If you have coeliac disease (CD), you’ve probably been told that there is no cure and that cutting gluten out of your diet is the only way of successfully controlling your condition. However, exciting new research has revealed that friendly bacteria living in your gut could hold the key to a breakthrough in treating this distressing disease.
Around one person in a hundred suffers from the condition, which is caused by an inability to digest gluten a combination of proteins found in wheat, barley and rye. While oats also contain a substance similar to gluten, most people with CD are able to tolerate this grain in small amounts.
Some people confuse the condition with wheat sensitivity or allergy, but it is a distinct and separate condition. In wheat sensitivity, the digestion of this grain is difficult and causes various reactions in the body, like bloating, wind, fatigue and sinus congestion. These reactions can happen three or four days after eating wheat. A true wheat allergy, on the other hand, is very rare and involves an immediate reaction to even tiny amounts, resulting in nausea, vomiting, asthma and, in severe cases, anaphylactic shock which can cause suffocation and heart failure.
CD affects the lining of the small intestine, in particular the millions of tiny finger-like villi, through which we absorb nutrients from digested food. When gluten comes into contact with the villi in CD sufferers, it causes an inflammatory reaction in which the immune system attacks and destroys the villi as though they were invading organisms.
This destruction of the villi means sufferers are unable to absorb nutrients from their food properly, leading to symptoms such as bulky pale stools, bloating, stomach cramps and weight loss. The condition can also cause secondary illnesses due to nutritional deficiencies, such as anaemia (iron deficiency) and osteoporosis (caused by a lack of calcium).
CD is not just a gut problem its also linked to ataxia, schizophrenia and epilepsy
To some extent, CD is a genetic disease and tends to run in families. However, how old you are when your immune system first encounters gluten is also important. A recent US study found that exposing babies to gluten in the first three months of life increased their risk of CD by a massive 23 times (JAMA 2005; 293: 2410-2412). Alarmingly, gluten is a common ingredient in baby milk formulas, so children often get gluten in their diet even before they are weaned onto solids.
Research reveals that the body’s immune reaction to gluten is not confined to the gut and even people without digestive symptoms can have the antibodies that show the disease is present (J Neurol Neurosurg Psychiatry 2002; 72: 560-563;).
Many of these patients have neurological conditions, such as ataxia involving unsteadiness, clumsiness and slurred speech or psychiatric problems like depression or schizophrenia (BMJ 2004; 328: 438-439; Am J Gastroenterol 1999; 94: 839-843). Research in Italy has also shown that three quarters of epileptics test positive for CD (Lancet 1992; 340: 439-443).
People with CD need nutritional supplements as well as a gluten-free diet
Doctors have surprisingly little to offer CD sufferers, beyond advice to avoid gluten-containing foods, since no drugs have been specifically developed for the condition. Steering clear of gluten is not easy, though, since most processed foods include it, often under other names such as modified starch.
Although some gluten-free foods, mainly bread and pasta, are available in health food shops, CD sufferers generally have to make their meals from scratch, replacing gluten grains with alternatives like rice, buckwheat, maize and millet.
Sufferers need a daily multivitamin and mineral supplement to avoid nutritional deficiencies. It is also advisable to take extra magnesium (500mg daily), as around one third of patients are deficient in this mineral (Osteoporosis Int 1996; 6: 453-461). A diet that includes plenty of fresh foods, particularly dark green leafy vegetables, nuts, oily fish, eggs and liver will also help ensure adequate nutrition.
Why probiotics could be an effective treatment for CD
Recent studies conducted in Sweden offer new hope for those struggling with CD. Researchers at Umea University have found that children with the condition, whether or not they were avoiding gluten, frequently had rod-shaped bacteria on the lining of their gut that were absent in healthy children. The gut lining of the CD children also contained unique carbohydrate structures that appeared to allow the bacteria to gain a hold (Am J Gastroenterol 2004; 99(5): 894-904).
Separate research at Swedens Karolinska Institute has shown that children with CD have significantly different gut flora bacteria and other microbes living in their intestines from normal children (Am J Gastroenterol 2005; 100(12): 2784-2788).
The candida fungus, which normally lives in the gut and can flare up out of control if the gut flora get out of balance, could also be implicated in CD. Scientists at the University of Utrecht in the Netherlands have discovered that a protein in filaments of candida, that allows them to stick to the gut wall, is virtually identical to gliadin, the protein in gluten that triggers an immune system response in CD (Lancet 2003; 361: 2152-2154).
This means that exposure to candida can trigger the production of antibodies that are unable to distinguish between candida and gliadin and so attack the villi every time gluten comes into contact with them.
This research points to dysbiosis an abnormal condition of the gut flora as a possible factor in CD. An effective way of rebalancing the gut flora in favour of the beneficial organisms is to take a probiotic supplement.
Although no clinical trials of probiotics have yet been carried out in CD patients, the above studies suggest that they are likely to be of great benefit. Take a daily probiotic supplement that contains at least three billion live organisms per capsule. NHR will be watching developments on this potential new CD therapy and will bring you the results of further studies as soon as they become available.