Celiac Disease treatment with natural supplements, vitamins, and herbs
July 1 2016 by Ray Sahelian, M.D.

Celiac disease is a digestive disorder that damages the small intestines and interferes with the absorption of important nutrients from food. Patients with this condition have an intolerance to the protein in gluten which damages their intestinal lining and makes it difficult to absorb nutrients. Celiac disease affects about one out of 8 children with type 1 diabetes. Treatment is based on the avoidance of gluten containing food. It appears that most celiac disease patients can tolerate up to 50 mg of gluten a day. My impression is that many people think they have gluten sensitivity since it is talked about so much in the press but their symptoms may actually be due to another medical condition or intolerance to another type of food.
   Originally considered a rare malabsorption (poor absorption) syndrome of childhood, celiac disease is now recognized as a common condition that may be diagnosed at any age and that affects many organ systems. About 1.5 million to 2 million Americans have celiac disease, but just 40,000 to 60,000 have been diagnosed by a physician. In the United State, celiac disease is four times more common now than it was in the 1950s.

Autoimmune disorder
Celiac disease is a unique autoimmune disorder, since the cause is known. This condition was previously called celiac sprue, based on the Dutch word sprue, which was used to describe a disease similar to tropical sprue that is characterized by diarrhea, emaciation, aphthous stomatitis, and malabsorption. People who have CD appear to have a higher rate of Crohn's disease than the general population.

 It is the prototype of an immune mediated response dominated by the activation of the adaptive immune system and in particular of CD4+ HLA class II restricted T cells.

Celiac disease and gluten
Celiac disease is caused by gluten in genetically predisposed persons. Gluten is the major storage protein of wheat and similar grains. Parents of a child with this medical disease should bring some gluten-free dishes to a cookout, such as baked beans, corn on the cob, gluten-free potato salad or a bowl of mixed berries. This will ensure that the child has something they know is safe to eat. Bring a gluten-free bun or get creative and use a large piece of lettuce as a substitute for a hamburger bun.

The grain quinoa seems safe according to a British study, The American Journal of Gastroenterology, news release, Jan. 21, 2014.

It's known that gluten -- found in wheat, rye and barley -- is the cause of health problems in people with celiac disease. These individuals may also react to non-gluten wheat proteins. A large number of people with celiac disease have an immune reaction to five groups of non-gluten proteins.

Gluten-free diets seem to be the latest fad, yet the number of people being diagnosed with celiac disease hasn't budged. People with celiac disease have no choice but to avoid gluten in their diet. If they don't, their small intestine is damaged every time they eat something with gluten. Gluten-free diets appear to have become a trendy way to address any sort of gastrointestinal problem.

Non-celiac wheat sensitivity
Gluten sensitivity appears to be a real medical problem, and not a figment of the popular imagination conjured up by the gluten-free craze. Some people suffer changes within their bodies after eating gluten that are separate and distinct from those that accompany either celiac disease or wheat allergy. People with non-celiac wheat sensitivity appear to suffer from a weakened intestinal barrier, which leads to an immune response after they eat foods that contain the gluten protein -- typically wheat, rye or barley. Their symptoms involve bloating, abdominal pain and diarrhea, but also include fatigue, headache, anxiety, and problems with memory and thinking skills.

Natural supplements for celiac disease patients
At present, strict and lifelong gluten-free diet is the only effective treatment for celiac disease. Even small amounts of gluten (50 mg / day) can be immunogenic; therefore all food and food items and drugs that contain gluten and its derivatives must be eliminated completely from the diet.

B vitamin supplements reduce the risk of developing very high levels of homocysteine in patients with celiac disease. Celiac disease raises the risk of folate and vitamin B12 deficiency, which can contribute to the development of excess levels of homocysteine, an amino acid, and its association with vascular disease. B-vitamin supplements can normalize B6, folate and B12 status, and total homocysteine levels. World Journal of Gastroenterology, February 28, 2009.

Is Inulin fiber a safe supplement to use for those with celiac disease?
   To the best of my knowledge, inulin can be used by those with celiac disease. Confirm with your doctor before using inulin to see if it is appropriate for your particular condition.

Celiac disease and thyroid conditions
Individuals with CD are at significantly increased risk for developing thyroid disorders, including hypothyroidism, hyperthyroidism and thyroiditis. Journal of Clinical Endocrinology and Metabolism, 2008.

Future Potential treatment
Celiac disease is a disorder of the small intestine caused by an inappropriate immune response to wheat gluten and similar proteins of barley and rye. At present, the only available treatment is a strict gluten-exclusion diet, that means avoiding breads, cereals and other products containing whole wheat or wheat flours, including grains such as bulgur, barley, spelt, kamut and semolina. There are several attractive targets for new treatments. Oral enzyme supplementation is designed to accelerate gastrointestinal degradation of proline-rich gluten, especially its proteolytically stable antigenic peptides. Complementary strategies aiming to interfere with activation of gluten-reactive T cells include the inhibition of intestinal tissue transglutaminase activity to prevent selective deamidation of gluten peptides, and blocking the binding of gluten peptides to the HLA-DQ2 or HLA-DQ8 molecules. Other possible treatments include cytokine therapy, and selective adhesion molecule inhibitors that interfere with inflammatory reactions, some of which are already showing promise in the clinic for other gastrointestinal diseases.

Symptoms and signs
The major modes of presentation of patients with celiac disease are the classic diarrhea-predominant form and silent celiac disease. Those with silent celiac disease lack diarrhea, although they may present with manifestations of celiac disease that include an irritable bowel syndrome, anemia, osteoporosis, neurologic diseases, or malignancy. Many additional celiac disease symptoms are possible, see a list submitted by a reader bottom of page.

Symptoms of this disease differ from person to person. The most common symptoms and signs associated with Celiac disease include weight loss, chronic diarrhea, persistent abdominal pain, anemia, gas, and bone pains.

People with the digestive disorder celiac disease are at increased risk for nerve damage, medically known as neuropathy. JAMA Neurology, news release, May 11, 2015

Celiac Disease and Osteoporosis
Some people develop osteoporosis, the mineral loss disease that leads to brittle bones, because their bodies cannot tolerate wheat flour. Gluten intolerance, called celiac disease, can be treated, so the damage done by osteoporosis can be reversed in such patients. As many as three to four percent of patients who have osteoporosis have the bone disease as a consequence of having celiac disease, which makes them unable to absorb normal amounts of calcium and Vitamin D.

Causes of Celiac Disease
While there is a genetic predisposition for celiac disease, many people don't develop symptoms until later in life. Chemotherapy for certain forms of cancer can sometimes induce celiac disease. Another possibility is repeated infection with a virus.
   Repeated rotavirus infections may increase the risk of celiac disease in genetically susceptible children. Intestinal infections have long been thought to contribute to the development of celiac disease, a common digestive disorder triggered by eating wheat products and other foods containing the protein gluten. Few studies, however, have looked at the role of specific infectious agents in the development of the disease. As participants in a study of the natural history and environmental triggers of diabetes and celiac disease, 1,931 children from the Denver metropolitan area who are genetically susceptible to celiac disease were monitored from infancy for rotavirus infection and the development of celiac disease autoimmunity -- an erroneous immune reaction against "self" proteins. Each "study" child was matched to two "control" children. Dr. Marian Rewers from the University of Colorado School of Medicine in Aurora and colleagues report that 54 study children developed celiac disease autoimmunity at a median of 4.4 years of age. Thirty-six of these children had an intestinal biopsy, of which 27 (75 percent) were positive for celiac disease. According to the team, frequent rotavirus infections predicted a higher risk of celiac disease autoimmunity. The rate ratio for celiac autoimmunity was 1.94 for one rotavirus infection and 3.76 for two or more rotavirus infections compared with zero rotavirus infections. The current study "provides the first indication that a high frequency of rotavirus infections may increase the risk of celiac disease autoimmunity in childhood in genetically predisposed individuals." American Journal of Gastroenterology, 2006.

Children who have a lot of infections in the first 18 months of life may have an increased risk for celiac disease. A study found that children with 10 or more respiratory and gastrointestinal infections during the first 18 months of life were 30 percent more likely to develop celiac disease than kids who had fewer than five infections. Norwegian Institute of Public Health, news release, Sept. 28, 2015.

Celiac disease and breast feeding
Mothers who breast-feed their children may help to protect them from developing celiac disease, which is characterized by intolerance to a protein found in wheat, rye and barley. In a review of 15 studies, the longer children are breast fed the less likely they are to suffer from the illness.

Celiac disease is most common among people whose ancestors come from India's Punjab region. Previously, experts thought celiac mostly affected white people with European ancestry. Celiac also seems to affect men and women equally, regardless of ethnicity. It is now recognized as one of the most common hereditary disorders worldwide.

Clinical features and diagnosis of celiac disease.
Gastroenterology. 2005.
Celiac disease is a chronic enteropathy caused by intolerance to gluten. The true prevalence of this condition is much greater than previously recognized, with increasing numbers of silent cases being diagnosed. Population-based studies, using serologic screening, have indicated that the prevalence of celiac disease in Caucasian populations is 0.5% to 1%. The pattern of incidence is changing, with a greater proportion of cases diagnosed later in adulthood. The pathologic lesion is characterized by a flattened small intestinal mucosa with a lymphocytic infiltrate, crypt hyperplasia, and villous atrophy. Absorptive function may be impaired and patients can experience gastrointestinal symptoms and malabsorption leading to development of anemia, osteoporosis, or other complications. Untreated celiac disease is associated with significant morbidity and increased mortality, largely owing to the development of enteropathy-associated intestinal lymphoma. The pathologic changes and symptoms resolve when gluten is excluded from the diet for a sustained period.

Women with celiac disease, a digestive disorder caused by sensitivity to gluten, have fertility and pregnancy experiences similar to women without celiac disease.

Gluten-free diet may alleviate depressive and behavioural symptoms in adolescents with coeliac disease: a prospective follow-up case-series study.
BMC Psychiatry. 2005.
Celiac disease in adolescents has been associated with an increased prevalence of depressive and disruptive behavioural disorders, particularly in the phase before diet treatment. We studied the possible effects of a gluten-free diet on psychiatric symptoms, on hormonal status (prolactin, thyroidal function) and on large neutral amino acid serum concentrations in adolescents with celiac disease commencing a gluten-free diet. Although our results of the amino acid analysis and prolactin levels in adolescents are only preliminary, they give support to previous findings on patients with celiac disease, suggesting that serotonergic dysfunction due to impaired availability of tryptophan may play a role in vulnerability to depressive and behavioural disorders also among adolescents with untreated celiac disease.

Ancient grains
Dr. Oyvind Molberg of the University of Oslo in Norway believes that the aberrant immune response seen in celiac disease is driven by T-cell recognition of small pieces of protein -- called peptides -- derived from gluten. Using intestinal T-cells taken from people with celiac disease, the researchers had previously found that particular bits of the gluten protein --known as 33mer fragments -- are targeted by T-cells, and seem to be the main source of the inflammatory response in celiac disease. The goal of the new study, published in the journal Gastroenterology, was to find out whether those same T-cells would go after the gluten found in ancient strains of wheat. The researchers tested the cells' ability to recognize the gluten from a number of wheat strains, which carried different variants of the genes that code for gluten. Most of tested wheat strains are currently cultivated in the historic "Fertile Crescent" area of the Middle East. The researchers found that wheats of certain genetic makeups -- including a grain known as einkorn, and certain pasta wheats -- did not appear to contain the troublesome 33mer fragment or protein bits similar to it. Some of the ancient wheat strains may be turned into "high-quality" bread. The main obstacle is that the structure of the plants keeps them from being harvested as easily as widely used bread and pasta wheats. That problem could be overcome through breeding. Gastroenterology, 2005.

Email from a person with this condition
As you know Celiac Disease is one of the most undiagnosed/misdiagnosed diseases in the U.S. I had to move to Germany to find out I had it! And only after two Doctor visits.  Pretty amazing since I suffered for years and years (I was 42 at diagnosis) and no U.S. Doctor was aware of it and the many symptoms which are manifested. May I add the following for people who have one or more of the following symptoms: (I'll * the ones I had)

Chronic sinus and/or respiratory infections
Constipation* /diarrhea
Joint pain
Weight gain* /weight loss
Excessive gas
Abdominal pain
Neurological conditions
Chronic fatigue
Muscle cramps
Steatorrhea (common with undiagnosed CD)
Fuzzy-minded after gluten ingestion
Burning sensations in the throat
Pot belly with or without painful bloating
Concentration* or behavioral problems
Failure to thrive in infants
Dental enamel defects
Skin Rashes and Acne
Spastic colon
Thyroid problems

It's clear to see that gluten intolerance affects the entire body.) Many patients have been diagnosed with the following problems which have disappeared once the correct diagnosis of Celiac Disease was given:

Liver problems
Thyroid Disease
Dermatitis Herpetiformus
Chron's Disease
Spastic Colon
Irritable Bowel Syndrome

Celiac Patients are at greater risk for:
Addison's Disease
Chronic active hepatitis
Alopecia Areata
Graves Disease
Myasthenia gravis
Lymphomas non Hodgkins lymphoma (t cell and b cell)
Sjogren's syndrome
Crohn's Disease
Thyroid Disease

The reason I was diagnosed so quickly (compared to the average 10 years for U.S. citizens) is because European Doctors are trained in nutrition and preventive medicine much more thoroughly.  Rather than the 'pill' approach (Nexium, Zelnorm their ad cries out Celiac Disease, Tums, Rolaids, etc. etc.) Rather than giving me constant antibiotics which I'd been given over the past 10 years, my Doctors here truly wanted to find out the underlying reason for My chronic rhinitis, sinusitis and bronchitis amongst the many other symptoms. Getting off of gluten was the best diet I ever went on. I eat gluten-free cookies, crackers etc.  regularly but the weight fell off (30 pounds in 4 months) after going gluten-free!

I was just reading your list of symptoms of celiac disease. In it you mentioned skin rashes. Would this include petechiae too? In other words, could petechiae be a likely symptom of celiac disease?
    I am not an expert in celiac disease but I have not come across petechiae as being related to this condition.

I purchased IP6 supplement, but I have celiac sprue. Does IP6 interact in those with celiac disease?
   We have not seen any studies regarding the interaction of IP-6 in those who have celiac sprue.

I saw the question about whether or not a celiac patient can take IP6. While it is anecdotal, I am a celiac patient and take IP6 anytime I feel I have been exposed to sickness and I certainly take it when I feel I am coming down with something. I can't sing the praises of this wonderful supplement enough. I NEVER let myself run out and keep it at my office and at home. I have found that quick action at the first symptom gets the best response. I have never seen any negative effects and have been taking it for many years now.

I'm a former cancer patient who now has developed celiac disease. I'm doing a project on it for my MPH, and I was wondering if you guys had any studies I could cite in the link between chemotherapy treatment as a potential cause of celiac disease expression.
    I have not studied this topic but it seems interesting.

I have just read your article and was blown away how it described what I have been going through for the last year. I have only recently, at the age of 59 (female) been diagnosed with "sensitivity" to gluten, as well as all the "night shades" and to soy. For the past few months I have been having hypothyroid -symptoms with rashes fatigue , some sugar, dry red skin, hair loss, frequent urination, ( until now very healthy active although had IBS symptoms during my life always attributed to my emotionally sensitive self and not celiac) and do to the fact that my blood work was within the norms (until now when my TSH just went up) all the doctors specialists one by one would say either fibromyalgia, CFS or you need a shrink. Although told me only "sensitive" to gluten ( not to worry about foods in gluten surroundings) I do think that I am completely celiac because only lately I get these attacks every so often even when not eating gluten (but maybe manufactured with other gluten).