What is coeliac disease?
According to Official coeliac websites, coeliac (or, celiac) disease is a lifelong ‘auto-immune disease’ caused by gluten. It affects about one in a hundred people. Apparently, only 24% of people who have it, have been diagnosed as having it, according to Coeliac UK. And if it affects a direct family member, your chances of getting it rise from one in a hundred to one in ten. Gluten is found in wheat, rye and barley.
Symptoms of coeliac disease
Wind, bloating, diarrhoea or constipation, nausea, fatigue, sudden weight loss, skin problems.
I love the bits about ‘caused’ by gluten; and that 76% of people who have it, don’t know they have it. So how can anyone tell it is 76% not 72%, or 68%?
Of course it is not ‘caused’ by gluten (as research later in this piece will confirm). The truth is that a large group – approximately 40% of the population – have a genetic predisposition to coeliac disease yet it only manifests itself in about 2-3% of that group – or about 1% of the total population. It doesn’t appear in the other 97-98%, even though genetically they can’t manage gluten. So, the question to answer is ‘Why do only some people with a genetic predisposition have gluten intolerance?’
A classic cause of an allergy is to have lost certain commensal (good) bacteria that would have processed the specific food for you. And, it is now known that an auto-immune system condition can be explained by occurrences forming structures in your gut that bring on an attack by your white cells, which then attack similar structures elsewhere in the body. So, the issue is, what occurences?
Coeliac Disease and gut bacteria
When an individual with celiac disease eats a food containing gluten, the immune system immediately starts attacking and damaging the small intestine lining.
What is clear is that people of a certain genetic make-up (who express a gene called DQ8) have the potential for gluten intolerance, but as we said above not all are actually smitten. In fact, just 2-3%. So what’s going on?
In 2015, a team from the Digestive Health Research Institute at McMaster University in Canada, lead by Dr. Elena Verdu engineered the gut microbiomes of mice to have no bacteria (clean mice), only good bacteria (pathogen-free), or a normal healthy gut mix including pathogens such as Proteobacteria, such as Escherichia, Streptococcus, Staphylococcus and Helicobacter.
By giving gluten to the pathogen-free mice, they saw an immediate pick up in immune lymphocytes in the blood, and damage to the gut wall villi, with increase in death of intestinal lining cells. Interestingly, the clean mice did not have the auto-immune response. So, some good bacteria seem to play a role in gluten intolerance.
But, the most interesting group though were the ‘normal’ mice. When they received gluten, they had the biggest reaction of all. Conclusion? The reaction was made far worse by ‘bad’ Proteobacteria?
That seemed confirmed when the clean mice received Escherichia coli from a patient with celiac disease, they too showed all the responses.
And, when the researchers gave newborn mice an antibiotic (vancomycin) their gluten reaction became worse. This was because the antibiotic damaged levels of commensal bacteria, which normally keep the pathogens in check. After the antibiotic, higher levels of Proteobacteria were seen, more ‘gluten sensitivity’ and a greater immune response.
Antibiotics given in early life may also therefore be a factor in gluten intolerance.
So, it still seems uncertain but looks like the worst immune response could be due to the greater presence of uncontrolled pathogens which boost the immune response to gluten.
The conclusion is however clear. An imbalanced microbiome lies behind both the gluten ‘intolerance’ and the immune response.
In August 2016, the research team at McMaster showed in a second study that mice that received Pseudomonas aeruginosa (Psa) from coeliac patients produced gluten sequences that stimulated inflammation in their gut wall. However, mice that had received strains of Lactobacillus metabolised and detoxified the gluten.
What is happening is that gluten cannot be metabolised by 40% of people because they have a genetic fault that does not allow the correct enzymes to be produced. In these cases, the majority of people who have the genetic problem find their gut bacteria take over and do the job for them. But, in a limited number of cases, they have lost the correct helpful bacteria and so they become fully gluten intolerant.
The bottom line
The next step is simply to find out exactly the gut bacteria that can best help the digestion of gluten, and probiotics could then be the answer. It already looks like L. acidophilus might help.
Go to: The Heal Your Gut Article