Celiac disease – formerly also known as local sprue – is a chronic and usually lifelong autoimmune disease characterized by intolerance to gluten. In those affected, the consumption of foods containing gluten leads to inflammation of the intestinal mucosa, which causes the intestinal villi to shrink.
Intestinal villi are lined-up elevations or protuberances of the intestinal mucosa in the small intestine. They are responsible for absorbing the nutrients from our food. If they regress over time, fewer and fewer nutrients can be absorbed, which eventually leads to nutrient deficiencies.
If you are already familiar with celiac disease but are looking for holistic treatment options, then scroll to the “Naturopathic measures for celiac disease” section.
Gluten is a protein found in wheat and other grains such as rye, barley, spelt, emmer, Khorasan wheat (known as Kamut) and triticale (a cross between rye and wheat).
Gluten is widely used in food processing because it causes the flour to combine with water to form a sticky, elastic dough that holds together well. In Australia wheat has been changed to contain 6x the amount of gluten it had naturally. That means for your gut that one slice of bread equals 6 slices of bread.
Due to these properties, gluten is also referred to as glue protein. Gluten is also used as a carrier for flavours and is therefore not only found in baked goods but can also be found in products that at first glance would not appear to contain gluten ( 1 ).
Gluten is not a single substance, but a collective term for a mixture of linked amino acids. It consists of the storage proteins prolamin and glutelin, which make up about 70 to 80 percent of the protein in grain and are located inside the grain (in the so-called endosperm). The remaining 20 to 30 percent of grain protein consists of the proteins albumin and globulin, which are found in the outer layers of the grain.
Depending on the type of grain, the two gluten proteins prolamin and glutelin have different names – but they are all summarized under the term gluten.
The problem with digesting gluten (or prolamin) is that it is not properly broken down into individual amino acids in celiac disease. Like any protein, prolamin is made up of a long chain of linked amino acids. The prolamin chains of wheat and many other cereals are particularly high in proline (an amino acid). And it is precisely this proline that is the problem with celiac disease.
This is because the enzymes in the human digestive system are unable to break the bonds on either side of the proline that links proline to other amino acids in the protein chain. So there are always shorter amino acid chains left (they are called peptides). In healthy individuals, these undigested peptides stay within the gut and are simply excreted the next time you go to the toilet.
Unfortunately, this does not apply to people with celiac disease, because their immune system initiates an inflammatory reaction to defend themselves: the peptides pass through the intestinal mucosa undigested and accumulate behind it, whereupon the body releases the enzyme transglutaminase. This enzyme is also made in healthy people and actually helps repair damage to the gut lining.
In people with celiac disease, however, the transglutaminase reacts with the undigested gluten fragments, which falsely triggers an immune response and leads to inflammation of the intestinal mucosa. As a result, the intestinal villi, which are responsible for absorbing nutrients, break down over time.
Although oats contain gluten, the oat-specific prolamin has a different composition than the wheat prolamin. While the latter is high in proline (proline is an amino acid), oat prolamin is low in proline. The proline content of oats is even as low as that of millet and corn, which can ultimately be eaten very well on a gluten-free diet.
However, oats can be contaminated with other gluten-containing grains through neighbouring fields, combine harvesters and during transport. That’s why you should use so-called gluten-free oats. Although this still contains the compatible oat gluten, it does not come into contact with other gluten-containing grains during harvesting and processing.
Nevertheless, to be on the safe side, some celiac disease societies recommend eating only 50 to 70 g of oats per day (children: 20 to 25 g), since the long-term effects of avenin have so far been little researched. Excessive oat consumption could therefore lead to renewed symptoms.
Celiac disease is a special case among autoimmune diseases because it is the only autoimmune disease that can be switched on and off – namely by not eating gluten. The gluten ensures that antibodies are formed that attack your own body. If no gluten gets into the body, the antibodies break down again and as long as no new gluten is supplied, no new antibodies are formed.
Researchers assume that in western countries around 1 percent of the population is affected by celiac disease, although the number of unreported cases is likely to be high because the symptoms can be very unspecific and sometimes there are no symptoms at all.
So it is possible that you have celiac disease but don’t even notice it. Even if there are no symptoms, the mucous membrane of the small intestine is damaged. For the diagnosis, it does not matter whether the disease is asymptomatic or not. You can find out how celiac disease is diagnosed below in the paragraph “The diagnosis of celiac disease”.
The European Society for the Study of Celiac Disease describes celiac disease as a statistical iceberg, as the majority of diseases remain undiagnosed.
In principle, celiac disease can occur at any age. However, 70 percent of those affected are only diagnosed when they are over 20 years old, because the disease often goes unnoticed for years and sometimes only develops in the course of life. It affects women more often than men ( 4 ) ( 5 ) ( 6 ).
The symptoms of celiac disease can be very different for those affected. Many people have only minimal symptoms or show no or only a few symptoms, which are then not associated with celiac disease or any disease at all.
Below is a list of possible symptoms of celiac disease:
Gastrointestinal complaints (nausea, vomiting, diarrhea, constipation, bloating, flatulence, abdominal pain, foul-smelling and bulky stools)
Since many of these symptoms also occur without celiac disease, it is difficult to recognize the disease at all, which is why therapy is often delayed by years. While some symptoms can appear shortly after eating gluten (e.g. gastrointestinal complaints, headaches, fatigue), others only develop gradually over months (e.g. weight loss and deficiency symptoms) – the disease does not progress in phases like it does many other autoimmune diseases.
Children and adolescents can basically experience the same symptoms as adults – but sometimes they appear a little differently. The most common identifying features in children are:
Another symptom of celiac disease is bulky, foul-smelling, and often greasy, shiny stools that are difficult to flush down the toilet.
Weight loss often accompanies celiac disease due to digestive problems and insufficient absorption of nutrients (as a result of damage to the intestinal lining). After switching to a gluten-free diet, the weight should return to normal over time.
Different forms of celiac disease can be distinguished based on the course: Typical celiac disease is often discovered in childhood due to the presence of gastrointestinal complaints such as diarrhea, bloated abdomen and growth disorders.
Atypical celiac disease, on the other hand, is usually not recognized until later, since it is not characterized by gastrointestinal symptoms. It is usually only discovered when skin problems, joint and muscle problems or the consequences of a deficiency occur – e.g. iron deficiency anemia. Atypical celiac disease is more common than typical.
Once the diet has been changed, those affected can cope quite well with the disease and live symptom-free. However, accidental gluten consumption can temporarily cause symptoms again. (More information on this can be found in the paragraph “How bad is a gluten accident?”).
In addition, the risk of secondary diseases increases if celiac disease remains undetected for a long time (section “What happens if celiac disease is not treated?”).
Genetic factors play an important role in the risk of developing celiac disease. If you have a family member who has celiac disease, your risk of developing it is higher – by 10 to 15 percent for first-degree relatives.
A genetic test can almost completely rule out the possibility that you have celiac disease or will ever develop one because 97% of those affected have inherited certain genes (HLA-DQ2 or HLA-DQ8). Conversely, the presence of these genes does not mean that you have or will have celiac disease, as 30% of people without celiac disease also have these genes.
Basically, a genetic test is a fairly reliable way of ruling out celiac disease if you do NOT have the relevant genes. If you have it, there is no way of knowing with certainty (genetic testing alone) that you will eventually have celiac disease, nor can it be said that your symptoms (if you have any) are always celiac. They could also have other causes.
People with trisomy 21 (Down syndrome), type 1 diabetes mellitus and other autoimmune diseases are also more frequently diagnosed with celiac disease than people without previous illnesses.
Researchers also suspect that people with an unusually permeable gut (leaky gut syndrome) have a higher risk of developing celiac disease. However, the connection between these diseases and celiac disease is not entirely clear, because leaky gut could also be a consequence of celiac disease.
Since the disease is partly hereditary, newborns can also get celiac disease. For years researchers have been trying to find out whether the risk of celiac disease in newborns can be reduced – for example, if foods containing gluten are not introduced immediately after weaning or vice versa if gluten is introduced particularly early to “harden” the immune system.
According to the current state of research (May 2022), it does not appear to be possible to reduce the risk of celiac disease in babies through diet: If you do not introduce gluten-containing food into the baby’s diet immediately after weaning, but wait e.g. 6 months, this only delays the onset of celiac disease.
However, the European Society for Pediatric Gastroenterology, Hepatology and Nutrition, for example, advises feeding at least a few foods containing gluten in the first few months after weaning – due to a possible influence of the amount of gluten. However, what constitutes a large quantity has not yet been established or investigated ( 21 ).
Possible triggers of celiac disease with hereditary predisposition can e.g. Gastrointestinal diseases or certain medications (e.g. antibiotics or proton pump inhibitors).
The number of people affected has also increased significantly in recent years, which researchers attribute not only to better diagnostic methods and greater awareness of the disease. It stands to reason that lifestyle, dietary habits and other environmental factors could also have an influence.
According to researchers, the herbicide glyphosate may play a role in the development of celiac disease and other autoimmune diseases. Almost all of the symptoms of celiac disease could be explained by the effects of glyphosate: the imbalance in the gut bacteria, the vitamin and mineral deficiencies, the reproductive problems, etc.
And since more and more glyphosate has been used in the fields, the number of people with celiac disease has also increased. At the same time, a decrease in new cases was noted when less glyphosate was used in 2009 and 2010 ( 7 ).
Dr Stephanie Seneff from the Massachusetts Institute of Technology (MIT) and Dr. Anthony Samsel see a causal connection in these parallels. They consider celiac disease to be one of the diseases caused by glyphosate.
If celiac disease remains undetected, there is a risk of progressive inflammation of the mucous membrane in the small intestine, followed by the consequences of this inflammation, namely intestinal problems, weight loss and deficiency symptoms because nutrients are not being absorbed adequately.
The inflamed intestinal mucosa can also lead to other intolerances, such as lactose intolerance, which sometimes only occurs temporarily until the intestine has recovered.
In addition, the inflammation of the intestine can cause the so-called leaky gut syndrome (= permeable intestine), which means that bacteria or incompletely digested particles from the intestine can get into the bloodstream, which now leads to further diseases in the area of allergies and can lead to autoimmune diseases. Those affected also have a higher risk of colon cancer, thyroid and liver diseases.
A distinction must be made between celiac disease and non-celiac gluten sensitivity (NCGS) – also known as gluten intolerance or simply gluten sensitivity – and wheat allergy. The most important distinguishing features can be found in the following table:
|Celiac||Gluten sensitivity||Wheat allergy|
|Time after eating gluten when symptoms appear||Hours to month||Hours||Minutes to hours|
|Trigger||Gluten||Gluten and other grain parts||Wheat gluten and other wheat proteins|
|Damage to the digestive tract||Yes||None to little||None|
|Gluten free diet as even small parts can do damage||Gluten free diet, sometimes a little gluten can be ok||Wheat free diet|
|Occurrence in industrial countries||1 %||6 %||4 %|
Non-celiac gluten sensitivity is difficult to pin down and define. It is neither an allergy nor an autoimmune disease. Gluten sensitivity also does not appear to be heritable.
The symptoms of gluten sensitivity are almost identical to the symptoms of celiac disease, which is why the first step is to test whether you have celiac disease or possibly a wheat allergy. If this is not the case and a gluten-free diet then leads to the symptoms disappearing, gluten sensitivity is usually assumed.
Three different components of wheat and other cereals are currently being discussed as the cause, namely gluten, amylase trypsin inhibitors (certain wheat proteins ) and FODMAPs (a group of carbohydrates and sugar alcohols). Gluten sensitivity used to be dismissed as imagination, but this has now changed.
In the case of a wheat allergy, when wheat proteins arrive, the immune system forms antibodies that trigger allergy-typical symptoms (swelling of the mucous membranes, skin reactions, but also a few hours later digestive problems).
In contrast to non-celiac gluten sensitivity, celiac disease can be diagnosed relatively easily.
Patients who suspect they may have celiac disease should consult a doctor before trying a gluten-free diet. If, on the other hand, you eat gluten-free for a while, this makes the diagnosis considerably more difficult because the specific gluten antibodies are broken down and the intestinal mucosa builds up again during the gluten-free period. The disease can then no longer be easily detected and you would first have to eat gluten again for a few days or weeks. Of course, this can be very uncomfortable, since the symptoms can then return.
If you would like to have celiac disease clarified, you should first contact your family doctor or a gastroenterologist. Gastroenterologists deal with diseases of the gastrointestinal tract.
If celiac disease is suspected, a blood sample is first taken and analyzed for specific antibodies. If antibodies were detected in the blood sample, a small intestine biopsy follows. This is usually done by a gastroenterologist. A camera probe on a thin tube is pushed through the mouth, esophagus and stomach into the small intestine under a mild anaesthetic.
Five to six samples are then taken from different areas of the duodenum to get a better overview of the overall condition of the intestinal mucosa.
Because with celiac disease, the changes in the intestinal mucosa are sometimes not evenly distributed. Rather, the inflammatory changes can occur in patches. With a single sample, there is always a risk of overlooking the disease.
This tissue sample can then be used to identify damage to the intestinal mucosa. The diagnosis of celiac disease is then based on the antibodies in the blood, the small intestine biopsy and the subsequent improvement in the symptoms with a gluten-free diet (see paragraph after next).
First of all: Self-tests for celiac disease cannot replace a diagnosis by a doctor, because only the presence of antibodies is measured – but the complete diagnosis also includes a small intestine biopsy.
The tests can be bought online.
The following diseases are similar to celiac disease and should be ruled out by thorough examinations:
A strict, lifelong gluten-free diet is the most important measure for celiac disease and, to date, one of the only treatment options.
Occasionally one reads that the gluten-free diet is unhealthy or has no health benefits, at least not for people who do NOT have celiac disease.
Of course, a gluten-free diet can be unhealthy – just like any other form of nutrition. Anyone who mainly eats (gluten-free) ready-made products is of course not doing their health any good. However, those who eat wholesomely, naturally gluten-free ingredients, cook freshly and bake them themselves often eat more healthily and with more variety than someone who eats “normally”
So look forward to the change, to more conscious food choices and to getting to know completely new foods! We have many simple and delicious gluten free recipes for you. You can find these in our Library under Even healthier Recipes.
Food is legally considered gluten-free if it contains no more than 20 milligrams per kilogram (20 ppm) of gluten.
If a product contains more gluten, the ingredient must be listed in the list of ingredients. Some manufacturers also write the note “contains gluten” in the declaration.
In order to protect themselves legally, many manufacturers also note on the packaging that the product may contain “traces of gluten”, even though no ingredient in the food contains gluten. Traces can therefore be present if not only gluten-free but also gluten-containing raw materials and foods are processed in the manufacturing plant and contamination cannot be ruled out as a result.
Keep in mind that particularly sensitive celiac sufferers react even to traces of gluten. Therefore, the manufacturer’s declaration on the respective food must always be studied or, if anything is unclear, ask the manufacturer.
Those affected who live in a household with people who eat normally should also not use chopping boards, bread knives, baking trays, toasters and flour mills – all kitchen utensils that cannot be cleaned thoroughly after each use pose a risk of contamination.
However, the list of ingredients does not have to contain gluten literally. The gluten-containing ingredients only have to be highlighted – even with ingredients that in turn consist of several components. So it may be that you read “spices ( wheat protein )”. If, on the other hand, it only says “spices”, then there are no gluten-containing ingredients in these spices. The same applies e.g. for “aroma”. Pay particular attention to the following designations:
Gluten-free wheat starch has also been available for a number of years, but not all people with celiac disease tolerate it.
Before you go to a restaurant, you should clarify whether there is a gluten-free menu. Many restaurants give special attention to gluten-free dishes on the menu. However, anyone who is already reacting to traces of gluten must be able to be sure that special utensils such as cutting boards are used to prepare gluten-free dishes. If possible, eat outside of peak times. When there is a lot of activity, it is easy to make mistakes, which increases the risk of contamination.
The intestinal villi can only build up again by avoiding foods containing gluten. For some people, the symptoms disappear after just a few days – for others only after a few weeks or months. However, it can take months to years for the intestine to fully recover (also depending on how long the disease has remained undetected and how long the affected person has suffered from symptoms). As soon as gluten-containing foods are eaten again, the disease worsens again.
Even small amounts of gluten can lead to new symptoms, although it is not certain how much gluten per day is considered safe for celiac disease. The guide values are a maximum intake of 10 to 100 mg per day. The range is so large because some people already react to traces and others only when there are somewhat larger amounts. For comparison: A white flour roll (40 g) contains an average of 2313 mg gluten – 200 g cooked pasta even contains 8600 mg.
Gluten accidents can happen to even the most cautious and organized of individuals. If you have accidentally eaten gluten (e.g. in a restaurant or through contamination) despite following a gluten-free diet, you will very likely temporarily develop the same symptoms that you already had.
So if your body previously reacted with gastrointestinal complaints and headaches, it will react in the same way after a gluten accident. The symptoms can appear a few hours to days after eating gluten and also disappear within hours to days. While some people feel drained for days and would just like to sleep, for other people everything is fine again after a bit of stomach ache.
However, even a gluten accident can damage the intestine again or set it back in its healing process – even if your symptoms are only temporary. So don’t accept a gluten accident under any circumstances – if the waiter in the restaurant can’t give you any information, for example, then it’s better to go to another restaurant. If it does happen, don’t fret and try to be more careful next time.
Although research into medicines and other treatment methods has been going on for years, a gluten-free diet has so far also been considered the most important measure for celiac disease in conventional medicine.
For a number of years, dietary supplements containing enzymes have been available in health food stores, pharmacies, and online, which are said to help break down gluten in the body so that an immune reaction does not occur in the first place ( 12 ) ( 13 ).
The enzymes are taken in the form of capsules with meals – if you take the enzymes after the meal, they can no longer develop their effect. However, the preparations cannot replace a gluten-free diet, but only serve to render traces of gluten in already gluten-free foods harmless in the case of particularly sensitive sufferers.
Accordingly, the capsules are only taken as a supplement to a gluten-free diet, for example, to be on the safe side when eating out or when travelling. Treating yourself to a piece of cake containing gluten because you have taken enzymes is not an option.
The authors of a 2021 review that looked at various enzyme supplements also warn that sufferers should by no means relax their gluten-free diet simply because they are taking these supplements ( 14 ).
Because the composition of the food has an influence on the effectiveness of the enzymes and this factor has so far been insufficiently researched – so one cannot assume that one is protected by taking these preparations. In addition, the capsules are not equally suitable for every person, since not everyone is equally sensitive to gluten.
*An enzyme preparation can be found below.
Meanwhile, several drugs against celiac disease are being researched that have not yet been approved. The mechanisms of action differ depending on the preparation: For example, they aim to make the intestine less permeable and thereby reduce symptoms, or similar to enzyme preparations, they are intended to increase gluten tolerance or promote gluten digestion ( 15 ).
The active ingredient ZED1227, which was developed in Germany, has been the best researched so far. The active substance is currently (May 2022) in clinical study phase 2b. ZED1277 is said to inhibit the body’s own enzyme transglutaminase. This reacts with the undigested gluten fragments and triggers the immune response that leads to inflammation of the gut lining ( 16 ).
However, these approaches are not aimed at replacing a gluten-free diet. This means that a gluten-free diet will remain the best treatment method for celiac disease even after these drugs are approved.
In addition to a gluten-free lifestyle, the following naturopathic measures can also be used for celiac disease:
Scientists are currently assuming a connection between intestinal flora and celiac disease. The microbiome is affected by diet, medication, stress, and personal hygiene (washing affects the bacterial flora of the skin, which in turn also affects the bacterial composition inside the body) ( 17 ).
Furthermore, infectious, metabolic and inflammatory diseases can permanently disrupt the microbiome. Apparently, the microbiome of people with celiac disease who are not yet on a gluten-free diet has fewer lactobacilli and bifidobacteria , but more E. coli bacteria, proteobacteria and staphylococci than the microbiome of gluten-free celiac disease patients and healthy people. However, it is not clear whether this imbalance is also a cause of celiac disease or rather a consequence of it.
Studies have been conducted in recent years that have tested the effects of probiotics in celiac disease patients. It has been shown that certain bifidobacilli and lactobacilli can inhibit the harmful effects of gluten in the gut by preventing the gluten from making the gut lining more permeable. The most effective were those preparations containing several different strains of bifidobacilli and lactobacilli ( 18 ).
Fermented foods, such as miso, kimchi, kombucha, kefir, and sauerkraut, are considered natural probiotics. So, you could incorporate these foods into your gluten-free diet to support your gut. You could also take probiotic dietary supplements that promote the development of intestinal flora. Choose a preparation that contains as many different strains of bacteria as possible.
A diet rich in fibre, vitamins and minerals with lots of fruit, vegetables and gluten-free whole grain products can also support the growth of good intestinal bacteria. On the other hand, sugar, salt, sweeteners, and other food additives (firming agents, humectants, etc.) can encourage the growth of bad gut bacteria ( 19 ).
Also eat a lot of different fruits and vegetables, such as broccoli, spinach, onions and garlic, as well as berries, walnuts, herbs and fresh spices such as turmeric and ginger, because the secondary plant substances contained have an anti-inflammatory effect. On the other hand, avoid sugar and highly processed foods like salami and sausage, as these can be pro-inflammatory ( 20 ).
Choose anti-inflammatory oils and fats whenever possible. These include in particular omega-3 fatty acids from linseed oil and hemp oil. Also make sure you have a healthy ratio between omega-6 and omega-3 fatty acids: a maximum ratio of 5:1 or better 3:1 (omega 6:omega 3) would be ideal. Because too many omega-6 fatty acids can in turn promote inflammation.
Celiac disease can lead to poor absorption of vitamin A, vitamin D, vitamin E and vitamin K, as well as folic acid and iron since these vitamins, are primarily absorbed through the small intestine. (In the case of vitamin D, this only applies to the vitamin D that enters the body through food). B vitamin deficiencies are also possible, although less common. Mineral deficiencies can also occur: magnesium, calcium, copper, zinc and selenium are particularly affected.
You could consult a holistic practitioner to help you advise you on taking supplements. Because depending on how far the shrinkage of your intestinal villi has progressed, you will not be able to compensate for a vitamin or mineral deficiency through diet alone.
So far, it has been assumed that celiac disease cannot be cured – but after changing your diet to gluten-free foods, the disease can be symptom-free. Nevertheless, there are reports of alleged healings on the Internet, i.e. from people who suffer from celiac disease and then suddenly tolerate foods containing gluten again.
The treacherous thing about this is that the disease can sometimes be almost completely symptom-free even with gluten intake, or earlier symptoms can also disappear again, although the intestine is damaged when eating foods containing gluten. Final clarification as to whether the villi of the small intestine are actually recovering and building up again despite a gluten-containing diet (which would in fact be a cure) is only possible with a new small-bowel biopsy.
Only transient celiac disease, which is very rare and mostly occurs in children under the age of two, is a temporary form of celiac disease that can actually disappear again. After the symptoms have subsided as a result of an appropriate diet, the corresponding antibodies and changes in the mucous membrane of the small intestine can suddenly no longer be detected when gluten is fed again. However, it is recommended that the antibodies in the blood be checked regularly.
Below we summarize the most important measures for celiac disease:
Colonics help to keep your gut and your microbiome healthy. And if you are moving away from Gluten a series of colonics can be beneficial.
But as mentioned in our article, the holy grail is the ‘Gluten Free Diet’.