As you can probably tell from the changes in menus and products available in supermarkets gluten related disorders are on the rise. While symptoms can very between mild to extreme digestive distress (as well as to neurological and skin issues) a diagnosis of coeliac disease can be a tricky one to adjust to, especially as the western diet features gluten containing foods as a foundation.
I’ve worked with people who have been dealing with gut issues that they’re actually relieved to have been diagnosed with coeliac by their doctor as it finally provides a reason for why they’ve been feeling so bad for such a long time. Although the solution in avoiding all gluten containing foods seems simple enough, at least on paper, the in practice the adaptation of the diet to find new ‘go-to’ foods can take a little bit of time.
Increased Rates of Coeliac
Over the last 50 years there’s been an increase of 400-450% in the rates of coeliac disease.
Our genes haven’t changed, so what has? A few explanations are:
- Shorter duration of breastfeeding
Breast milk helps to support the development of the gut bacteria which seem to be critical in our response to food.
- Increased frequency of c-section birth
Similar to the above as vaginal delivery provides a healthy dose of bacteria to the infant.
- Age when gluten is introduced
Introduction of gluten before 4 months of age has been linked to an up to 500% increase risk of the conditions.
- High antibiotic use
Antibiotic use impacts out gut bacteria and weakens this area.
- Changes in food preparation
Nitrogen fertilisers usage increases the amount of gluten the plant produces. Also, traditional fermented food preparation such as sourdough bread fermentation starts to breakdown the gluten proteins before they’re ingested which essentially makes it easier on the gut to mange.
Once someone has been diagnosed with coeliac and begins a gluten free diet there are a couple of tests that can be used to monitor progress of how the immune system and the gut lining is responding. One test is to measure levels of anti-tGA IgA at 3, 6 and 12 months to monitor adherence to a gluten free diet. Anti-tGA IgA are the antibodies produced by the immune system when it’s presented with gluten. Ideally these should drop significantly after 3 months and normalise after 1 – 2 years. The second test measure intestinal permeability which is more often known as leaky gut. Since gluten will damage the gut, molecules can pass through more readily. This test correlates with biopsy results from the small intestine. Ideally this should normalise over a 12-month period.
So, this is how things would play out in an ideal world but what happens where you’re doing everything right and you’re still not feeling better?
Nonresponsive Coeliac Disease (NRCD)
10-20% of coeliacs will have persistent symptoms despite strictly following a gluten free diet. This can be somewhat explained by gluten finding its way into their diet through hidden sources such as sauces and pre-packaged foods. In addition to gluten triggering the symptoms other non-gluten containing foods may ‘cross-react’ or mimic the effects of gluten and results in stomach aches, brain fog or headaches every time they’re eaten. Some research indicated that 50% of coeliacs may also have issues with dairy and some with coffee. The same can be said of the list below:
As well as this there are other digestive conditions that can co-exist.
Other possible issues that be present alongside coeliac
o Fructose/lactose intolerance
|o IBD (Crohn’s / microscoptic colitis)
o Low digestive enzyme production
SIBO is a condition where there’s an elevated number of bacteria in the small intestine. When certain carbohydrates are eaten it can result in their fermentation a result of which is gas production which can trigger IBS type symptoms – bloating, altered bowel movements and cramping.
IBS is an umbrella term used to describe digestive symptom but not what is actually triggered them. SIBO, low digestive enzyme production and parasites can all be potential contributing factors as can vitamin D deficiency, chronic stress and physical inactivity. Lifestyle support as well as stool testing and SIBO testing can be helpful here.
- IBD (Crohn’s / microscoptic colitis)
These inflammatory conditions can both be an issue for coeliac sufferers. More often than not they will be assess by a GP or gastroenterologist but can still be worth bearing in mind.
- Low digestive enzyme production
A large amount of digestive enzymes are produced by the cells in the small intestine. If these cells are damaged, as in coeliac disease, production will be impacted and even though a gluten free diet might be being followed 100%, since the gut has not healed production may not be adequate. Focus on healing the gut and supportive supplementation with brush border enzymes may be of benefit in this situation.
To bring about lasting change and get back to feeling well after a coeliac diagnosis the focus needs to be on:
- Ruling out any infections or imbalances in the gut
- Microbiome restoration
- Digestive enzyme support
- Immune system support
- Identifying and eliminating out any other problematic foods
Sometimes a diagnosis can be helpful but it can also be a good starting point at getting your digestive symptoms under control.