Celiac disease is an autoimmune disease triggered by the consumption of gluten-containing foods. The medical approach for celiac disease is a lifelong gluten-free diet. However, recent evidence demonstrates that a gluten-free diet may not be enough to prevent many complications associated with this disease.
According to a new study published last week in the Journal of Pediatric Gastroenterology and Nutrition, approximately 20% of children with celiac disease have intestinal abnormalities after one year following a strict gluten-free diet.
In this study, researchers reviewed medical records of 103 children and adolescents with celiac disease. The participants followed a gluten-free diet for an average of 2.4 years. They also had an endoscopy and biopsy at least two times, at diagnosis and after one year on the diet.
The study focused on the rate of persistent celiac enteropathy (damage to the intestinal cells caused by gluten), which was present in 19% of the children. These results suggest that 1 out of 5 children with celiac disease may have persistent enteropathy, despite following their recommended gluten-free diet. This issue can lead to long-term effects and complications.
Few studies have looked at the effect of non-gluten proteins and celiac disease. An all-too-common contributor to non-responsive celiac disease is cross-reactivity with other foods. Assessing gluten-associated cross-reactive foods is essential for patients with gluten sensitivity and celiac disease, since these patients are sensitized to a broad range of dietary proteins due to enzyme dysfunction, villi damage and other disorders.
As a result, many functional abnormalities can persist, such as increased gut permeability, pancreatic insufficiency, small intestinal bacterial overgrowth (SIBO) also known as small bowel bacterial overgrowth syndrome (SBBOS), nutritional deficiencies, hypochlorhydria, and allergies.
Often, patients with celiac disease have to do more than just follow a gluten-free diet to maintain optimal health. Although a majority of celiac patients feel better after implementing this type of diet, they continue to have poor nutrient status. Celiac disease attacks and damages the villi of the small intestine, resulting in the body not being able to absorb all the nutrients it needs. The most common deficiencies are vitamin D, calcium, folate, vitamin B12 and iron. Therefore, it is important to assess the nutrient status. This can be antioxidant status, vitamins, essential fatty acids, vitamin D, etc. In addition, it is essential to use stool testing that can assess the overall function of the gastrointestinal tract to rule out autoimmune triggers, digestion and absorption issues, as well as inflammatory and immune problems.
By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS
Source: Maureen M. Leonard, Dascha C. Weir, Maya DeGroote, Paul D. Mitchell, Prashant Singh, Jocelyn A. Silvester, Alan M. Leichtner, Alessio Fasano. Value of IgA tTG in Predicting Mucosal Recovery in Children with Celiac Disease on a Gluten Free Diet. Journal of Pediatric Gastroenterology and Nutrition, 2016; 1 DOI: 10.1097/MPG.0000000000001460