May is Celiac Awareness Month, so it’s the perfect time to shine a light on this often misunderstood autoimmune disease. Roughly a third of us bear the genetic predisposition for celiac disease, with the disease manifesting itself in about 1% of the population^A-E. However, many of those who suffer from the condition remain undiagnosed.

Part of the reason for this is that celiac disease symptoms can be subtle and nonspecific; while the disease can cause significant digestive issues such as pain, bloating or diarrhea, it is common that adults with celiac disease may only notice a bit of joint pain, brain fog or tiredness due to anemia ^A,D.

Celiac Disease vs Gluten Intolerance

Celiac disease is often mislabeled as a gluten allergy, when in fact, it is an autoimmune disease that is triggered by eating gluten. Gluten is a protein naturally found in wheat, barley and rye and any food or cosmetic containing these ingredients. When someone with celiac disease consumes even the tiniest crumb of gluten, it triggers an auto-immune cascade that damages the intestinal lining, causing a great deal of inflammation that hinders digestion and can lead to nutritional deficiencies. Left untreated, infertility, osteoporosis and other health concerns can result - so it’s important we become aware of the signs and symptoms, and how it differs from non-celiac gluten sensitivity^A.

This is different from non-celiac gluten sensitivity (NCGS), where eating gluten can cause many of the same digestive symptoms or fatigue, but without the intestinal damage and autoimmune response^E. Affecting up to 6% of the population, a lot is still unknown about the underlying physiology of NCGS, with some believing that it is early on the spectrum of celiac disease and others suggesting that it is another component of gluten-containing grains, such as FODMAPs, that is causing the reactions ^E.

As we learn more about celiac disease and NCGS, it has led some to mistakenly believe that gluten is inherently dangerous; however, it’s merely a naturally occurring protein found in wheat, barley, and rye. What is unusual about the gluten protein is that it has an amino acid sequence that is difficult for our bodies to fully digest and absorb, meaning that these partially digested protein fragments, or peptides, remain in the gut ^B. For some, the presence of these peptides can activate an immune response, but for others, they are simply excreted ^B.

Understanding our Risk

Celiac disease is on the rise…but why? And, with up to a third of us carrying the genetic predisposition to the disease, why don’t we all have it? Is celiac disease really genetic?

It is known that something needs to occur in our environment to ‘turn on’ the genetics associated with the disease^A,B,D. These switches can be a hormonal shift like puberty and pregnancy or a traumatic injury^A,B,D. Celiac disease can occur in childhood, and research suggests that early life exposures such as C-sections, breastfeeding or antibiotic use can impact risk for the disease ^C. However, diagnosis in later life is increasingly common, meaning that environmental exposures are constantly shaping our disease risk.

Increasingly, signs point to a leading role for our gut microbiome^B-D. Our trillions of gut bacteria are in constant communication with our immune system, helping it to distinguish friend from foe in addition to helping protect and maintain the integrity of the gut barrier and keep our immune response calm and alert. Dysbiosis, or an imbalance in the gut microbiome, is thought to interact with your risk of disease by altering the communication between bacteria and the immune system, decreasing immune tolerance and inciting a strong immune response ^C. For example, studies have found that a decrease in Actinobacteria such as Bifidobacterium and increases in Staphylococcus species may be associated with a higher risk of developing Celiac Disease ^C,D.

Your genes…your bacteria

Modern investigations have shown that people with celiac disease may have altered expression of the genes that regulate how the immune system interacts with our microbiomes ^C. It has been shown that the microbiome of those with celiac disease differs from healthy individuals; it is typically less diverse and contains different types of species ^C. Even after treatment with a gluten-free diet, it’s important to understand that some of these detrimental features remain, including increased E.coli species ^C,D. In addition, it is thought that certain bacteria may enzymatically alter gluten peptides in the gut, with some like Bacterioides fragilis rendering them more immunogenic while others like Bifidobacterium longum IATA-ES1 making them less immunogenic ^C.

Tending to our Microbial Garden

If the health of our intestinal microbiota holds the key to maintain a proper immune response and minimizing inflammation, it’s time to take a proactive approach to create a healthier gut. Some species, such as Lactobacillus rhamnosis GG have been found to protect the gut barrier in the face of gluten exposure while many others have been shown to fight off the more pro-inflammatory bacteria such as E.coli that may increase risk for the disease ^C.

This is where a daily probiotic comes in. A clinical strength probiotic such as Bio-K+ helps to support a balanced microbial community and stand in for the protective functions of a healthy microbiota when the system is under duress from poor diet, medication use or stress. In the literature, probiotics may help support decreases in inflammatory response in celiac disease ^C. What’s more, Bio-K+ is proven effective in fighting off potentially harmful bacteria such as Clostridium difficile and E.coli.

However, you also have to feed your body – and your gut microbes – well. And good bugs like plants. A typical North American diet high in hyper-processed foods filled with sugar and white flour and heavy on meat and dairy foster potentially detrimental changes in the gut microbiota. Instead, eating more high fiber plants foods such as fruits, vegetables, legumes and whole grains will help feed beneficial bacteria, reduce inflammation and keep the gut strong. It’s worth noting that the gluten-free diet can also result in detrimental effects to the gut microbiome, as it is typically lower in fibre and higher in refined starch and sugars so it’s important to choose more naturally gluten-free whole foods to protect gut health.

Get the Support you Need

If you suspect that eating gluten is causing you to feel unwell, it is critical that you go see your doctor BEFORE you eliminate gluten from your diet. The reason for this is that the presence of gluten is necessary to accurately diagnose celiac disease. When you remove gluten from your diet, it may lead to a false positive on the screening test, causing you to miss this important diagnosis.

Digestive health is the foundation of a healthy body and mind. If something doesn’t feel right, be sure to explore it with your healthcare provider. If you find yourself with a diagnosis of celiac disease, know that a gluten-free diet is essential for treating the disease and keeping you healthy and happy for life.

Do you have any other questions about your gut health? Ask us in comments below. If you are looking to stock up on Bio-K+, head to our store locator. For more information on Bio-K+, probiotics and digestive health, contact us, find us on Facebook and Instagram or join our community. 

References:

1. Celiac Disease. National Institute of Diabetes and Digestive and Kidney Diseases Website. https://www.niddk.nih.gov/health-information/digestive-diseases/celiac-disease/definition-facts
2. Denham, Jolanda M, and Ivor D Hill. “Celiac disease and autoimmunity: review and controversies.” Current allergy and asthma reportsvol. 13,4 (2013): 347-53. doi:10.1007/s11882-013-0352-1
3. Cenit, María, et al. "Intestinal microbiota and celiac disease: cause, consequence or co-evolution?." Nutrients7.8 (2015): 6900-6923.
4. Wacklin, Pirjo, et al. "The duodenal microbiota composition of adult celiac disease patients is associated with the clinical manifestation of the disease." Inflammatory bowel diseases19.5 (2013): 934-941.
5. Igbinedion, Samuel O et al. “Non-celiac gluten sensitivity: All wheat attack is not celiac.” World journal of gastroenterologyvol. 23,40 (2017): 7201-7210. doi:10.3748/wjg.v23.i40.7201