Q: Lisa I writes:
Hi Dr. Sarah. I have celiac disease and have been on a strict gluten-free diet for 7 years. Unfortunately, I still have a lot of GI problems along with other health issues such as nerve and joint pain. I’m so tired of feeling ill. Any suggestions? Thank you so much!
A: Great question, Lisa! I hear this all the time from new clients. Here are my thoughts:
Celiac disease is one autoimmune disorder in which the environmental trigger (gluten), genetic predisposition (HLADQ haplotypes), and manifestations are well known. Therefore, it’s very important to remove the trigger to prevent further damage to the intestinal lining. This differs from a gluten sensitivity or intolerance, which I discussed in depth on a previous blog on my homepage (see resources below).
However, it’s important to treat the long-term nutrient deficiencies and malabsorption issues that result from celiac disease or various symptoms can remain. This can be done by the “Four R process” which I discussed in my mold blog a few weeks ago and go into detail below.
The Gut-Healing-Four-Step Remediation Plan
1. Remove the trigger.
In celiac disease, the obvious trigger is gluten. However, the result of chronic malabsorption and intestinal permeability from celiac disease can lead to microbiota imbalances and overgrowth in the gut, including mold, bugs, and parasites. Besides infectious triggers, emotional and environmental stressors can also damage and down regulate the gut’s ability to heal.
Functional testing of digestive health can help determine if there is a chronic overgrowth or unwanted microbes. Furthermore, it can provide sensitivity testing for natural and pharmaceutical methods that would help to eradicate the unwanted critters.
2. Replace enzymes and nutrients lost to malabsorption.
Supporting the digestive process by taking pancreatic enzymes and/or betaine hydrochloride with meals can assist with digestion, assimilation, and promote the ability to absorb nutrients for healing.
Due to the fact that many foods and grains can cross-react with gluten, enzymes taken on an empty belly can also prevent re-infestation of microbes and immune stimulation from undigested and improperly broken down proteins from trigger foods eaten previously. These foods can ferment in the gut as a result of a compromised and tired system and further complicate the symptom picture if not dealt with.
Replacing nutrient deficiencies is also important. For example, one common vitamin lacking for most celiac disease sufferers is vitamin B12. Did you know that B12 is absorbed in the small intestine and can cause neurological issues including numbness, tingling, and mood disorders?
(You can find out how to test for B12 deficiency here: http://dr-lobisco.com/the-taste-of-health/.)
3. Re-inoculating with healthy bacterial species found in the gut to favorably modulate the immune response.
I recommend strains that are specific for my clients’ needs, as everyone has a different genetic microbiome blueprint. Furthermore, a healthy diet high in fiber and veggies are encouraged to feed the bugs that build a home in our gut.
4. Repairing and rejuvenating the gastrointestinal lining with herbals and nutrients.
I like to use demulcent, smoothing herbals such as aloe vera, deglycyrrhized licorice, and marshmallow along with nutrients such as zinc-carnosine and glutamine. Again, I consider protocols specific for the individual’s needs.
Caveats to Consider:
1. Celiac testing only tests for one family of wheat gliadin. Many who have an immune reaction to one protein in gluten could have a reaction to similar protein structures of gluten found in other foods.
You may want to consider a cross-reaction panel from Cyrex with a practitioner that is familiar with this testing to find out if other foods are causing intestinal damage in your body. Dr. Perlmutter (The “Grain Brain” doc) includes a list here: http://www.drperlmutter.com/eat/foods-that-cross-react-with-gluten/
You can also find all the different gluten cross reactions here: http://www.cyrexlabs.com/cyrextestsarrays/tabid/136/default.aspx
2. You may save time by getting functional medicine testing or some guidance from a knowledge functional medicine or naturopathic practitioner to assist you with this process and finding the right supplement for you.
Below, I’ve included some links to resources on healing a worn out gut and imbalanced immune response. I look forward to hearing how you do, Lori.
You Got Questions? I Want to Help!
I am now taking questions and answers for upcoming blog posts.
After all, it makes sense to write about what you want to read. Post your questions here or on my Facebook page-https://www.facebook.com/DrSarahLoBisco
This week on my homepage I discussed psoriasis & “sun allergy,” carrot seed oil, and going gluten-free for skin health.
Dealing with Leaky Gut: http://dr-lobisco.com/922009-weight-loss-cravings-part-ii/
What’s the Deal with Gluten Free?: http://dr-lobisco.com/whats-the-deal-with-gluten-free/
Simple Steps for Immune Health: http://dr-lobisco.com/simple-solutions-for-immune-health/
Addressing the Cause of Conditions-Moving Beyond Labels: http://dr-lobisco.com/7302009-anxiety-tylenol-mouth-mercury/
Celiac Disease, Gluten Sensitivity, and Gluten Intolerance: http://dr-lobisco.com/gluten-on-the-brain-and-body/
The Prevalence of Antibodies against Wheat and Milk Proteins in Blood Donors and Their Contribution to Neuroimmune Reactivities. Nutrients 2014, 6, 15-36; doi:10.3390/nu6010015
Gareau MG, Silva MA, Perdue MH. Pathophysiological mechanisms of stress-induced intestinal damage. Curr Mol Med. 2008 Jun;8(4):274-81. PMID: 18537635
AAAAI. Food Allergies. Practice Parameters. Accessed January 2010.
AAAAI. Allergen cross-reactivity between grains, with particular attention to wheat and barley. June 28, 2013. http://www.aaaai.org/ask-the-expert/cross-reactivity-grains.aspx