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.
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:
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.
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.
Dr. Fuhrman’s general supplement protocol for adults (see Vitamin Advisor for details) includes:
Multivitamin (without beta-carotene, vitamin A, vitamin E, folic acid, copper), such as Women’s Daily Formula +D3, Men’s Daily Formula +D3, or Gentle Care Formula.
Omega-3 DHA and EPA, such as DHA+EPA Purity.
Optional: Consider adding a mixed mushroom immune supplement, such as Immune Biotect, because of the potential immune system benefits throughout life from assorted mushroom phytochemicals not normally consumed in the diet. Consult your physician if you are on medication.
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.
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.
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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
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.)
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?
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.
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?
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
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.