Digestive Wellness: Strengthen the Immune System and Prevent Disease Through Healthy Digestion, Fourth Edition (109 page)

Small intestinal bacterial overgrowth

Stomach rumbling

Stunted growth

Thyroid disease

Turner syndrome

Type 1 diabetes

Uncoordinated/clumsy

Vitamin deficiencies

Weight loss

Williams syndrome

Sources:
www.celiac.com
;
www.celiaccentral.com
; Alessio Fasano, “Celiac Disease Insights: Clues to Solving Autoimmunity,”
Scientific American
(Aug. 2009); Institute of Functional Medicine, GI Module 2010.

The recognition of celiac disease and gluten intolerance is rising, although it still takes someone with celiac disease an average of 9 to 11 years and at least five doctors to be diagnosed. It affects about 1 in 133 people. Ninety-five percent of people with celiac are thought to be undiagnosed. Ninety-five percent of people with celiac disease have positive HLA-DQ2 and HLA-D3 genes. Yet most people with these genes will never develop celiac disease: 35 percent of us have these gene types, while less than 1 percent have celiac.

As with all of the genetic diseases, three conditions need to be met for it to be expressed: have the right genes, have the right environment to trigger the disease, and have a leaky gut. Changes in the microbiome can predispose us to celiac. This is why some people develop celiac in early childhood and other people are diagnosed well into adulthood. If you have a relative with celiac or other autoimmune diseases (such as type 1 diabetes, rheumatoid arthritis, or lupus) your risk is 8 to 15 times higher than the general population.

Gluten is a protein component of wheat and several other grains. It’s what makes bread and pastries elastic and “gluey.” Gluten is a complex molecule, and digesting it thoroughly is something that we humans find difficult to do. Gluten is an unusual molecule that is rich in proline and glutamine. Part of the molecule is impervious to our digestion. In healthy people, the molecule stays inside the gut lumen and is passed as waste in stool. In people with leaky gut, the molecule passes through the gut, where it plays havoc. In people with celiac, this molecule provokes immediate and ultimately chronic inflammation and malabsorption. At a couple of the recent Defeat Autism Now conferences, Dr. Alessio Fasano, from the University of Maryland, who is one of the foremost celiac researchers in the world, showed a video of mice, one of which had been exposed to gluten, and the other one who had not been exposed to gluten. In the mouse that was exposed, there was a buildup of intraepithelial lymphocytes (IELs) at the inside of the gut lumen. IELs are white blood cells that immediately release cytokines to get rid of molecules that don’t belong there. (At the time of writing, Dr. Fasano’s lecture and video can be seen at
http://www.autism.com/pro_categories.asp?con=Baltimore&Year=2010
.)
Dr. Fasano states that this happens in
all
of us when we eat gluten-containing grains. If we have a leaky gut, then it becomes an issue because every time we eat gluten-containing grains, there is more immune involvement.

The lucky part about celiac is that if you completely stop eating gluten-containing grains, the body heals. You will see big changes almost immediately, and over 3 to 12 months the small intestine will heal. Avoiding all gluten is easier than it used to be, but still it can be daunting. How deeply you have fallen into the celiac rabbit hole will determine how long it will take for you to be renourished and how well some of the coexisting conditions will heal.

About half of all people with celiac disease are also lactose intolerant at the time of their diagnosis. Lactase, the enzyme required to split lactose, is manufactured at the tips of the villi. Because these villi are damaged in people with untreated celiac disease, their bodies can’t manufacture the lactase. Once people have gone onto a gluten-free diet and the intestinal lining is repaired, some will be able to tolerate dairy products. Right now the
only
safe treatment for celiac is to avoid gluten 100 percent. Researchers are working hard to find additional approaches for people with celiac. There is some promise with the use of digestive enzymes to break down gluten. Others are trying to inhibit tissue transglutaminase (tTG) so that it doesn’t modify undigested gluten particles so that they bind to the HLA-DQ2 and DQ8 proteins. Dr. Fasano is studying a drug, Larazotide, that blocks zonulin (which opens the tight junctions in the intestine, increasing leaky gut). Still others are working on possible vaccines. It’s too soon to know for sure what will be discovered, but keep your eyes open.