Celiac disease or gluten sensitive enteropathy is a permanent intolerance of dietary gluten. Hashimoto’s and celiac disease are closely connected due to common genetic predisposition and increased autoimmunity that can be triggered by gluten. Recent research suggests that Hashimoto’s patients have some sort of gluten intolerance or full-blow celiac disease.
Until recently, the celiac disease was considered to be rare mainly because many of its patients have very subtle or no symptoms and remain undiagnosed.
According to official data, the prevalence of celiac disease among the general population of western countries is about 1%, however due to unreliable conventional testing the numbers can be much higher.
People who test negative for celiac disease may still experience gluten allergy symptoms called non-celiac gluten sensitivity. Non-celiac gluten sensitivity is a gluten intolerance resulting in symptoms and illness similar to the disease without meeting the diagnostic criteria. Many individuals are not aware that they have it because the symptoms are often very non-specific and the tests come back normal.
People with celiac disease usually have more obvious symptoms such as bloating, insulin-dependent diabetes, osteoporosis, short in stature, canker sores and/or chronic liver disease of unknown cause, weight loss or gain, diarrhea, iron deficiency anemia, unexplained neurological syndromes and infertility.
For the majority of patients gluten damages the brain, heart, skin, respiratory tract and the joints. Many research papers reports that early in the disease most untreated celiacs have no digestive symptoms at all.
Most people may not develop the illnesses until adulthood. The average age of diagnosis is between 40 and 60. Factors that may trigger the disease are emotional stress, pregnancy, surgery, physical trauma or viral infection.
How gluten causes the disease
Celiac disease is a multisystem disorder that causes body’s immune system to respond to the proteins in certain grains:
- gliadin in wheat type grains
- hordein in barley-type grains
- secalin in rye
The immune system responds to gluten as an antigen and builds antibodies against these proteins. The antibodies destroy the villi, which allow absorption of the nutrients from the food. The intake of gluten causes swelling and inflammation of the intestinal lining leading to digestive disorders.
Undiagnosed and untreated many gluten sensitive individuals deplete their nutritional status and immune system and continue to develop illnesses. Due to damage to the villies absorption is disturbed and causes malabsorption.
The nutrients, minerals and vitamins from the food will not enter the body despite adequate diet. If the damage to the intestine is severe it is possible that iron, protein, calcium, vitamins B and fat soluble vitamins such as A, D, E and K are not being properly absorbed.
As the damage to the small intestine continues, gluten leaks into the blood stream causing the antibodies to raise and injure a wide variety of human tissues. If the small intestinal leakage continues for a prolonged period of time the antibodies are then produced at a very high level.
With daily gluten consumption present, the suppression of digestion and a leaky gut will follow causing excessive quantities of antibodies to circulate throughout the body and increase the risk of autoimmune diseases.
Recent research studies have shown that other grains can also contain different types of gluten proteins that can be harmful for people with celiac disease. There are three mechanisms how gluten proteins and alike can lead to negative effects:
- Cross contamination. One random study of gluten-free grains and mainly packaged processed foods that contained gluten-free ingredients but were not labeled as gluten-free products showed that 41% of them were contaminated with gluten. You can read more about it here
- Crossreactivity with other foods. There are about 24 foods such as coffee, potatoes and dairy that can cause similar reaction as if it would be gluten. If you have gluten intolerance or celiac disease it is important to know what other foods you could be reacting to in order to get optimal results and heal the intestines by eliminating them from your diet.
- Gluten-like proteins in gluten-free grains such as rice and corn can cause damage .
All this information is most likely new to you and you may be very gluten confused at the moment. In the following video Dr. Peter Osborne explains the differences between celiac disease, wheat allergy, gluten intolerance and sensitivity. He also talks about cross contamination and gluten-like proteins in the widely accepted gluten-free foods that actually can lead to damage in those who have issues with digestion of gluten.
Other common food allergies could increase the intestinal permeability called leaky gut syndrome causing the substances other than gluten to leak into the system and initiate autoimmune reaction. If the immune system responds by making antibodies against these substances, then gluten and other allergens containing diet may provide the necessary trigger of an autoimmune disease.
The test for intestinal permeability just recently became available at at the Cyrex Labs. This test helps to find out what exactly is causing leaky giving your practitioner the information what to specifically target for faster and more efficient gut repair. However, only a registered doctor could order the tests at Cyrex Labs. If you would like to order the test for intestinal permeability yourself you could do it through the True Health Labs.
Genetic predisposition to celiac disease
Besides sensitivity to gluten, people with celiac have a strong genetic predisposition to the disease. HLA proteins named DQ2 and DQ8 are found in more than 90 and 94 percent respectively of those with celiac. HLA-B8 is also common and is found in about 80 percent of celiac patients.
These genetic markers for celiac disease could be tested. There are HLA-DQ2 and HLA-DQ8 tests available and could be ordered by the patient without a doctor’s referral and health insurance.
However, those who tested positive do not necessarily develop celiac disease, since the environmental factor gluten is the main trigger and is necessary to initiate the disease. Genetical testing confirms the genetical predisposition to gluten intolerance and could help to prevent the disease or confirm the diagnosis.
The incidence of celiac disease in the families with celiac is 1 in 22 for first degree relatives (parents and siblings), 1 in 39 in second degree relatives (grandparents, aunts, uncles, cousins), and 1 in 56 in symptomatic patients.
Besides the first- and second degree relatives of individuals with celiac disease, the population at risk include individuals with type 1 diabetes and those with Turner, Down or Williams syndromes.
Tests for celiac disease
A standard procedure to determine celiac disease includes blood testing for the following antibodies:
- IgA anti-endomysial antibody (EMA)
- IgA anti-tissue transglutaminase (anti-tTG) antibody.
However, the comprehensive testing includes measurement of two additional thypes antibodies:
- Gliadin (Gluten) Antibody Profile- IgG, IgA
- Immunoglobulin A (Total IgA)
You could order a comprehensive Celiac Disease Test Panel at the True Health Labs that includes all four types of antibodies.
Celiac disease could be diagnosed if a person is positive to one or more of these antibodies. It is important to to eat gluten before being tested. If the individual is on the gluten free diet already, the antibodies often could not be detected even if a person has the disease.
If the blood tests are positive, then a follow up with an endoscopy is usually ordered. A biopsy is then performed to identify the extent of damage to the small intestine.
Standard blood tests for gluten intolerance have a less than 30% accuracy rate. The antibodies show up when the damage to intestinal lining occurs. Since some people are not in this advanced stage or the other part of the body is a target organ, for example skin, the tests do not show an increased level of antibodies.
The True Health Labs use advanced methods of testing such as Intestinal Permeability Test with higher accuracy rate than standard blood tests used in the conventional medicine. In addition, True Health Labs offer comprehensive panels and analysis that significantly decrease the chance of missing a diagnosis.
Other option to identify and diagnose gluten intolerance is to use an elimination diet, a strict diet in which gluten and gluten associated foods are completely eliminated for a significant period of time. If the patient shows relief of the symptoms on the gluten-free diet and symptoms appear again after the re-introduction of gluten then gluten could be identified as a trigger.
There are other tests that could be performed to determine the severity of the disease, involvement of other organs and nutritional abnormalities:
- Complete blood count to check for anemia
- Erythrocyte sedimentation rate and C-reactive protein to evaluate inflammation
- Comprehensive metabolic panel to determine electrolyte, protein and calcium levels, and to check the status of the kidney and liver
- Vitamin B12, D, E and iron to determine anemia
- Comprehensive Stool Analysis evaluates digestion and absorption, bacterial balance and metabolism, yeast (candida), immune status and signs of malabsorption. You could order the test at True Health Labs (see under Autoimmune – Celiac disease).
If digestion is significantly impaired, allergies often appear. Additional allergy testing can be ordered since allergy to other foods becomes common. For example, about 50% of people who are sensitive to gluten are also sensitive to dairy.
Over 150 medical conditions have been reported to have an increased prevalence among gluten sensitive individuals. Celiac disease is associated with several immune and non-immune based diseases of the digestive system including ulcerative colitis, microscopic colitis, Crohn’s and liver diseases. However, many health conditions outside the digestive system have also been linked with celiac disease.
In untreated celiac patients there is a significantly increased risk of many types of cancer. Small intestinal limphomas are found up to 100 times as frequently in celiac patients. They also have about 12 times the risk of esophageal cancer, and 10 times the risk of mouth and pharynx cancer and twice the risk in breast cancer.
Gluten derivatives called exorphines cause an increase in insulin production and release. Higher insulin levels mask the malabsorption and also help to feed the tumors accelerating their growth because cancer cells need glucose to grow.
Prevalence of celiac disease was noted to be in up to 19% of patients with type 1 diabetes mellitus, up to 4.5% in Grave’s and 13% in Hashimoto’s disease. The coexistence of celiac and autoimmune thyroid disease is partly due to a common genetic predisposition. Both celiac disease and Hashimoto’s thyroiditis are reported to be associated with the genes HLA-DQ2 and HLA-DQ8 and share common trigger of – gluten.
Moreover, celiac disease affects thyroid autoimmunity due to impaired absorption of selenium and contributes to development of Hashimoto’s thyroiditis. Adequate selenium levels can protect against autoimmune thyroid disease and goiter development in adults. Studies show that treatment with seleno-methionine for 6 months reduces TPO antibodies and decreases the severity of Hashimoto’s disease.
Benefits of gluten-free diet
By eating gluten-free foods the villi are not destructed or irritated by the gluten protein and allowed to heal. The time required for healing after going gluten-free varies: depending on the degree of intestinal damage, it can take months to years for the lesions to clear.
The small intestine usually heals in 3 to 6 months in children but may take several years in adults. It can take up to 6 to 8 months for gluten to fully leave the body. The effects and symptoms of gluten can be felt for up to three years.
There are many autoimmune diseases affected by gluten. The risk of autoimmune disorders increases with the length of time in which a celiac patient consumes gluten. About 65 to 68% of celiac children and adults have circulating antibodies that attack some of their own tissues.
A large majority of the celiac patients with high antibodies are not following gluten free diet. Eliminating gluten from the diet can reduce the production of antibodies and improve the symptoms of associated autoimmune conditions.
It was reported that high level of thyroid antibodies was significantly lower after 6 months and was practically non-detectable after 12 and 24 months in patients following gluten-free diet. Persistence of the antibodies suggests poor dietary compliance, either knowingly or by mistake due to many hidden sources of gluten. In this situation nutritionist can help to identify sources of gluten in the diet.
Early diagnosis of celiac disease and dietary change can reduce complications such as malabsorption, osteoporosis and lymphoma, and improves the absorption of medications for the associated conditions such as hypothyroidism and osteoporosis.
It can take weeks or months to see the improvements following a gluten-free diet. If a person does not show improvements it is important to ensure that the food consumed does not contain any hidden gluten.
Gluten is often unexpectedly found in some vitamin pills, nutritional supplements, candies, medicines such as cough syrup, salad dressings, in the adhesive used on envelopes and processed foods. Gluten is used in shampoos, conditioners and lotions for its protein value benefiting hair and skin. You can find gluten in lipstick, play-dough and other cosmetics.
Despite of clear symptoms and indications for celiac some patients do not feel better being on the gluten free diet. Newer research shows this may be due to cross-reactivity of gluten with other foods.
In cross-reactivity the body mistakes another food for gluten and shows autoimmune response. For example, the structure of dairy is so close to gluten that it could be mistaken for gluten. At the moment, there are 24 different foods that may be causing cross-reactivity some of which are dairy, coffee, amaranth, quinoa and yeast.
Treatment of celiac disease
A gluten-free diet is the only treatment for celiac disease and is considered to be the best treatment for dermatitis herpetiformis. Gluten-free diet is a life time requirement in these conditions.
Starting a gluten-free diet can be challenging because many foods most people eat on a daily basis contain gluten. The Gluten-free foods list, Gluten containing foods list and “Hidden” sources of gluten in the Resources section could help you to make right food choices.
With time patients who follow gluten-free diet can improve the symptoms of malabsorption and increased intestinal permeability (leaky gut syndrome). Supplementing with high quality micronized L-Glutamine speeds up the recovery and helps the healing process.
However, it is important to make dietary changes first and know when is the right time to use supplements, because supplements alone will not help. The following life changing video from doctor of Functional medicine Karen Brimeyer explains how to heal the leaky gut syndrome naturally and permanently. To watch the video click here
Seleno-Methionine 200 mcg, 250 caps by Douglas Labs.
Micronized L-Glutamine 1.1 lbs (500 g)
There is a lot more to discover about Hashimoto’s thyroiditis, so sign up for Outsmart Disease blog updates and get FREE e-mail course Nutritional guide for Hashimoto’s disease to learn more.
Dangerous grains: why gluten cereal grains may be hazardous to your health by J. Braly, R. Hoggan, Penguin, 2002
Going against the grain: how reducing and avoiding grains can revitalize your health by M.D. Smith, McGraw-Hill Professional, 2002
Celiac disease: guide to living with gluten intolerance by S.L. Bower, M.K. Sharrett, S. Plogsted, Demos Medical Publishing, 2006
Celiac disease and autoimmune thyroid disease. Clin Med Res. 2007 Oct;5(3):184-92.
What type of gluten intolerance do you have? Newsletters January, 2011 by D. Kharrazian the author of a thyroid book:
Why do I still have thyroid symptoms when my Lab tests are normal? by D. Kharrazian, Morgan James Publishing, 2009
Prescription for nutritional healing: a practical A-to-Z reference to drug-free remedies using vitamins, minerals, herbs and food supplements by P.A. Balch, Penguin, 2010