Coeliac Disease: A Historical Journey into Our Gut

The 21st century is slowly being heralded as the ‘Century of the Gut' by scientists and physicians the world over. The volume of research and corresponding knowledge gained is highlighting the significance of this oft overlooked part of the human anatomy: namely, our gastrointestinal tract. From extensive research into the microbiome (the population of microorganisms that inhabit our gut) to research into the effects of the very food we are eating; it seems everything we’ve been taught is being turned on its head.

The Swedish Health Authorities recently endorsed the high fat, low carbohydrate diet and Harvard University followed suit a week later. Gluten consumption has now become a widely recognised risk to human health.

It has been estimated that coeliac disease affects one in 2000 people worldwide. In the USA the statistic is even more unnerving; as it has now been identified in approximately 1 in every 100 Americans! Additionally, according to the Centre for Disease Control in the USA, diet has now surpassed smoking as the number one risk factor for disease and death in that country and trends are showing that this startling fact is increasingly being mirrored in the rest of the world.

So what we eat, is of major significance when it comes to our health and well-being.

To track the history of coeliac disease we have to look back at a time when human beings first began to adopt grain from wheat as it is unlikely that the condition existed before this period. The Neolithic period (9500 -10 000 BCE) marked the time humans first started to cultivate grains. This began in Western Asia and spread across all continents.

Of Ancient Greece And Misdiagnoses

The disease state was first officially named by the Greek physician Aretaeus of Cappadocia in the first century – he named it an “affliction of the koiliakos” – or ‘coeliac,’ which translates to abdomen. Aretaeus erroneously believed the affliction arose due to a lack of heat in the abdomen, disrupting the digestive enzymes in the stomach – of course he couldn’t have been aware of the intricacies of autoimmune disorders back then because the immune system had not been discovered yet, – strangely enough, he actually believed that the disorder was caused by drinking too much cold water! Bless those Ancient Greek physicians.

The British paediatrician Samuel Gee gave the first modern-day description of coeliac disease in children in 1887. Gee kept the name Aretaeus’ had coined (coeliac) and then quite prophetically claimed that the only way to cure or treat this disease would by through dietary changes.

Gee recognised that milk intolerance is a problem with coeliac children and that highly starched foods should be avoided. The link with wheat was not made until the 1940s.

The link to the gluten component of wheat was made in the 1950s.

Coeliac Disease Redefined In Modernity

Unstretched, the average small intestine in an adult human is around 6-7 m long and about 2-3 cm wide. Contemporary medical knowledge recognises coeliac disease as an autoimmune disorder of the small intestine. It is believed to be genetically inherited and occurs in people of all ages. It is caused by the immune system’s reaction to gliadin (a component of the protein gluten) found in wheat, and similar proteins in other crops (common grains such as barley and rye.) Now this immunological reaction is absolutely normal as gluten is actually not a very productive compound, that wreaks all sorts of havoc on the body. The reason why it is labelled as an ‘auto’ immune disorder is because the antibodies specific for gliadin start cross-reacting with the tissue lining the gut, causing inflammation,  in turn, the intestinal villi (that line the intestines – increasing surface area for better absorption of nutrients) begin to atrophy – lose their shape and become flat. This decreases the absorption of nutrients from the digested food coming from the stomach.

This villous atrophy was first observed and reported in 1954, after showing up in intestinal tissue samples taken during surgery.

Gluten also increases the permeability of the intestines leading to what is colloquially referred to as a ‘leaky gut’ – once in the blood stream it is responsible for downregulating the blood brain barrier and it actively crosses into the brain allowing all the inflammatory mediators to affect the brain and central nervous system. The negative effects this brings with it are so great, that coeliac disease is being redefined by some physicians, as a neurological condition not just an autoimmune disorder of the digestive tract. It also appears that gluten affects neural tissues lining the central nervous system and that this disrupts proper functioning of the autonomic nervous system (the part us that subconsciously regulates – among other things – our breathing, heart rate and absorption in the gastrointestinal tract.)

An abnormal overgrowth of harmful bacteria in the gut has also been related to coeliac disease – this interferes with proper absorption of nutrients.

What Are The Symptoms Of Coeliac Disease?

The main symptoms of coeliac disease include discomfort in the digestive tract (sometimes painful,) joint pain, fatigue, chronic constipation and malodourous stool (often manifested as diarrhoea.) In children, a failure to thrive has been observed. Some people have reported a tingling sensation in their hands. Anaemia and thyroid dysfunction are also symptoms, though these appear in a smaller percentage of people. Both weight loss and gain have been reported, the latter mostly in children.

Coeliac disease results in deficiencies in most vitamins and minerals due to the impaired absorption in the gut. As such it makes it sense to supplement with the vitamins and minerals that are missing, especially during the transition period – following the initial diagnosis by a qualified health practitioner.

But the fact still remains that the most effective treatment for coeliac disease is altering one’s diet to avoid gluten, for life.

Important Nutrients That Are Lacking in Coeliac Disease

With impaired digestion, it becomes difficult to absorb fat-soluble vitamins like Vitamin A, Vitamin D, Vitamin E, and Vitamin K.

Vitamin K is an instrumental component in the signalling cascade responsible for our bloods’ ability to clot, so some people with coeliac disease have an elevated risk for abnormal bleeding.

Vitamin D is important because it helps regulate the cells of the immune system that are responsible for inflammation(T-cells), not only does it regulate the cells, it also modulates the messengers (cytokines) that communicate the “inflammation message” between cells – hereby it curbs the spread of inflammation. Vitamin D also helps regulate gut elasticity which counteracts the gut permeability that gluten promotes. Adequate levels of Vitamin D also ensure the integrity of the mucosal barrier that protects the lining of our gut – this reduces the damage caused by the immune system attacking the gut. So try and get out in the sun more!

Reduced absorption of B vitamins (particularly Vitamin B6) can result in elevated levels of homocysteine (an amino acid implicated in cardiovascular disease.) Supplementing with Vitamin B will reduce blood levels of homocysteine. In one clinical study it was found that people with coeliac disease who supplemented with Vitamin B had significantly higher B-vitamin levels and significantly lower homocysteine levels compared with those who were not supplementing with Vitamin B.

Echinacea may also help with decreasing inflammation and also its anti-bacterial qualities may be beneficial in reducing the overabundance of harmful bacteria in the gut characteristic of coeliac disease. Vitamin C is another supplement that can help reduce the bacterial overgrowth as well curbing the oxidative stress caused by metabolic waste from the bacteria.

Omega 3 fatty acids are another important supplement as they possess anti-inflammatory qualities and are important for the structural integrity of our brain and central nervous system (over 60% of our brain is made up of fat – with omega 3 fatty acids making up 15% of that.)

Glutamine promotes a healthy metabolism and may help re-establishing the integrity of the intestines (very important for a leaky gut.)

Another way to fend off the harmful bacteria is ensuring that there is no space for them to colonise. We can achieve this through supplementing with probiotics – where beneficial bacteria populate the viable “real estate” in the gut, allowing no room for pesky squatters and unwanted overstayers.

Iron anaemia is common in people with coeliac disease, so it could be important to supplement with iron (discuss with your health practitioner.) Calcium is another important element that may be present at lower than optimal levels.

The Coeliac Diet

If you make bread, try to source gluten free flour. Eating foods high in fibre will help re-establish the integrity of your gut. Eggs, beans, chickpeas, corn, buckwheat, soy, vegetables, fruit, lean meat, fish, rice, corn and quinoa are all gluten free foods.

Once you have omitted gluten from your diet successfully the symptoms of coeliac disease will become milder and hopefully disappear altogether. This is a really tough disease to deal with as there is no treatment other than changing one of the most fundamental aspects of our life, namely our diet. But it’s achievable – through hard work and diligence! If you have a friend or family member who has recently been diagnosed, then learn to empathise and support them with all you have. Maybe even think about joining them on their quest to avoid gluten products.

As gluten isn’t good for anyone, really. Coeliac diagnosis or not.

NB It is important to note that gluten also exists in certain products we wouldn’t normally associate it with: Gluten has been found in the adhesive strips of envelopes and stamps as well as certain vitamin supplements and medical drugs. Always read product labels carefully.

by Christopher von Roy BSc, MSc, DCP Immunology

References  “Novel role of the vitamin D receptor in maintaining the integrity of the intestinal mucosal barrier”

We’d Love Your Feedback

Have you recently been diagnosed with Coeliac Disease? Can you share any diet transition ideas or other tips on how to deal with this life adjustment?