Being Gluten-Free is Not Enough for Celiac’s

You must approach Celiac from 3 perspectives.

Photo by Mae Mu on Unsplash

The best treatment we currently have for those with Celiac is life long adherence to a gluten-free diet (GFD). Now, if you’ve looked at a food label recently, you probably know that gluten is in darn-near everything. On top of that, trace amounts of gluten can also be found in toothpastes, shampoos, body washes, and makeup, trace amounts being enough gluten to trigger the immune system in those with Celiac. They basically have to be on high alert all the time for hidden sources of gluten.

As difficult as being totally gluten-free is, there’s more to the puzzle. In Celiac, the immune system attacks a certain area of the small intestine, called the microvilli. Why is that important? The microvilli help in the digestion and absorption of nutrients, including protein, carbs, iron, magnesium, zinc, folate, and B6. Imagine trying to build a house on top of a rotten foundation; it’s probably not going to be the safest house.

It’s not as easy as just taking vitamin and mineral supplements, you have to address the rotten foundation first, the damaged microvilli. Also, since Celiac is an autoimmune condition, it might be worth your while to employ strategies to address your immune system. To put a cherry on top, symptoms such as diarrhea, abdominal pain, brain fog, joint pain and even depression can dramatically alter someone’s quality of life. How does one tackle all those problems?

It Starts in the Gut

Lucky for us, we can address both the microvilli and the immune system by focusing on the gut. Part of the autoimmunity could be related to intestinal hyperpermeability (leaky gut). Leaky gut can be a side effect of Celiac, and some even theorize that it contributes to the cause of the disease. Glutamine is an amino acid that helps seal up this leaky gut environment. Glutamine is found in the majority of high protein foods: chicken, eggs, beef, and whey protein powders.

Children with Celiac Disease have shown to have lower levels of this gut-supportive amino acid in their blood (1). Not only that, but the lower their glutamine levels, the higher their autoimmunity levels were. That leads us to say, is there evidence to support glutamine supplementation for Celiac? Unfortunately, nothing comes up. But, we can deduce a few things. 1) Glutamine has shown to be beneficial for leaky gut, and 2) Leaky gut often takes place with Celiac (2).

What about the case for probiotics?

A 2020 systematic review and meta-analysis (highest quality of evidence) found that probiotics led to nearly 30% reduction in GI symptoms when compared with placebo (3). Being that diarrhea and abdominal pain are two of the more common symptoms of Celiac, strategies to reduce those life-altering symptoms seems like a good idea.

Saying to take probiotics is like saying to go exercise, it’s too broad of advice and needs a little more nuance. If you’re wanting to run a trial with probiotics, you want to take probiotics from all 3 categories: 1) Lacto/Bifido- species, 2) Saccharomyces Boulardii, and 3) Bacillus species.

Vitamin & Mineral Concerns

Nutrient deficiencies are a potential side effect of Celiac. Specifically, iron, Vitamin B6, Folate, Zinc, and Magnesium are nutrients of concern (4). Once the microvilli have healed, there’s a greater chance of absorbing these nutrients. Strict adherence to a gluten-free diet (GFD) is currently the best way to heal the villi, as gluten exposure can re-trigger the immune system to attack the villi. As we discussed, glutamine can also be a great support strategy for the microvilli.

There’s some support for B vitamin supplements helping improve blood levels of B12, B6, & Folate. There’s not much evidence for the use of zinc and magnesium to help improve nutrient status. However, I think zinc especially would still be worth trying due to its gut-protective role.

Children with Celiac on a strict GFD seem to heal their small intestine faster and more reliably than adults adhering to a GFD (It’s not uncommon for children to heal faster in general) (4). I think this leads us to say that children need to pay less attention to supplementation and more to the diet itself, whereas adults need to be more meticulous about supplementing with possible nutrients they’re missing out on absorbing (Zinc, Magnesium, B6, & Folate).

If you’re a female with Celiac Disease, I’d also pay more attention to your iron levels, using serum ferritin rather than serum iron as your marker of iron status. For males, you don’t engage in a hormonal cycle that causes you to lose blood, and iron, every month, so it’s less of a concern.

Remember, you have to approach Celiac from 3 places: 1) Gluten-free lifestyle, 2) Strategies to heal the gut, and 3) (MOST IMPORTANT) Figure out what’s driving the immune problems. Once you’ve addressed those areas, then I’d worry about supplementing for nutrient deficiencies. If you don’t work on the gut and the autoimmunity, it doesn’t matter how many B vitamins you try to take, you’ll struggle to absorb them.

Immune Support

By having an autoimmune disease you’re automatically at an increased risk of other autoimmune conditions. Inflammatory Bowel Disease (IBD) is also theorized to be an autoimmune disease taking place within the gut, and wouldn’t you know that if you have Celiac, you may have a nine-fold increased risk of having IBD (5). Thankfully, we have many validated support options for IBD, and due to this Celiac-IBD connection, these options could theoretically help with the immune system in Celiac as well.

Turmeric, Omega-3s, and even probiotics can all improve disease activity of IBD (6). Green tea polyphenols have long been studied for their anti-inflammatory, anti-oxidant, anti-microbial, and neuro-protective roles. A molecule present in green tea, EGCG, could inhibit the absorption and metabolism of the gluten fragments that induce an immune response (7).

There you have it. Probiotics, glutamine and zinc for gut support, turmeric, omega-3s and green tea polyphenols for immune support, on top of the gluten-free diet. I’ve given you an array of tools to choose from, but the actual implementation is the most important, and most confusing, part. If you’re looking for a healthcare provider who understands these nuances of Celiac and how to implement all these strategies, check out The HIVE Natural Health Center and head on over to the Functional Medicine page.

As always, Trust in Your Gut.

Disclaimer: The contents of this article are for educational purposes only, and are not intended to diagnose or treat any condition. Do not apply any of the information in this article without first speaking with your doctor.

References

1. Sevinc E, Sevinc N, Akar HH, et al. Plasma glutamine and cystine are decreased and negatively correlated with endomysial antibody in children with celiac disease. Asia Pac J Clin Nutr. 2016;25(3):452–456. doi:10.6133/apjcn.092015.09
2. Rao R, Samak G. Role of Glutamine in Protection of Intestinal Epithelial Tight Junctions. J Epithel Biol Pharmacol. 2012;5(Suppl 1-M7):47–54. doi:10.2174/1875044301205010047
3. Seiler CL, Kiflen M, Stefanolo JP, et al. Probiotics for Celiac Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials [published correction appears in Am J Gastroenterol. 2021 Sep 1;116(9):1968]. Am J Gastroenterol. 2020;115(10):1584–1595. doi:10.14309/ajg.0000000000000749
4. Kreutz JM, Adriaanse MPM, van der Ploeg EMC, Vreugdenhil ACE. Narrative Review: Nutrient Deficiencies in Adults and Children with Treated and Untreated Celiac Disease. Nutrients. 2020;12(2):500. Published 2020 Feb 15. doi:10.3390/nu12020500
5. Pinto-Sanchez MI, Seiler CL, Santesso N, et al. Association Between Inflammatory Bowel Diseases and Celiac Disease: A Systematic Review and Meta-Analysis. Gastroenterology. 2020;159(3):884–903.e31. doi:10.1053/j.gastro.2020.05.016
6. Malinowski B, Wiciński M, Sokołowska MM, Hill NA, Szambelan M. The Rundown of Dietary Supplements and Their Effects on Inflammatory Bowel Disease-A Review. Nutrients. 2020;12(5):1423. Published 2020 May 14. doi:10.3390/nu12051423
7. Chiu HF, Venkatakrishnan K, Golovinskaia O, Wang CK. Gastroprotective Effects of Polyphenols against Various Gastro-Intestinal Disorders: A Mini-Review with Special Focus on Clinical Evidence. Molecules. 2021;26(7):2090. Published 2021 Apr 6. doi:10.3390/molecules26072090