Celiac Disease and Gluten Intolerance

After receiving a celiac or GS diagnosis, most patients leave their doctor's office with instructions to adhere to a strict gluten-free diet — and that's it. While it's wonderful to have a definitive diagnosis and not to have to take medication for the rest of your life, it's also important to know that there are powerful over-the-counter tools at your disposal.
I frequently encourage newly diagnosed clients to start a course of nutritional supplements for six months to a year depending on the severity of their condition. Not only do the nutritional supplements listed below promote intestinal health and healing, they can actually accelerate your recovery.

Without a small intestine biopsy, it is difficult to estimate how ravaged your intestines are. Since biopsies are no longer required to diagnose celiac disease, most newly diagnosed patients are in the dark about the condition of their digestive track. According to the National Institutes of Health, diet alone will heal existing intestinal damage and prevent further damage. Yet, the amount of time it takes to heal completely varies depending on a number of factors, particularly age. For example, in children, the small intestine can take three to six months to heal; however, in adults, it may take several years before healing is complete.

While waiting for the gut to heal, many of the nutrients you consume are lost. A healthy intestine has an abundance of villi (tiny, finger-like projections that increase the intestinal surface area), which allows for the absorption of nutrients into the bloodstream. With celiac disease these villi are flattened and proper absorption of nutrients is compromised. The continued malabsorption of nutrients such as calcium, magnesium, vitamin D, B vitamins, and omega-3 fatty acids can contribute to mood disorders, lower energy levels, poor bone health, insomnia, attention problems, and a host of other issues.

Until recently, conventional medical wisdom presumed that only those with celiac disease suffered from severe intestinal degradation, the kind that destroys your villi. In the spring of 2011, however, Dr. Alessio Fasano completed a research study that found differences in levels of intestinal permeability and the expression of genes regulating the immune responses in the gut mucosa possibly associated with gluten sensitivity. What this study revealed is that gluten sensitivity and celiac disease are part of the same spectrum of gluten-related disorders. Meaning that those with gluten sensitivity suffer from intestinal permeability issues similar to those with celiac disease, but to a lesser degree. In other words, people with gluten sensitivity — not just those with celiac disease — have absorption issues caused by an immune response to gluten.

For the people with celiac disease and gluten sensitivity who more than likely have intestinal inflammation and permeability issues, the question remains: "How to return the digestive track back to normal as quickly as possible?"

Nutrition Supplements to Support Healing

The following nutrition supplements are effective and work independently of each other. These supplements also complement each other, so taking them together can help heal many aspects of the gut at once. In my experience as a Registered Dietitian working with patients who are afflicted with gluten issues, I have found that glutamine, probiotics, and fish oil (in that order) are my "Top Three" choices. Before you begin taking these, or any supplements, I encourage you to have a consultation with a dietitian who has experience with gluten disorders.

Glutamine is the most abundant amino acid in the body. It is a protein building block and is involved in more metabolic processes than any other amino acid. Glutamine also serves as a source of fuel for the cells lining the intestine and can promote healing in these cells when they are damaged by gluten. How much Glutamine you should take depends upon several factors. I suggest you consult a dietitian for the dosage that is right for you.

Probiotics are live bacteria that improve the intestinal microbial balance and enhance overall health. They are the "good" bacteria found in the gastrointestinal track. Inflammation or toxins in the gut can disrupt the balance between "good" and "bad" bacteria. Probiotics may be taken to restore a healthy balance and assist in the removal of toxins created by gluten insensitivity or celiac disease. In addition, a preventative dose of probiotics is a good idea as these microbes promote immune health, and they are frequently absent in modern diets. Probiotics come as capsules, tablets, liquids, powders and contain many different strains of bacteria. Be sure to purchase your probiotics from a reputable company that ensures the potency and efficacy of their products. Contact these companies for documentation stating probiotic viability and research studies using the strains in their formulas — or visit their websites. I normally recommend that my patients receive a daily dose of at least 10 billion (or more) live, viable, organisms per gram containing: Lactobacillus acidophilus, Lactobacillus bifidobacteria, Streptococcus thermophilus and Lactobacillus bulgaricus.

Omega 3 fatty acids are comprised of the fatty acids EPA and DHA and are found in fish and fish oil supplements. These essential fats are not made by the body and must be eaten or taken in supplement form to ensure the body's adequate functioning. In addition to reducing inflammation, these fats help to support healthy heart, brain, skin, and bone function. Significant health problems may result when these nutrients are not adequately absorbed. I recommend a dosage of 1,000 mg EPA and 1,000 mg DHA be taken daily from a high quality product with low mercury and toxin levels.

Digestive enzymes aid the body in digesting and breaking down proteins, fats, and carbohydrates. Digestive enzymes from either animal or plant sources should be taken an empty stomach, 20 minutes before meals or snacks. Enzymes help break down food into forms that the body can use. When the gut is damaged a condition called "leaky gut syndrome" occurs, and undigested food particles can pass through the intestinal wall into the blood stream in a form the body cannot use. These unusable food particles then activate an immune response because the body has detected an "invader." This immune response adds inflammation to the ongoing food sensitivity issues. Digestive enzymes assist in breaking food down into the right form for the body to use. In general, plant- or microbial-derived enzymes are more effective and work in more areas of your digestive system than their animal-derived counterparts.

Anti-inflammatory herbal formulas can help reduce inflammation and promote healing. Look for herbs like turmeric, aloe vera, ginger, and boswellia in formulas or by themselves as a part of your healing regime. Again, working with a dietitian to decide dosages and which combination of these herbs would be most beneficial to you is recommended.

What to Consider if You Are Not Getting Better

There are some people with celiac disease that show no improvement on a gluten-free diet. One of the most common reasons for a poor response to the diet is that small amounts of gluten are still being consumed. Hidden sources of gluten include medications, additives such as modified food starch, preservatives, and stabilizers made with wheat. Additionally, those with severe sensitivities may not be healing because of cross contamination caused by production facilities. Most corn and rice products are produced in factories that also manufacture wheat products. For some people, even these minute amounts of cross contamination can add up. Some people should only consume packaged foods from GF certified facilities, or in extreme cases, consume no packaged foods at all.

Some people with celiac disease continue to have intestinal flare ups despite being on a strict gluten-free diet. People with this condition, known as refractory celiac disease, have severely damaged intestines that heal very slowly — if at all. Because their intestines are not absorbing enough nutrients, these celiac sufferers may need to receive many of their nutrients intravenously.

Cross reactivity to some gluten-free grains can also be a problem. Intolerances to grains that do not contain gluten, which people on gluten-free diet tend to eat more of, can also develop. Many times these secondary intolerances develop because of gut permeability and the body's response to foreign material outside the gut lining, where it is not suppose to be. Cyrex Labs offers a Gluten Cross Reactive Foods Test that looks at the 24 most common foods that cross-react with gluten. This test will help you identify and avoid other foods that are preventing you from healing and feeling better.

In my experience, time does heal these wounds, but the amount of time varies widely from person to person. I have seen many people's symptoms — in particular, severe cases that have gone unresolved for decades — abate faster and more thoroughly thanks to additional supplementation. Any time the gut has undergone stress, the supplements mentioned above can be of benefit — and always be mindful when purchasing supplements to be sure they are gluten-free.