The gluten-free diet may not be all that is needed to treat celiac disease.
I was diagnosed with celiac disease twelve years ago. It was quite a journey to arrive at the diagnosis, as it is for so many. When I finally found the answer, the sense of relief was overwhelming. I was additionally comforted by the fact that my treatment was a diet and not medication. Like most celiac patients, I was told to start a gluten-free diet and all would be well. Unfortunately, it wasn’t that easy. The diet was manageable, and my symptoms improved dramatically, but many persisted.
It is a common misconception that all celiac patients get completely well with only the gluten-free diet as a treatment. Many do, but many do not. A 2003 study found that celiac patients on a gluten-free diet have twice as many gastrointestinal symptoms as the general population. For many patients, continued gluten ingestion is the cause of their persistent symptoms. When patients strictly adhere to the gluten-free diet and symptoms persist, however, the answer may lie within.
A Finnish study published in the American Journal of Gastroenterology evaluated celiac patients suffering from persistent symptoms while adhering to a strict gluten-free diet. The subjects had been on a gluten-free diet for at least three years. Their lab results and biopsies had normalized, but they still had symptoms. What the researchers found is of potentially great significance to the future of celiac disease treatment. While the paper did not receive the attention in popular media that many gluten-related articles receive these days, the findings of the study are vitally important to anyone with celiac disease.
The microbiome defined
Before I explain further, it is important to talk about the microbiome. The term refers to the trillions of bacteria that inhabit our bodies in our gastrointestinal tract, our skin, hair, etc. These bacteria are vital to our existence. We need them. They also significantly impact our health. The genetic material they contain may be as important as the DNA we inherit from our parents and may be influencing our predisposition to certain diseases.
Just as we have our own genetic make-up, we also have a unique microbiome. The health of our microbiome appears to play a pivotal role in our overall health. The study of the microbiome is so important that the National Institutes of Health initiated the Human Microbiome Project in 2007 to determine its overall impact on health and disease.
The amount of research on this topic is expanding rapidly, and alterations in the microbiome have been correlated to conditions such as obesity, inflammatory bowel disease, other autoimmune diseases, and cancer. The information resulting from microbiome research is changing the practice of medicine.
Celiac disease and the microbiome
Several studies have reported imbalances in the microbiome in people with celiac disease, and another showed the bacteria we have may affect what symptoms we display. This may explain why some celiac patients experience headaches, while others have joint pain; the type of bacteria they have in their intestine may be playing a role.
Results of a 2014 Finnish study
The 2014 study from Finland found less bacterial diversity (fewer different types of bacteria) and an imbalance in certain types of bacteria in celiac patients with persistent symptoms. The bacterial make-up of people with ongoing symptoms resembled that of untreated celiac patients. Why this occurs in some people is not known, but may be related to a delay in diagnosis and a “resetting” of what is a normal microbiome. The microbiome stays relatively stable in healthy people, but when illness or antibiotics upset the balance, the microbiome is altered. In theory, the longer this occurs, the higher the risk of a new microbiome “set point.”
How this may affect the treatment of people with celiac disease and other autoimmune disorders
This is exciting news for people with celiac disease. If we can learn to optimize and balance the microbiome in addition to following a gluten-free diet , persistent symptoms may be alleviated. If we can modulate the microbiome with targeted probiotics or even fecal transplants, the potential for optimal health is improved.
Since a correlation is also being found between bacterial imbalance and autoimmune diseases, balancing and optimizing the microbiome may also decrease the risk of other autoimmune diseases, such as thyroid disease, that occur more commonly in people with celiac disease. And perhaps by modulating the microbiome, we can even decrease the risk of cancer. The possibilities are exciting.
Optimizing your microbiome
Effective treatments to modulate the microbiome are in development, but until then there are things we can do to optimize it on our own.
Popular articles on the microbiome:
“You Are Your Bacteria: How the Gut Microbiome Influences Health” by Veronique Greenwood, Time Magazine, Aug. 29, 2013
“Some of My Best Friends Are Germs“ By Michael Pollan, The New York Times Magazine, May 15, 2013
THIS ARTICLE IS COPYRIGHTED BY AMY BURKHART, MD, RD.
Past columns by Dr. Burkhart:
November 2015: Cold Sores, Canker Sores and Gluten
July/August 2015: A New Home Test To Monitor Gluten Exposure
February/March/April 2015: Arsenic in the Gluten-Free Diet: Facts and Tips
December 2014/ January 2015: The Microbiome and Celiac Disease: A Bacterial Connection
October 2014: Should You Trust Gluten-Free Labels?
September 2014: Triggers for celiac disease: One possible answer
July/August 2014: Ten Tips for a Healthier Gluten-Free Diet
June 2014: Back Pain and Gluten
April 2014: Update on Restaurants and Gluten-Free Dining
January 2014: Four Vitamin Toxicities on a Gluten-Free Diet
December 2013: Move Over Gluten-Free, Low FODMAP is Next
November 2013: SIBO, Gluten and IBS: What Is The Connection?
September 2013: Is gluten really the culprit in gluten sensitivity?
August 2013: Clarifying the Gluten-Free Labeling Rule
June/July 2013: No such thing as Mild Celiac Disease
May 2013: Magnesium Deficiency
March 2013: Why am I having migraines?
February 2013: What is fructose malabsorption?
January 2013: Educating doctors about celiac disease
December 2012: Are supplements to digest gluten safe and useful?
Photo by www.michaelandersongallery.com
“I have been a patient of Dr. Amy Burkhart for several years. I suffer from Crohn’s disease and was having difficulty in my daily life. After visiting many doctors, all of whom were unable to help me, Dr. Burkhart took the time and patience to create a plan which brought me back to health. I still follow her plan to this day and have been living a normal healthy life. Dr. Burkhart listened to my symptoms along with listening to me, she took her time in preparing a plan which led me to the road for recovery. I cannot thank Dr. Burkhart enough, and I would recommend her to anyone.”