost completely symptom-free even with gluten intake, or earlier symptoms can also disappear again, although the intestine is damaged when eating foods containing gluten. Final clarification as to whether the villi of the small intestine are actually recovering and building up again despite a gluten-containing diet (which would in fact be a cure) is only possible with a new small-bowel biopsy.

Only transient celiac disease, which is very rare and mostly occurs in children under the age of two, is a temporary form of celiac disease that can actually disappear again. After the symptoms have subsided as a result of an appropriate diet, the corresponding antibodies and changes in the mucous membrane of the small intestine can suddenly no longer be detected when gluten is fed again. However, it is recommended that the antibodies in the blood be checked regularly.

Conclusion: get the celiac disease under control with the right diet

Below we summarize the most important measures for celiac disease:

  • Eat a gluten-free diet, but avoid processed foods, sugar, and additives. Eat a balanced diet with plenty of vegetables, fruit, nuts, pseudocereals, and legumes. See the previous link for more information on healthy gluten-free foods.
  • Have yourself examined for vitamin deficiencies and mineral deficiencies and compensate for the deficiencies as far as possible with your diet and additional food supplements.
  • Try fermented foods or take probiotics. All information about the use and intake of probiotics can be found under the previous link.
  • Also, follow our tips for a healthy intestine and for building up intestinal flora.
  • As described above, celiac disease is often accompanied by a leaky gut, i.e. a permeable intestine.
  • According to a study, if you are a woman with celiac disease, you can reduce the risk of your child also developing the celiac disease by consuming plenty of fiber from fruit and vegetables during pregnancy.
Avatar photo

Written by Danielle Moore

So you landed on my profile. Come on in! I am an award-winning chef, recipe developer, and content creator, with a degree in social media management and personal nutrition. My passion is creating original content, including cookbooks, recipes, food styling, campaigns, and creative bits to help brands and entrepreneurs find their unique voice and visual style. My background in the food industry allows me to be able to create original and innovative recipes.

Leave a Reply

Your email address will not be published. Required fields are marked *

Crohn’s Disease: Vegan Diet Better Than Medication

Extreme Fatigue: The Most Effective Tips