What Is Celiac Disease?

CD is an auto-immune disease and is sometimes referred to as celiac sprue.  It is genetically influenced condition that results from eating gluten.  The primary damage that CD causes is to the mucosal lining of the small intestine.  Nutritional therapy is the only accepted treatment for celiac disease.  Treatment requires elimination of the gluten grains primarily wheat/rye/barley and potentially oats.

What Is Gluten?

Gluten is the term for the storage protein of wheat, rye, barley and several other grains in the grass family. (Green, 2006;22)  The gluten fraction that is most studied in celiac disease (CD) is called glaidin.

Understanding Celiac Disease

In your questionnaires all stated they wanted a better understanding of the disease and how it impacts the body.

I’ll start by saying that normally when we digest protein, it gets broken down in the stomach and small intestine into amino acids that are readily absorbed by the small intestine.

The primary damage that CD causes is to the mucosal lining of the small intestine.  Nutritional therapy is the only accepted treatment for celiac disease.  Treatment requires elimination of the gluten grains, primarily wheat, rye, barley, and potentially oats.

Grains, Seeds, and Other Starches Sources in the GFD

* These sources are more nutritious that other starches in the GFD; higher fiber, protein, calcium, iron.
But the gluten molecule is resistant to the enzymes that break down proteins.  It is not easily digested.  As a result, what is left is a long peptide (amino acid) chain, which is the toxic protein fraction gliadin.

In CD this gliadin gets into the mucosal wall and an immune response is initiated and the body’s immune cells attack the lining of its own small intestine, which lead to the hallmark intestinal changes that define CD. (Green, 2006;23)

That change in the small intestine is called villus atropy.

The villi are the workhorses of the small intestine.  They are the final intestinal link between the food you eat and your blood stream.  And this is where CD does its primary damage.

This damage to the villi of the mucosal layer has many negative health ramifications for the celiac – because the villi pay a critical role by:

1. increasing the surface area of small intestines to allow the absorption of nutrients,releasing enzymes that continue and complete the breakdown/digestion of food,

2. absorbing the products of digestions & transporting them into the bloodstream for distribution throughout the body, and

3. acting as a barrier that blocks bacteria, parasites and toxins form entering the body.

To give you a picture of what was going on in the intestines before stopping ingesting gluten.
What was happening in the intestines was a lot like what happens to burn patients.  They lose fluid, serum and protein through the inflamed destroyed layers of skin.  When we have a prolonged inflammation of our intestinal lining, the lining:

1. becomes permeable to substances not meant to be absorbed, and

2. allows substances like fluids to seep into the intestine through the leaky lining – and then be lost to the body.

What All Have In Common

1. A long road to diagnosis

2. All in this celiac education and support group went many years with many symptoms before diagnosis

3. All reported a wider variety of symptoms including diarrhea, chronic constipation, anemia, osteoporosis, fatigue, other autoimmune diseases, abdominal pain and bloating and weight loss.

4. Malabsorption

5. The longer we go undiagnosed, the more severe are the consequences of our metabsorption.  And this is what puts the celiacs at higher risk for other health problems.

Health Risks

1. The untreated celiac have a 30% chance of developing another auto-immune disease Vs. a 3% chance for the general population.  (Green. 2006;152)

2. The risk equalizes after the treatment for the gluten free diet.

3. But it is important to realize the importance of strictly adhering to the diet because those who do not are at higher risks for fibromyalgia, lupus, rheumatoid arthritis, thyroid disease, diabetes, auto-immune liver disease, cardiomyopathy, alopecia, MS, ADHD, osteoporosis.

The Good News

1. We can control our risk.
2. CD is the only auto-Immune disease where one environmental toxin is known to be the cause.
3. Once it is removed and we are adhering to a strict gluten-free diet reversal of the symptoms and remission of the condition occurs.
4. The risk for associated illnesses reduces to the same level as for the general population.
5. Through diet & nutrition we have the ability to reverse the disease, stop the symptoms and do a great deal to heal the damage it has done to your body.

Why is Nutrition so Important for Celiacs

Celiac patients go undiagnosed for an average of 10 years.  This means that our nutritional status has been severely compromised due to the malabsorption caused by the disease.

We have been borrowing from whatever nutritional reserves we had and over time.  We've built up a huge nutritional deficit.

Our tissues and bones have been robbed of nutrients they need to be really healthy.

Good nutrition and eliminating gluten from the diet is the means by which we as celiacs can pay down our nutritional debt.

Optimal Nutrition for the Celiac

1. The essential foundation for the celiac diet is that gluten be entirely eliminated.  The strict avoidance of gluten leads to the healing of the mucosal lining of the small intestine and the end of malabsorption.
2. Yes, it is very possible to eliminate gluten and still have a nutritionally sub-adequate diet.
3. We as celiacs have a lot of lost time (nutritionally) to make up for, so our goal is to optimize our nutrition.

What is Optimum Nutrition for a Celiac?

Fresh, organic, seasonal fruits, vegetables and legumes.
Organic, grass-fed, free-range meats and poultry.
Wild coldwater fish e.g. Pacific salmon, sardines, eel, pike, haddock and cod.
Quality dairy – butter, cream, whole milk, eggs.
Quality Fats – cod liver oil, olive oil, coconut oil, ghee, soaked nuts & seeds.
Variety – colors too.  Integrating a wide variety of fruits, vegetables, protein sources & non-gluten grains is important if we are to optimize our nutrient intake.
Super food – Concentrated sources of vitamins and minerals – sea vegetables, alga, chlorella spirulina and nutritional yeast.
Fresh, organic and unprocessed foods have fewer man-made chemicals like pesticides, fungicides and toxic metals and have been shown to have higher nutrient content, including improved protein quality and up to 30% more vitamin C, iron, magnesium and phosphorus (Braly, 2002;86)

Common Nutrient Deficiencies in Celiac Disease

Recommendations

Supplementation is particularly important during the post diagnosis stage and then remains important though not as critically.

Supplementation Post-Diagnosis for Healing Mucosal Lining

1. Pancreatic enzymes to promote complete digestion of food. (Taylor, 2000;69)
2. Demulscent herbs such as slippery elm, marshmallow root, and aloe vera juice promote mucosal healing.
3. Often necessary to add HCL supplementation or 1 T apple cider vinegar in 8 oz. warm water with meals (if food entering small intestines is not acidic enough, it won’t signal duodenum to secrete the hormones necessary to signal pancreas to secrete enzymes).  (Lupoki, 2005; 187)
4. Gucosomine Sulfaste is a key precursor in the geosynthesis of mucosal glycoproleins that form the most superficial layer of the mucosal lining, which protects the underlying tissues from assault and damage. (Murray, 1996; 337)
5. L-Glutamine – This amino acid is the primary fuel for the mucosal cells.  Adequate intake is required for synthesis of sig (secretory IGA) the immunoglobalin which is central to the normal function of the intestines as an immune barrier (Averdy, 1990).
6. Essential Fatty Acids – these are essential because we can’t make them we can only get them from our diet. We need a balance of Omega-6 (corn, sunflower, sesame, soybean and walnut oils) and Omega-3 (flax seeds and oil, coldwater fish e.g. Pacific salmon, sardines, eel, pike, haddock and cod).
7. The Omega 3’s improve blood flow and reduce inflammation–will help with mucosal healing. (Murray, 1996; 252)
8. Probotics such as L acidophilus which is normally one of the dominant microflora Species in the small intestine, support a healthy balance of gut microflora.  They are particulary important to the celiac because they improve digestion by digesting fiber and making short chain fatty acids (SCFA’s) which feed the intestinal cells of the mucosal layer.  They also aid in improving nutritional states by manufacturing B vitamins, which Celiac are commonly deficient and also Vitamin K. (Murray, 1996; 359)
9. Essential fatty acids.

Some Dietary Guidelines

Avoid:

1. Gluten
2. Alcohol
3. Sugar
4. Over-the-counter NSAID’s (damage lining)

First month

Avoid foods that could be irritating

General Vitamin & Mineral Supplementation

The importance of vitamin and minerals in creating and maintaining health can not be overemphasized.
Your improved diet will provide the bulk of your nutrition but because of our years of malabsorption, supplementation is a good thing.

B Vitamins:

Deficiencies are common in celiacs. (Brayly, 2002:97) Deficiencies in the B vitamins are associated with many conditions, some of which include fatigue, mental confusion, anemia, impaired immunity, nervousness, insomnia, headaches, adrenal fatigue and more. (Basuman, 2005; 345)  The B vitamins can be found in nutritional yeast, whole grains, nuts, legumes, seeds, green veggies and crunchy veggies.  B12 is in fish, cheese, meat. (Murray, 1996; 127)
Recommend high quality B-complex 1 cap 3x day

Calcium:

In adult diagnosed celiacs, there is almost universal bone mineral depreciation.  (Braly, 2002; 94).  It is important to remember that bone health and density depend on a number of nutrients and factors, including magnesium, boron, Vitamin K, Vitamin D & Zinc.  (Murray, 1996; 477)
Recommend: OSCAP by Thorne, 4 a day

Vitamin A & E:

One or more of the soluble vitamins have been reported deficient in celiacs. (Brayly 2002;99)  Vitamin A is necessary for the healthy mucosal linings of both the intestinal and respiratory tracts. (Murray, 1996; 24).  Food sources of pre-formed vitamin A include liver, kidney, butter, whole milk.  Provitamin A carotene sources are dark leafy greens and yellow and orange vegetables. (Murray, 1996; 20)  Vitamin E functions primarily as an anti-oxidant in protecting against damage to the cell membranes throughout the body. (Murray, 1996; 44)  Food sources include polyunsaturated vegetable oils, seeds, nuts and whole grains.
Recommend A – 5,000-10,000 IU daily
Recommend E – 400 IU daily

Vitamin C:

Promotes healing and makes us resistant to inflection.  It is found in broccoli, peppers, potatoes, Brussels sprouts, and citrus fruits. (Murray, 1996; 44)
Recommend 1,000 mg daily

Multi-mineral:

Celiacs have been shown to be deficient in many minerals, including selenium, iron, potassium & magnesium.  Minerals are essential components of enzymes and co-enzymes that are involved in speeding up chemical reactions necessary for our bodies to function in a healthy way. (Murray, 1996; 7)
Recommend: AR6 – Multi mineral, 1 3x daily

Vitamin D:

Low blood and tissue levels have been reported in untreated celiacs, and contributes to the low bone density found commonly in celiacs. (Murray, 1996; 38).
Recommend: Cod liver oil with vitamin D

How to Live a Gluten Free Life Know What’s Safe and What’s Not

Safe Sources and Ingredients in Flour

Unsafe Sources of Flour – May Contain Gluten

Reading Labels

Being diligent in reading labels will protect you from sources of hidden gluten. Watch out for these.

Resources

American Celiac Society 504-737-3293 americanceliacsociety.org

Celiac Disease Foundation 818-990-2354 celiac.org

Celiac Sprue Association 877-CSA-4CSA csaceliacs.org

Publications & Websites

Gluten-Free Living
A national magazine devoted to celiac disease, the gluten-free diet, and the lifestyle.  Extensive research available on ingredients.  Updated quarterly.
914-741-5420
glutenfreeliving.com

Scott-Free
Resources and information for people on gluten-free diets.
celiac.com

Sully’s Living Without
A lifestyle guide for people with allergies and food sensitivities.
847-480-8810
livingwithout.com

Manufacturers of Gluten-Free Products

510-524-9630 - kjoy@theranut.com

Serving Berkeley & Marin California and the surrounding areas.

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