Celiac disease is a complex inherited digestive disorder that affects I in 100 persons worldwide. This condition involves a unique immune response within the digestive tract to gluten, a protein found in the grains of wheat, barley, rye and oats. All persons with celiac disease, regardless of age, race or gender, are susceptible to intestinal damage when they eat food containing gluten or its derivatives. The treatment for celiac disease is a strict gluten-free diet that stops damage and allows recovery. Probiotics and prebiotics should be incorporated into the diet to improve the quality and balance of intestinal bacteria that inhabit the colon.
Intestinal enzyme deficiencies, sugar intolerances and associated dysbiosis, or imbalance of intestinal microbes, called flora, appear commonly in persons with celiac disease.1 Research indicates that the metabolic activity of intestinal microbial flora in celiacs is different from the general population and that it is a genuine phenomenon of celiac disease not affected by either the diet, the inflammation, or the autoimmune status of the patient.2 The severity of disturbances in intestinal balance of flora was found to depend on the gravity of the patients' state. 3
Celiac reactions work in the following way. Undigested fragments of gluten cause a “leaky gut syndrome” by relaxing the normally tight intercellular junctions that function to prevent large molecules from slipping through the lining. Penetrating gluten fragments become bound by the intestinal enzyme tissue transglutaminase (tTG) to form a molecule that triggers the development of antibodies. These antibodies then attack the altered gluten molecule within the lining.
The immune reaction within the gut lining causes inflammation and damage to the delicate structures of the lining, leading to failure to digest and absorb nutrients. Malabsorption leads to malnutrition that then brings about malfunction of any or all body systems, depending on the nutrients that are missing.
In this way hundreds of diverse health problems may develop from celiac disease.
Various microbial imbalances stem from the unnatural passage of undigested fat, carbohydrates and protein into the colon, poor gut motility, and certain nutrient deficiencies.
Passage of unabsorbed nutrients into the colon results from pancreatic insufficiency, bile insufficiency and digestive enzyme deficiencies.
- Pancreatic insufficiency results in deficiency of pancreatic digestive enzymes lipase, amylase, and protease needed for the digestion of fat, carbohydrates, and protein.
- Bile insufficiency results in impaired secretion of bile by the liver, obstruction of the bile ducts and abnormal circulation of bile salts that impairs the digestion of fats.
- Deficiency of lactase, sucrase, maltase and proteases result in failure to finish the digestion of sugars and protein required for absorption. Undigested nutrients arriving in the colon cause excessive fermentation and drawing of water from the bloodstream into the colon. These conditions produce symptoms such as abdominal pain, watery diarrhea, IBS-like symptoms, bloating, and gas. Pale foul-smelling stool that float or stick to the toilet bowl results from fat malabsorption.
Altered gut motility and low stomach acidity commonly found in celiac disease promote fermentation in the large bowel and also overgrowth of yeast and bacteria in the small bowel, both serious conditions.
The health and integrity of intestinal cells depends on adequate availability of niacin, zinc and vitamin A. Deficiency of these nutrients sets the stage for inflammation, infection and diarrhea that worsen gut function and induce overpopulation by pathogens.
For these reasons, persons with celiac disease should learn about and properly use both probiotics and prebiotics to improve their overall health and specifically their intestinal health. This is especially important if they continue to experience fatigue, weakness, achiness, depression, foggy thinking and digestive problems while maintaining a gluten-free diet.
Probiotic supplements and fermented foods, such as yogurt and unpasteurized apple cider vinegar, replace lost or reduced health-producing bacteria populations, such as lactobacillus and Bifidobacterium, in the colon.
Prebiotics, including flax, honey, greens (especially dandelion greens, but also spinach, collard greens, chard, kale, and mustard greens), berries, bananas, and other fruit, legumes (lentils, kidney beans, chickpeas, navy beans, white beans, black beans), will stimulate their growth.
Indeed, good health depends on good balance of intestinal bacteria.
1. Tjellström B, Stenhammar L, Högberg L, Fälth-Magnusson K, Magnusson KE, Midtvedt T, Sundqvist T, Norin E. “Gut microflora associated characteristics in children with celiac disease.” Scand J Gastroenterol. 2001 Feb;36(2):163-8.
2. Murray IA, Smith JA, Coupland K, Ansell ID, Long RG. “Intestinal disaccharidase deficiency without villous atrophy may represent early celiac disease.” Am J Gastroenterol. 2005 Dec;100(12):2784-8
3. Kamilova AT, Akhmedov NN, Nurmatov BA. “Intestinal microbiocenosis in children with intestinal enzymopathy.” Zh Mikrobiol Epidemiol Immunobiol. 2001 May-Jun;(3):97-9.
Copyright © Cleo Libonati 2007.
Cleo Libonati is the author of “Recognizing Celiac Disease,” an encyclopedia of celiac disease that can be found at www.recognizingceliacdisease.com. Libonati is President and CEO of Gluten Free Works, Inc. and co-founder of www.glutenfreeworks.com.