The Microbiome and Celiac Disease: The Role Of Gut Bacteria

by Amy Burkhart MD, RD

Your Gut Bacteria Play An Important Role In Your Health

The gluten-free diet may not be all that is needed to treat celiac disease. What role do the gut bacteria/microbiome play?  Can probiotics help?

It is common to think that all celiac patients get completely well with only the gluten-free diet as a treatment. Many do, but many do not. One 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 with ongoing symptoms while on 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. The celiac patients with ongoing symptoms had different gut bacteria that were out of balance (dysbiosis) compared to those with no symptoms on the gluten-free diet.

This is vitally important to anyone with celiac disease as it is a step toward targeted treatments to help rebalance the gut bacteria.

The term microbiome refers to the trillions of bacteria that inhabit our bodies in our gastrointestinal tract, 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 maybe 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 microbiome study 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 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.

Several studies have reported imbalances in the microbiome in people with celiac disease, and another showed the bacteria we have might 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.

The Finnish study mentioned earlier 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.”

Most studies with probiotics and celiac disease have been done in animals. Studies show that probiotics can decrease inflammation when gluten exposure occurs. Human studies are needed, and the best type of probiotic is yet to be identified, but the results thus far are promising. If you’re concerned about using probiotics, fermented foods such as yogurt, kimchee, and kombucha are natural probiotics sources.

Diversity in the gut means you have a lot of different types of gut bacteria. The diversity of gut bacteria is a good thing. Effective treatments to make the microbiome more healthy and diverse are in development. Until then, here are things you can do to optimize it on your own.

1. Diet:  A Mediterranean diet, has been shown to improve microbiome diversity. Including cultured or fermented foods may also improve gut bacteria’s diversity by providing natural forms of probiotics.
2. Exercise:  Exercise improves the diversity of our gut bacteria. Remember that it is a good thing. Set a goal of 30-45 minutes daily.
3. Sleep:  Improved sleep may improve the microbiome composition. Conversely, an altered microbiome can worsen sleep.
4. Stress management:  An altered microbiome has been shown to contribute to anxiety and depression, and higher stress levels correlate with an alteration in the microbiome. Improve your microbiome by using your favorite stress-reduction technique daily.
5. Weight management: Maintaining a healthy weight will help promote a healthy microbiome.
6. Probiotics and prebiotics: These can be used to manipulate the microbiome’s composition. Targeted or specific formulations for specific disease states may be an important part of medicine’s future.

This is exciting news for people with celiac disease or any autoimmune disorder.  If we can learn to optimize and balance the microbiome ( and follow a gluten-free diet if you have celiac disease), symptoms may be decreased or alleviated. If we can change the microbiome with targeted probiotics or even fecal transplants, the potential for optimal health is improved.

Since a correlation is also 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, which affects over 20 million people in the US alone. And perhaps by modulating the microbiome, we can even decrease the risk of cancer. The possibilities are exciting!

• The Microbiome In Celiac Disease-https://pubmed.ncbi.nlm.nih.gov/30711204/
• Celiac Disease And The Microbiome- https://pubmed.ncbi.nlm.nih.gov/31597349/
• Microbiome In Celiac And Probiotics- https://pubmed.ncbi.nlm.nih.gov/31590358/
• Complex Relationship Between Food/Diet And The Microbiome-https://pubmed.ncbi.nlm.nih.gov/27261897/
• Probiotics In Celiac Disease-https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6316269/