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Celiac Disease


Celiac disease (or celiac sprue) is a chronic autoimmune disease that is related to a sensitivity to gliadin (gluten) which is found in some grains such as wheat, rye, and barley. Exposure to gliadin in someone with celiac disease leads to an inappropriate immune response that results in inflammation and damage to the inner lining of the intestines.

 
  • Overview
  • Action Plan
  • Ask The Doctor
  • Read & Watch
  • See Also

Overview


The estimated number of persons diagnosed with celiac disease in the U.S. is approximately 1% of the population1 and roughly 1-3% in the world. Celiac disease is often times challenging to diagnose since the symptoms in many cases are mild and non-specific. Investigators have identified that many other diseases, including irritable bowel syndrome, fibromyalgia, psoriasis, and many other autoimmune diseases, for example, have a high correlation with gliadin (gluten) sensitivity. A higher number of persons are now being recognized as having a gluten sensitivity, even though many may not fulfill the diagnostic criteria for celiac disease. It is for these reasons that these prevalence estimates are likely to be underestimated.

Symptoms of celiac disease (or gluten/gliadin sensitivity) may display as:

  • Abdominal pain
  • Diarrhea
  • Gas or bloating
  • Weight loss and/or malnourishment related to malabsorption
  • Fatigue
  • Some will experience a rash on their skin
  • Some may experience headaches

We don’t know exactly what causes celiac disease, however, the incidence has risen possibly due to the proliferation of modern diets using processed foods and commercial baked goods. Those with a first-degree relative with celiac disease seem to have a higher risk (10% chance) of developing it themselves, suggesting a hereditary link, but most investigators think that a number of environmental factors may need to be present in order for someone to develop the disease, such as intestinal bacterial imbalances, dietary factors, and/or toxic exposures.

 
References

1. Rubio-Tapia A, Ludvigsson JF, Brantner TL, et al. The prevalence of celiac disease in the United States. Am J Gastroenterol 2012, 107:1538-1544; quiz 1537, 1545.

Action Plan


Diet

  • A modified Nutritarian diet may be used to help manage and resolve symptoms of celiac disease. The high level of plant-derived micronutrients and phytochemicals helps reduce inflammation, which works synergistically with removing gluten.
  • Avoid all wheat and other gluten-containing foods, such as barley, spelt, and rye. Focus on beans, legumes, root vegetables, nuts, and seeds as major calorie sources. Gluten-free whole grains include quinoa, amaranth, millet, buckwheat, and gluten-free oats.
  • Vitamins, minerals carotenoids, flavonoids, fiber, and other phytochemicals have anti-inflammatory effects.1-5 Maximize the intake of immune-system-regulating, anti-inflammatory foods such as green vegetables, mushrooms, onions, squashes, parsnips, turnips and rutabaga, which have low allergic or reaction potential.  Eat both raw and cooked cruciferous vegetables every day. 
  • Anti-inflammatory spices such as turmeric, ginger, cayenne pepper, cloves, garlic, and cinnamon should be used in seasoning dishes.6-9  

Supplements

  • Dr. Fuhrman’s general supplement protocol for adults (see Vitamin Advisor for details) includes:

  • Additional supplements:

    • Probiotics: Research has suggested that healthy gut bacteria may help to keep a normal functioning immune system, and probiotics may be helpful, in addition to eating a fiber-rich diet, for autoimmune diseases.10-13 There are only a few studies on celiac disease, however, some evidence suggests probiotic supplementation may reduce gastrointestinal symptoms of celiac disease.14  Ask your doctor if taking probiotics is right for you.

    • Omega-3 DHA and EPA are likely helpful for autoimmune disease due to their anti-inflammatory effects. High doses may be necessary to experience a difference in symptoms.15 However, omega-3 supplementation has not yet been studied specifically in patients with celiac disease. If considering higher doses of omega-3 supplementation, please discuss this with your doctor first as it is not appropriate for everyone.

Read

Other Considerations

Supervised, periodic water fasting can be used as an adjunct treatment for autoimmune conditions. I have documented remission of autoimmune diseases following supervised fasting in a published series of case reports.16 Additional studies have found that fasting (followed by a vegetarian diet) reduces pain in rheumatoid arthritis patients.17,18 Continuing to follow a Nutritarian diet after completing the fast is essential for sustaining the benefits of the fast. Fasting puts the body into a repair mode, facilitating the elimination of damaged molecules, reducing inflammation, and resetting the immune system.19, 20 I generally recommend that patients adopt the dietary protocol for a few months prior to considering adding fasting to their protocol.  Fasting is not compatible with most medications. Fasting should be done under the supervision of a competent health professional.  

Find additional help

ONLINE: All members of DrFuhrman.com can search the Ask the Doctor archives for discussions on this topic. Platinum and Diamond members can connect with Dr. Fuhrman by posting questions in the forum. Not a member? Join now.

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References
  1. Yahfoufi N, Alsadi N, Jambi M, Matar C. The Immunomodulatory and Anti-Inflammatory Role of Polyphenols. Nutrients 2018, 10. doi: 10.3390/nu10111618
  2. Gioia C, Lucchino B, Tarsitano MG, et al. Dietary Habits and Nutrition in Rheumatoid Arthritis: Can Diet Influence Disease Development and Clinical Manifestations? Nutrients 2020, 12. doi: 10.3390/nu12051456
  3. McAlindon TE, Gulin J, Chen T, et al. Indole-3-carbinol in women with SLE: effect on estrogen metabolism and disease activity. Lupus 2001, 10:779-783. doi:
  4. Kaulmann A, Bohn T. Carotenoids, inflammation, and oxidative stress--implications of cellular signaling pathways and relation to chronic disease prevention. Nutr Res 2014, 34:907-929. doi: 10.1016/j.nutres.2014.07.010
  5. Ruhee RT, Suzuki K. The Integrative Role of Sulforaphane in Preventing Inflammation, Oxidative Stress and Fatigue: A Review of a Potential Protective Phytochemical. Antioxidants (Basel) 2020, 9. doi: 10.3390/antiox9060521
  6. Mazidi M, Gao HK, Rezaie P, Ferns GA. The effect of ginger supplementation on serum C-reactive protein, lipid profile and glycaemia: a systematic review and meta-analysis. Food Nutr Res 2016, 60:32613. doi: 10.3402/fnr.v60.32613
  7. Zhu C, Yan H, Zheng Y, et al. Impact of Cinnamon Supplementation on cardiometabolic Biomarkers of Inflammation and Oxidative Stress: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Complement Ther Med 2020, 53:102517. doi: 10.1016/j.ctim.2020.102517
  8. Singh S, Aggarwal BB. Activation of transcription factor NF-kappa B is suppressed by curcumin (diferuloylmethane) [corrected]. J Biol Chem 1995, 270:24995-25000. doi:
  9. Aggarwal BB, Yuan W, Li S, Gupta SC. Curcumin-free turmeric exhibits anti-inflammatory and anticancer activities: Identification of novel components of turmeric. Mol Nutr Food Res 2013, 57:1529-1542. doi: 10.1002/mnfr.201200838
  10. Mohammed AT, Khattab M, Ahmed AM, et al. The therapeutic effect of probiotics on rheumatoid arthritis: a systematic review and meta-analysis of randomized control trials. Clin Rheumatol 2017, 36:2697-2707. doi: 10.1007/s10067-017-3814-3
  11. Kouchaki E, Tamtaji OR, Salami M, et al. Clinical and metabolic response to probiotic supplementation in patients with multiple sclerosis: A randomized, double-blind, placebo-controlled trial. Clin Nutr 2017, 36:1245-1249. doi: 10.1016/j.clnu.2016.08.015
  12. Tankou SK, Regev K, Healy BC, et al. A probiotic modulates the microbiome and immunity in multiple sclerosis. Ann Neurol 2018, 83:1147-1161. doi: 10.1002/ana.25244
  13. Tamtaji OR, Kouchaki E, Salami M, et al. The Effects of Probiotic Supplementation on Gene Expression Related to Inflammation, Insulin, and Lipids in Patients With Multiple Sclerosis: A Randomized, Double-Blind, Placebo-Controlled Trial. J Am Coll Nutr 2017, 36:660-665. doi: 10.1080/07315724.2017.1347074
  14. Pecora F, Persico F, Gismondi P, et al. Gut Microbiota in Celiac Disease: Is There Any Role for Probiotics? Front Immunol 2020, 11:957. doi: 10.3389/fimmu.2020.00957
  15. Proudman SM, James MJ, Spargo LD, et al. Fish oil in recent onset rheumatoid arthritis: a randomised, double-blind controlled trial within algorithm-based drug use. Ann Rheum Dis 2013. doi: 10.1136/annrheumdis-2013-204145
  16. Fuhrman J, Sarter B, Calabro DJ. Brief case reports of medically supervised, water-only fasting associated with remission of autoimmune disease. Altern Ther Health Med 2002, 8:112, 110-111. doi:
  17. Muller H, de Toledo FW, Resch KL. Fasting followed by vegetarian diet in patients with rheumatoid arthritis: a systematic review. Scand J Rheumatol 2001, 30:1-10. doi:
  18. Smedslund G, Byfuglien MG, Olsen SU, Hagen KB. Effectiveness and safety of dietary interventions for rheumatoid arthritis: a systematic review of randomized controlled trials. J Am Diet Assoc 2010, 110:727-735. doi: 10.1016/j.jada.2010.02.010
  19. Longo VD, Mattson MP. Fasting: molecular mechanisms and clinical applications. Cell Metab 2014, 19:181-192. doi: 10.1016/j.cmet.2013.12.008

Cheng CW, Adams GB, Perin L, et al. Prolonged Fasting Reduces IGF-1/PKA to Promote Hematopoietic-Stem-Cell-Based Regeneration and Reverse Immunosuppression. Cell Stem Cell 2014, 14:810-823. doi: 10.1016/j.stem.2014.04.014

Ask The Doctor


The following are sample questions from the Ask the Doctor Community Platinum and higher members can post their health questions directly to Dr. Fuhrman. (All members can browse questions and answers.)

Q.

I have celiac disease. I have been gluten free for over 4 years. However, in my earlier years I made a huge mistake and ate gluten. Now I am nutrient deficient due to damaged villi.

Do you know of any way to get the nutrients I need?

A.

As you remain gluten free, the villi will heal and you will be able to have maximal absorption of nutrients. Eat very carefully and take the recommended supplements including vitamin D. Have a 25 hydroxy vitamin D level done to see if you are sufficient as you progress.

 
Q.

I was diagnosed with celiac disease shortly after I was born. My parents were never given much information about it, so I was fed foods with gluten as I grew older. How can I find out if the diagnosis was correct? Are there definitive tests that I can take?

A.

One way to test for this is a blood test called “Celiac Disease Reflexive Panel” which will go through a series of tests, depending on the first one drawn, minimizing extra tests you don’t need. Another way to do it is to just do the following two tests which, if positive, will indicate high likelihood of the disease.

Tissue Transglutaminase Antibody, IgA
AND
Deamidated Gliadin Peptide Antibodies, IgA

The blood tests are not the gold standard (biopsy of your intestines is) but will at least give you somewhat of a confirmation. If you notice sensitivity to gluten with your experience, then this is a test all by itself and should be recognized regardless of the blood test results because you could still have sensitivity to gluten and not technically have the diagnosis of Celiac.