The simplest answer to that question is: Celiac disease is an autoimmune disease caused by the ingestion of gluten (2009). Pointing to gluten as the causal factor is the foundation for the only effective treatment that modern medicine has to offer – that is, a lifelong gluten-free diet.
Both the definition and the treatment of celiac disease (CD), however, are oversimplified.
Celiac disease symptoms are much more complex than merely an autoimmune reaction caused by gluten.
Research provides some details that explain how CD works. They are partly helpful for understanding what causes CD and what to do about it.
Modern Medical View
Although CD is defined as an autoimmune disorder, modern medicine is pretty clueless about what causes autoimmunity. Nevertheless, science shows us how it works in CD.
Immunity vs Autoimmunity. The classic response by the immune system against foreign invaders (“antigens”) entails the production of antibodies. Antibodies form complexes with antigens, thus rendering them harmless and setting up their removal from your body.
Autoimmunity, on the other hand, happens when your immune system misidentifies a normal substance (cell, tissue, protein, etc.) in your body as foreign and makes antibodies against it. It is an immune response to “self” – thus, autoimmunity.
Destruction of normal substances by autoimmunity is the foundation for all of the symptoms of CD and other autoimmune disorders.
Autoimmunity in Celiac Disease. The main response of the immune system in CD involves manufacturing antibodies against a particular enzyme called tissue transglutaminase (tTG). This enzyme crosslinks proteins together throughout the body, both within and between cells. Such protein mash-ups are valuable as structural complexes that stabilize blood clots, skin, and hair.
Whatever triggers the immune system to treat your own tTG as a foreign invader is currently a mystery. However, once tTG autoantibodies are formed, they create havoc wherever they appear.
In addition to your own tTG, another form of TG that is widely used as a food additive makes your autoimmune response even worse. It is TG isolated from bacteria, called microbial transglutaminase (mTG). It is commonly referred to as “meat glue” due to its ability to crosslink proteins together in meat.
Gluing proteins together with mTG is how food processing makes imitation crab meat, chicken nuggets, fish balls, reconstituted beef and pork (steaks, fillets, roasts, cutlets), sausages, hot dogs, and novel meat combinations (e.g., lamb and scallops, bacon and beef).
It is also used for making meat noodles (shrimp), for thickening egg yolks, for strengthening dough mixtures, and for increasing yield in tofu production.
The increased uses of mTG in food processing has now come under scrutiny as a potential causal agent for recent surges in the incidence of CD (2015).
Whatever the initial antigen might be, the result is an inflamed intestinal lining that develops holes. The outcome is leaky gut syndrome. This syndrome all by itself underlies body-wide symptoms of celiac autoimmunity.
Classic GI problems include chronic diarrhea, bloating, gas, acid reflux and heartburn.
Outside the digestive system, the most common symptoms of CD are:
- Anemia, usually resulting from iron deficiency
- Loss of bone density (osteoporosis) or softening of bone (osteomalacia)
- Itchy, blistery skin rash (dermatitis herpetiformis)
- Damage to dental enamel
- Mouth ulcers
- Headaches and fatigue
- Nervous system injury, including numbness and tingling in the feet and hands
- Cognitive impairment
- Joint pain
- Reduced functioning of the spleen
- Intestinal cancers (esp. intestinal lymphoma and small bowel cancer)
Associated Autoimmunities. Autoimmune diseases come in bunches. At least two dozen are associated with CD (2013). The most widespread of these may be rheumatoid arthritis, diabetes, thyroiditis, and lupus.
Since so many autoimmune diseases appear together, they are often referred to as “risk factors” for each other. This is an intellectually slippery way of implying cause and effect when it is logically not possible to do so.
Risk factors of CD actually indicate a susceptibility to autoimmunity. Pulling back the curtain to discover what causes autoimmunity in the first place is the key to understanding and treating CD and its so-called risk factors.
Genetics of Celiac Disease. One of the risk factors for CD is supposedly a genetic one. Certain genes are associated with a greater prevalence of CD. Approximately 90% of CD patients have a particular genotype (2008). This alone might support a genetic cause for CD. However, genetic risk factors are also common in 30-40% of the population that do not develop autoimmunity.
This should be no surprise, since genes are simply blueprints. They work based on environmental cues. Obviously, carriers of supposedly risky “CD genes” who do not develop CD are exposed to different environments.
Another aspect of this puzzle is the 5-fold increase in the incidence of CD between 1974 and 1989 (2010). Such a rapid increase in CD cases is too fast to be explained by genetic change.
The Gender Puzzle. CD is diagnosed predominantly in women. In most cultures, women comprise 60-70% of confirmed cases of CD (2010). This pattern reflects the greater susceptibility of women to all autoimmune diseases. Several proposed explanations have been put forth to explain this discrepancy between women and men.
Women have stronger immune responses, which raises their inflammation load. Autoimmune symptoms vary with female hormonal fluctuations.
The X chromosome, which women have two of, seem to have defects that might raise autoimmune susceptibility. After pregnancy, fetal cells can circulate for years, leading to autoimmune responses. Finally, some surveys suggest that higher rates of autoimmune diagnoses represent the observation that women use healthcare services more than men (2010).
Treatment Options. Focusing on gluten as the causal agent directs the main treatment option – that is, a gluten-free diet. Indeed, this approach is considered the only effective treatment for CD. No medication exists that prevents autoimmunity in the presence of gluten.
Going gluten-free is prescribed as a lifelong diet for treating CD.
Unfortunately, strict adherence to a gluten-free diet rarely succeeds in normalizing the intestinal damage caused by CD. For example, a 2009 study in the The Journal of Alimentary Pharmacology and Therapeutics found that only 8% of adult patients returned to normal gut health even after following a gluten-free diet for 16 months.
This means that prescribing a gluten-free diet is, at best, inadequate for addressing CD. The conventional CD treatment is incomplete and not working, at least not by itself.
A more comprehensive treatment protocol must start with restoring basic gut health.
Basic Gut Health
Several additional strategies have become critical for healing the gut in the face of CD.
Nutrient Supplementation. Once the gut becomes damaged by CD, you lose the ability to absorb nutrition from your food. Even after 10 years of going gluten-free, more than half of all celiac patients show poor vitamin status (2002).
The first step toward good gut health is, therefore, to incorporate nutritional supplements into the diet. Common deficiencies for CD patients include fiber, calcium, iron, magnesium, zinc, folate, niacin, riboblavin, vitamin B-12, vitamin D, and protein.
Heal the Leaky Gut. Inflammatory foods make CD and every other gut-related health issue worse. Healing a leaky gut after years of chronic inflammation is an absolute must for putting out the fires of CD. Health professionals offer a breadth of advice on foods for treating a leaky gut. Not all of it is helpful.
Information from Dr. Josh Axe is a good start (The Leaky Gut Diet and Treatment Plan, Including Top Gut Foods). Dr. Axe is one of the few physicians who understands that the dogmatic advice about anti-inflammatory foods is often just plain wrong. The most common error that he points out is the recommendation to eat legumes (beans, peas, soy) and whole grains (wheat, oats, rye, rice, etc.). They are highly inflammatory and should be avoided.
Healing a leaky gut also rests on eliminating as many sources of gut inflammation as you can. The worst offenders include additives in most processed foods (7 Food Additives that Trigger Leaky Gut). In general, the best advice is simply to avoid all processed foods.
Microbiome Balance. The 40 trillion or so microbial cells in your GI tract determine your response to inflammation, including autoimmune responses. When they are healthy, so is your gut. When they are damaged, your gut deteriorates. Virtually every aspect of your health follows suit.
In the past, microbiome balance depended on fermented foods that provided probiotic bacteria. Live cultures are still available from dairy (yogurt, kefir), vegetables (kimchi, sauerkraut), and soy (natto). Commercial products, however, are too often adulterated with additives that undermine their value as sources of probiotics.
The simplest modern strategy for restoring and maintaining microbiome balance is supplementing with probiotics. This means daily consumption of a supplement that provides at least 50 billion colony-forming units (“cells”) of a variety of different bacterial species.
Explaining the rapid rise in the incidence of CD clearly points to changes in our modern environment, starting around the mid-1970s. What has changed?
Of course, the accelerated use of “meat glue” (mTG) in food processing is one factor. It is not the only one.
The closest correspondence between the increased incidence of CD and an environmental change is the use of a weed killer called glyphosate (brand name: RoundUp) on wheat (2013). Glyphosate damages the microbiome, promotes the production of autoantibodies to transglutaminase, depletes the gut of key nutrients, and inhibits our normal detoxifying enzymes. All of the features of CD can be explained by the known effects of glyphosate.
Another environmental change that corresponds to a rise in autoimmunity overall is something called electrosmog. This term refers to man-made electromagnetic waves in the microwave frequency range from, for example, cellphones and Wi-Fi communication signals.
Recent research shows that such frequencies make our vitamin D receptor (VDR) susceptible to disruption (2017). Vitamin D is a key component of our immune defense system (2016). It is currently under investigation as a treatment for autoimmune disease. Unfortunately, simply supplementing with vitamin D does not account for a failed VDR due to electrosmog.
Early research already shows that protecting the brain from exposure to electrosmog improves disease symptoms in 90% of subjects with autoimmunity (2016).