Why do some people develop celiac disease while others tolerate gluten without issue? From a root-cause medicine perspective, celiac disease is not simply about gluten—it’s about what’s happening beneath the surface: genetics, gut health, immune dysregulation, and environmental factors all combine to create a “perfect storm.”
At its core, celiac disease is an autoimmune response to gluten, driven by a combination of genetic susceptibility (HLA-DQ2/DQ8 genes), immune dysfunction, and leaky gut. This intestinal permeability allows gluten fragments and other harmful substances to escape the gut and trigger an immune attack on the body’s own tissues, including the small intestine.
But what causes the gut lining to become “leaky” in the first place? Key contributors include environmental toxins, microbiome imbalances, chronic inflammation, and infections. By addressing these root causes, functional medicine offers a more comprehensive approach to managing and even reversing the damage caused by celiac disease.
Why Does Celiac Disease Develop? The Role of Leaky Gut and Triggers
1. Toxins and Environmental Exposures
Modern farming practices and industrial chemicals are significant players in the rise of autoimmune conditions like celiac disease. For example:
- Glyphosate, a pesticide commonly used on non-organic grains, disrupts the gut microbiome and damages the proteins that seal the gut lining (tight junctions), leading to leaky gut.
- Heavy metals like mercury and lead increase oxidative stress and impair gut barrier function.
- Food additives, including emulsifiers and microbial transglutaminase, can mimic gluten proteins, worsening the immune response in those with gluten sensitivity.
2. Microbiome Imbalance (Dysbiosis)
The gut microbiome is crucial for regulating the immune system and maintaining gut barrier health. Factors such as antibiotics, a poor diet, or exposure to toxins can disrupt this delicate ecosystem, reducing the production of protective compounds like butyrate and increasing gut inflammation.
3. Chronic Inflammation
A diet high in processed foods, sugar, and refined carbohydrates fuels inflammation in the gut, which over time erodes the intestinal lining. Inflammation from infections or stress can also activate the immune system and create a pro-autoimmune environment.
4. Infections
Viral and bacterial infections, such as rotavirus or Campylobacter, have been implicated as triggers for celiac disease in genetically predisposed individuals. These infections can damage the gut lining, increase intestinal permeability, and “turn on” the immune system inappropriately.
5. Stress
Chronic stress affects gut motility, reduces blood flow to the digestive tract, and compromises immune regulation, creating a favorable environment for leaky gut and autoimmune activation.
Signs and Symptoms of Celiac Disease
Celiac disease is often called a “great imitator” because it presents with a wide variety of symptoms, many of which overlap with other conditions. Here’s what to look for:
Digestive Symptoms
- Chronic diarrhea or constipation
- Bloating and gas
- Abdominal pain and cramping
- Nausea and vomiting
Nutrient Deficiencies
Damage to the small intestine impairs nutrient absorption, leading to:
- Iron-deficiency anemia
- Low folate and vitamin D levels
- Calcium and magnesium deficiencies
Systemic Symptoms
- Fatigue and weakness
- Unexplained weight loss
- Brain fog and difficulty concentrating
Skin Issues
- Dermatitis herpetiformis: A rash characterized by itchy blisters, often on elbows, knees, or buttocks.
Neurological Symptoms
- Migraines
- Peripheral neuropathy (tingling or numbness in extremities)
- Mood changes such as depression or anxiety
Children with celiac disease may exhibit delayed growth, behavioral problems, or failure to thrive.
How Is Celiac Disease Diagnosed?
Functional medicine goes beyond conventional testing to uncover the root causes of celiac disease. Here are the key tools:
1. Blood Tests
- Tissue Transglutaminase Antibodies (tTG-IgA and tTG-IgG): These are the most commonly used tests for celiac disease.
- Deamidated Gliadin Peptides (DGP): Useful for detecting gluten sensitivity in people who may not show positive tTG antibodies.
2. Genetic Testing
- Identifies HLA-DQ2 and HLA-DQ8 genes. While the presence of these genes doesn’t confirm celiac disease, it can rule it out if they’re absent.
3. Toxin Testing
- A functional medicine approach may include tests for environmental toxins like glyphosate, mercury, and lead, which contribute to gut permeability and immune dysregulation.
4. Stool and Microbiome Testing
- Identifies gut dysbiosis, markers of inflammation, and gluten breakdown products to assess overall gut health.
5. Small Intestine Biopsy
- This remains the gold standard for diagnosing celiac disease by identifying villous atrophy (damage to the intestinal lining).
What Can Be Done? Healing from Celiac Disease
Healing from celiac disease requires more than just removing gluten from the diet—it involves addressing the root causes and rebuilding a healthy gut. Here’s how functional medicine approaches treatment:
1. Strict Gluten Avoidance
Eliminating all sources of gluten is non-negotiable. Even small amounts of gluten can trigger an immune response and undo healing progress.
2. Heal the Gut
- Remove: Eliminate inflammatory foods (processed grains, refined sugar, seed oils) and environmental toxins.
- Replace: Supplement with digestive enzymes to support nutrient absorption.
- Repopulate: Restore the microbiome with probiotics, prebiotics, and fermented foods.
- Repair: Use gut-healing nutrients like L-glutamine, zinc carnosine, collagen, and aloe vera.
3. Reduce Toxin Exposure
- Opt for organic produce to minimize glyphosate exposure.
- Use water filters to remove heavy metals and other toxins.
- Avoid plastic containers and switch to glass or stainless steel.
4. Correct Nutrient Deficiencies
- Supplement with iron, folate, and vitamin D in bioavailable forms to address deficiencies caused by intestinal damage.
5. Support Detoxification
- Include liver-supporting foods like cruciferous vegetables, garlic, and onions.
- Consider supplements like N-acetyl cysteine (NAC) and milk thistle.
6. Regulate the Immune System
- Use anti-inflammatory compounds like curcumin (turmeric), omega-3 fatty acids, and polyphenols from green tea and berries.
Long-Term Strategies for Health
Healing from celiac disease is a journey that extends beyond the gut. Here are some lifestyle strategies to ensure long-term health:
- Manage Stress: Incorporate mindfulness, yoga, or other stress-reduction techniques.
- Stay Active: Regular exercise supports gut motility and immune regulation.
- Build a Support System: Connect with others managing celiac disease for practical tips and emotional support.
The Functional Medicine Perspective
Celiac disease is more than an issue with gluten—it’s a manifestation of deeper imbalances in gut health, immune function, and environmental exposures. By addressing these root causes through personalized care, functional medicine empowers individuals to not only manage their condition but to thrive.
If you suspect celiac disease or want to explore a root-cause approach, please schedule a call at the link at the top of the page to discuss next steps.
RESEARCH:
All Disease Begins in the (Leaky) Gut: Fasano, 2020
Microbiota and Celiac Disease: Caio et al., 2020
Leaky Gut as a Danger Signal: Mu et al., 2017
