In Australia, the estimated prevalence of coeliac disease (CeD) is 1.2% in adult men and 1.9% in adult women. CeD affects, on average, approximately 1 in 70 Australians.
Furthermore, around 80% of this number remains undiagnosed (Walker et al., 2017). This means most Australians are unaware that they have CeD. In most CeD individuals, a family genetic polymorphism is passed down through the generations carrying the genotype HLA-DQ2 or HLA-DQ8.
Studies show individuals may have one or both genotypes, with other studies showing no genetic polymorphism in the presence of CeD. Relatives have a one in ten risk of developing CeD irrelevant of symptoms or no symptoms, the consensus in some studies is to rule out CeD in genetically susceptible families.
Population screening may help identify unrecognised CeD. A study of 1064 male/female individuals randomly selected in Christchurch, New Zealand, resulted in a 1.2% prevalence of undiagnosed CeD cases, which is three-fold more common than diagnosed CeD.
1 in 70 Australians have Coeliac disease
The CeD associations and foundations point to a need for increased funding for research, rigorous CeD training in medical schools and primary care education programs to aid improvements in diagnoses.
Often undiagnosed during childhood, chronic autoimmune CeD is multifactorial, involving environmental factors, genetically susceptible individuals, abnormal intestinal innate immune response to gluten, and intestinal dysbiosis.
Symptoms include abdominal bloating, chronic diarrhoea, vomiting, constipation, pale foul- smelling or fatty stool, irritability/behavioural issues, fatigue, migraines, delayed growth & puberty, short stature, failure to thrive, iron deficiency anaemia, weight loss, fatigue and itchy rash.
Did you know cross contamination can occur from sieving everyday pasta and then using the same sieve to strain gluten-free pasta for a family member
Gluten exposure is an exogenous trigger. Gliadin (prolamin) is the main component of wheat. The wheat gluten protein contains hordein (prolamin) and secalin (prolamin), also found in rye and barley. These prolamins are rich in proline and glutamine polypeptides which cause a TH1 immune response.
Watch out for gluten contamination in lipstick and shampoo
Specifically, α-gliadin and γ-gliadin (33/26-mer) are the most toxic making them potent T cell activators for the development of onset or relapse of CeD.
The enterocytes are impacted in the duodenal lumen by gliadins. Undigested gliadin peptides enter via a paracellular and transcellular passage to the extracellular matrix of the small intestine submucosa. Within the lamina propria, tissue transglutaminase (tTG) deaminates gliadin peptides.
Genetic pathophysiology
HLA-DQ2 or HLA-DQ8 molecules recognise the deaminated gliadin, which stimulates an immune response. Followed by inflammatory pathways, Th1 and Th2 are activated. Apoptosis of the enterocytes is then caused by Th1, which stimulates natural killer cells. B cells differentiate by stimulating Th2, producing anti- tTG and antigliadin antibodies. Further epithelial damage is caused by interactions between extracellular tTG and anti-tTG.
Food intolerance or sensitivity
Another environmental factor to consider is additional food intolerances/sensitivities. Histamine and lactose sensitivities activated by an IgG (Immunoglobulin G) inflammatory response (relating to GI problems) have been shown to coexist alongside CeD. Coexisting Food sensitivities were seen in 50% of individuals in one study findings on the outcome of refractory (non-responsive) CeD.
30 % of coeliac sufferers experience persistent or recurrent gut complaints despite following an exact gluten-free diet
The treatment plan considerations should include further investigation of other food intolerance/sensitivities with individual dietary recommendations; a simple diet diary can be a valuable tool to assess foods alongside GI symptoms before suggesting IgG and IgA testing.
Excluding gluten food
A valuable treatment for CeD is the immediate and permanent exclusion of gluten-containing food. Potential naturopathic treatments and complementary alternative medicine (CAM) may aid significant improvements in the self-management of CeD and reduce the risk of associated complications and remission by improving the function of the gastrointestinal system whilst educating/supporting diet and lifestyle to improving quality of life for CeD individuals. The NICE international guidelines highlight the need for long-term support regarding improvements in the quality of life with diagnosed CeD.
Microbial pathogens (baddies)
Microbial pathogens coexisting with CeD promote damage to the small intestine and villi, causing microbiota imbalance, driving inflammation and intestinal hyperpermeability. Gliadin reacts with T cells and cross-reacts with bacterial peptides, suggesting the involvement of microbial exposure as an environmental factor in CeD.
Gastrointestinal hyperpermeability (Leaky gut)
Gastrointestinal hyperpermeability and inflammation increase villous atrophy (clubbing and flattening of the villi that absorb nutrients), which triggers a zonulin immune cascade, causing malabsorption and deficiency of micronutrients and macronutrients. In a clinical study, 78% of children (2-14 years old) presented with Zinc deficiency alongside CeD. Diarrhoea and bloating in children were noted as the most prevalent symptoms in CeD.
Book an appointment with me
ZTN (Zoe Turner Naturopath) can help you using evidence-based individualised treatment plans, working alongside your doctor to help you regain control of this debilitating diagnosis and improve your quality of life for life.
Common specific goal
Improve the quality of life of CeD individuals by maintaining and enhancing remission of CeD symptoms within 6 to 12 months following the below treatment objectives.
• Adhere to an anti-inflammatory Gluten-free diet (GFD)
• Prevent further infestation of pathogenic infections
• Modulate the GI immune system to prevent inflammation.
• Improve nutrient status by promoting better nutrient absorption
• Improve microbiome health by modulating the microbiota
• Reverse and maintain intestinal hyperpermeability
Reduce your risk of malabsorption
Stopping gluten for CeD patients benefits the remission of CeD and reduces inflammation in most clinical studies. Regulating the immune response and preventing further intestinal damage, villous atrophy and enterocyte atrophy.
CeD individuals who consumed 10mg of GF daily experienced intestinal mucosal damage compared to CeD patients who consumed <10mg of GF who experienced no intestinal mucosal damage.
Adhering to a GF diet reduces the risk of relapse, including malabsorption, immune dysfunction, bacterial infection, microbiome imbalance and intestinal damage.
Is your gluten free diet showing no improvements?
Nonresponsive CeD can be a contaminated GFD, but also small intestinal bacterial overgrowth (SIBO) can trigger CeD acute symptoms as well as poor pancreatic function, refractory CeD (unresponsive to GFD), irritable bowel syndrome and other food allergies (IgE mediated) and sensitivities (IgG, IgM, IgA mediated). Appropriate testing can remove culprits driving CeD.
Warning signs
Acute, classic warning signs
• weight-loss
• malabsorption
• growth failure in children • diarrhoea
• steatorrhea (pale, foul-smelling,
fatty stools
Acute non-classical warning signs
• gastrointestinal pain
• chronic migraine. • depression and anxiety
• dermatitis herpetiformis
• chronic hypertransaminasemia
• occult blood in stools
• nausea and vomiting
• chronic fatigue
• abdominal distention
• iron-deficiency anaemia
• peripheral neuropathy
• vitamin deficiency (B12 folic acid) • difficulty losing weight
• dental enamel defects
• late menarche/early menopause, unexplained infertility
Naturopathy
There are many nutrients, prebiotic, probiotic and herbs that a naturopath can prescribe based on each individual persons case. Probiotic research has come along way and specific prebiotics and probiotics can really influence gut health and our wellbeing.
Coeliac disease is not an allergy and should not be confused with wheat intolerance or wheat allergy.
Feel free to get in touch and feel supported by me to help you take control with diet, lifestyle and coeliac knowledge 🙂 Book a consult now.
Coeliac Societies and Associations https://www.coeliac.org.au/s/the-gluten-free-diet. https://celiac.org/eat-gluten-free/gf-services/coeliac-australia/
Email me for references 🙂