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COELIAC DISEASE

What You Need To Know
WHAT IS COELIAC DISEASE?

Coeliac disease, also known as celiac disease, is an autoimmune condition characterised by a severe reaction to gluten, a protein found in wheat, barley, and rye. When individuals with coeliac disease consume gluten, their immune system mistakenly attacks the lining of the small intestine, causing inflammation and damage. This can lead to various symptoms and complications.

COMPLICATIONS OF COELIAC DISEASE

Untreated coeliac disease can lead to various complications and long-term health issues. Here are some potential complications of untreated coeliac disease:

  • Malnutrition: The damage to the small intestine in coeliac disease can impair nutrient absorption, leading to deficiencies in essential vitamins, minerals, and nutrients. This can result in malnutrition and associated complications.

  • Osteoporosis and Bone Disorders: Coeliac disease can interfere with calcium and vitamin D absorption, which are crucial for bone health. Untreated coeliac disease increases the risk of osteoporosis, osteopenia (reduced bone density), and other bone disorders.

  • Anemia: Chronic inflammation and malabsorption caused by coeliac disease can lead to iron deficiency anemia, resulting in symptoms like fatigue, weakness, and shortness of breath.

  • Infertility and Pregnancy Complications: Untreated coeliac disease can affect reproductive health and increase the risk of infertility. Pregnant women with unmanaged coeliac disease may face complications such as miscarriage, preterm birth, and low birth weight.

  • Neurological Disorders: Coeliac disease has been associated with various neurological disorders, including gluten ataxia, peripheral neuropathy, migraines, and epilepsy. These conditions can cause symptoms such as difficulty with coordination, tingling or numbness in the extremities, and recurrent headaches.

  • Dermatitis Herpetiformis: Dermatitis herpetiformis is a skin manifestation of coeliac disease characteriSed by itchy and blistering skin rashes. If left untreated, it can lead to long-term skin damage and scarring.

  • Increased Risk of Other Autoimmune Diseases: Individuals with untreated coeliac disease have a higher risk of developing other autoimmune conditions, such as type 1 diabetes, autoimmune thyroid disorders, and autoimmune liver diseases.

  • Intestinal Lymphoma and Cancer: Long-standing, untreated coeliac disease may increase the risk of developing intestinal lymphoma (a type of cancer) and other gastrointestinal malignancies.

WHAT IS REFRACTORY COELIAC DISEASE?
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SIGNS & SYMPTOMS
  • Digestive Symptoms: Abdominal pain and cramping, Bloating and flatulence. Diarrhea or frequent loose stools, Constipation

  • Nausea and vomiting, Acid reflux or heartburn

  • Weight Changes and Nutritional Deficiencies: Unexplained weight loss

  • Failure to thrive (in children)

  • Nutritional deficiencies, such as iron, vitamin B12, or folate deficiency

  • Fatigue and weakness

  • Gastrointestinal Issues: Distention (enlargement or bloating) of the abdomen, Pale, foul-smelling, or fatty stools, Decreased appetite,Malabsorption of nutrients leading to nutrient deficiencies

  • Skin and Oral Symptoms: Dermatitis herpetiformis (Itchy, blistering skin rash, often on elbows, knees, and buttocks), Mouth ulcers or sores, Dry or itchy skin

  • Musculoskeletal Symptoms: Joint pain and swelling, Muscle weakness, Osteoporosis or osteopenia (thinning of the bones)

  • Neurological Symptoms: Peripheral neuropathy (Numbness, tingling, or pain in the hands or feet), Balance problems, Seizures or epileptic-like episodes, Migraines or chronic headaches

  • Reproductive and Hormonal Symptoms: Delayed puberty or menstrual irregularities, Infertility or recurrent miscarriages , Hormonal imbalances, such as thyroid disorders

It is important to note that some individuals with coeliac disease may not experience any noticeable symptoms or may have atypical symptoms, making the diagnosis challenging.

Refractory coeliac disease (RCD) occurs in individuals with coeliac disease. In refractory coeliac disease, the symptoms and intestinal damage continue despite following a strict gluten-free diet. It is estimated that around 1-5% of people with coeliac disease may develop refractory coeliac disease.

There are two types of refractory coeliac disease:

 

  • Type 1: In type 1 refractory coeliac disease, the symptoms persist, but there are no abnormal changes in the cells of the small intestine when examined under a microscope. This type of RCD is generally less severe than type 2.

  • Type 2 refractory coeliac disease is more severe and less common. In this type, abnormal changes are seen in the cells of the small intestine, including the presence of abnormal or atypical lymphocytes. These abnormal cells can become cancerous over time, leading to a condition called enteropathy-associated T-cell lymphoma (EATL).

ANTIBODIES ASSOCIATED WITH COELIAC DISEASE

Antibodies play a crucial role in the diagnosis and monitoring of coeliac disease. Here are the antibodies associated with coeliac disease:

  • Anti-tissue transglutaminase antibodies: These are the most commonly tested antibodies in coeliac disease. They are produced in response to the tissue transglutaminase enzyme, which is found in the small intestine. Elevated levels of anti-tTG antibodies indicate an immune response to gluten.

  • Anti-endomysial antibodies: EMA antibodies target the endomysium, a connective tissue within the intestine. They are highly specific for coeliac disease and are often used as a confirmatory test alongside anti-tTG antibodies.

  • Anti-deamidated gliadin peptide antibodies: These antibodies react with a modified form of gliadin, another component of gluten. They are useful in the diagnosis of coeliac disease, especially in cases where anti-tTG and EMA antibodies may yield inconclusive results.

  • Anti-gliadin antibodies): AGA antibodies target gliadin and can be found in individuals with coeliac disease. However, they are less specific and sensitive compared to anti-tTG and EMA antibodies, so they are not commonly used for diagnosis.

 

It's important to note that the presence of these antibodies does not confirm a diagnosis of coeliac disease on its own. A definitive diagnosis requires a small bowel biopsy to assess the intestinal damage caused by gluten ingestion. Additionally, antibody levels may be used to monitor adherence to a gluten-free diet and assess disease activity.

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COELIAC DISEASE AND THE BRAIN

Coeliac disease, traditionally known as a gastrointestinal disorder, is now recogniSed as having neurological manifestations as well. Research shows that coeliac disease can involve neurological autoimmunity, leading to various neurological symptoms and conditions.

Neurological manifestations of coeliac disease can include:

  • GLUTEN ATAXIA: This is a form of cerebellar ataxia characterised by problems with coordination, balance, and voluntary muscle movements. It is caused by an autoimmune reaction to gluten in individuals with coeliac disease.

  • PERIPHERAL NEUROPATHY: Coeliac disease has been associated with peripheral neuropathy, a condition characterised by damage to the nerves outside the brain and spinal cord. Symptoms may include numbness, tingling, or weakness in the extremities.

  • HEADACHES AND MIGRAINES: Some individuals with coeliac disease may experience frequent headaches or migraines, which can be triggered by gluten consumption.

  • COGNITIVE IMPAIRMENT: Coeliac disease has been linked to cognitive dysfunction, including difficulties with memory, attention, and concentration. These cognitive impairments can improve with adherence to a gluten-free diet.

  • MOOD DISORDERS: Depression and anxiety disorders are more common in individuals with coeliac disease. The exact relationship between coeliac disease and mood disorders is not fully understood, but it is believed to involve both biological and psychosocial factors.

It's important to note that neurological symptoms can occur in the absence of gastrointestinal symptoms in some individuals with coeliac disease. If neurological symptoms are present, it is crucial to consider coeliac disease as a potential underlying cause.

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COELIAC DISEASE & LEAKY GUT SYNDROME

Coeliac disease can contribute to the development of leaky gut. In coeliac disease, the ingestion of gluten triggers an immune response that leads to inflammation and damage in the lining of the small intestine. This inflammation can disrupt the tight junctions between intestinal cells, compromising the integrity of the intestinal barrier and increasing permeability.

As a result, larger molecules, such as toxins, undigested food particles, and bacteria, may pass through the damaged intestinal lining and enter the bloodstream.

The chronic inflammation and ongoing damage in the intestine caused by coeliac disease can contribute to the development or exacerbation of leaky gut. The increased intestinal permeability allows harmful substances to enter the bloodstream, potentially triggering immune reactions and inflammation throughout the body. This immune response may contribute to the development of various health conditions or worsen existing symptoms in individuals with coeliac disease.

COELIAC DISEASE AND SIBO

Coeliac disease itself does not directly cause small intestinal bacterial overgrowth (SIBO), but there is evidence to suggest a connection between the two conditions. 

WHAT IS SIBO? ​

Small Intestinal Bacterial Overgrowth (SIBO): SIBO occurs when there is an abnormal overgrowth of bacteria in the small intestine. Normally, the small intestine has a relatively low concentration of bacteria compared to the large intestine. However, in SIBO, bacteria from the large intestine migrate or proliferate in the small intestine, leading to an imbalance.

THE CONNECTION BETWEEN COELIAC DISEASE AND SIBO: 

Several factors may contribute to the development of SIBO in individuals with coeliac disease, such as:

  • Intestinal Damage: In coeliac disease, the inflammation and damage to the lining of the small intestine can disrupt the normal gut flora and impair the movement of food through the digestive system. This disruption can create an environment that is more conducive to bacterial overgrowth.

  • Impaired Motility: Coeliac disease can affect the motility (movement) of the gastrointestinal tract, leading to changes in the transit time of food through the intestines. Slowed or altered motility can contribute to the stagnation of bacteria in the small intestine, increasing the risk of SIBO.

  • Alterations in the Gut Microbiota: Coeliac disease may also result in imbalances in the composition of the gut microbiota. Changes in the diversity and abundance of beneficial bacteria in the gut can contribute to the overgrowth of harmful bacteria in the small intestine.

It's important to note that not all individuals with coeliac disease will develop SIBO, and SIBO can occur independently of coeliac disease. However, there seems to be a higher prevalence of SIBO in individuals with coeliac disease compared to the general population.

 

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HOW WE CAN HELP YOU

A Functional Medicine Approach to Coeliac Disease

We take holistic and individualised approach, aiming to identify and address the root causes of disease. While coeliac disease is primarily managed through a strict gluten-free diet, functional medicine may provide additional strategies to support overall health and well-being for individuals with coeliac disease, especially for individuals with ongoing symptoms.

Here are some key aspects of a functional medicine approach to coeliac disease:

  • COMPREHENSIVE ASSESSMENT:  We conduct a thorough evaluation of the individual's medical history, symptoms, lifestyle, and environmental factors. This assessment helps identify potential triggers, underlying imbalances, and co-existing conditions that may impact coeliac disease.

  • PERSONALISED TREATMENT PLAN:  We recognise that each person is unique, so the treatment plan is tailored to the individual's specific needs. This may involve addressing nutritional deficiencies, optimising gut health, and supporting the body's natural healing processes.

  • NUTRITIONAL SUPPORT:  In addition to following a strict gluten-free diet, we may assess and address nutrient deficiencies commonly associated with coeliac disease. They may recommend specific supplements, such as vitamins, minerals, and probiotics, to support nutrient absorption, gut healing, and overall well-being.

  • GUT HEALTH SUPPORT: We understand the importance of gut health in overall health and immune function. We may focus on supporting a healthy gut microbiome, addressing dysbiosis (imbalances in gut bacteria), and reducing inflammation in the digestive tract.

 

  • IDENTIFYING AND ADDRESSING TRIGGERS: We may explore other potential triggers or sensitivities that could be exacerbating symptoms or impacting gut health. This may involve investigating food intolerances, assessing for other autoimmune conditions, and identifying environmental factors that could contribute to inflammation or immune dysregulation.

  • STRESS MANAGEMENT: Stress can play a significant role in immune function and overall health. We may incorporate stress reduction techniques, such as mindfulness practices, relaxation techniques, and lifestyle modifications, to support the body's healing process.​​​​

To take a proactive role in managing your health, we encourage you to reach out to our team. We have extensive experience assisting individuals with conditions such as psoriasis and are dedicated to helping you improve your symptoms and overall well-being.

SCHEDULE AN APPOINTMENT WITH US TODAY. 

 

 We offer a range of appointments in-person or online. 
You will receive the same service and expertise from us through our virtual, online clinic, just as you would if you visited us at our London clinic.

To discuss how we can assist you, call us on 020 3886 1339, or email us at  hello@autoimmunecliniclondon.com.

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