The Ins and Outs of Celiac Disease

July 4, 2024

Celiac disease – a common autoimmune condition, is prevalent, and several million individuals have celiac disease. What is celiac disease exactly? Celiac disease affects the small intestine’s structure, where the villous (plural: villi) structures that are important for digesting and absorbing nutrients are atrophy (they waste and weaken). Celiac disease can strike at any age and has serious long-term effects if left untreated. People with celiac disease have more significant risks of developing heart disease or small bowel cancer 

According to Makharia et al., gluten-containing food was introduced more than 10,000 years ago, and celiac disease appeared simultaneously. In the past few decades, the prevalence of the disease has increased. The increase in disease detection may be due to refined diagnostic tests, more awareness amongst clinicians, and changes in our environment and eating practices.  

Changes in Agricultural Practices 

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Higher intakes of wheat, barley and rye trigger immune responses associated with celiac disease. The United Nations Food and Agriculture Organization estimates that 700 million tonnes of grain are harvested and consumed annually. Novel agriculture methods and the pressure of producing wheat have led to wheat variants that can withhold extreme weather and climates, have improved bread-making qualities and have higher disease resistance. Making grains uphold against extreme weather conditions could have been the main factor in the changes in the wheat profile and immunogenic makeup. These factors may have contributed to a higher prevalence of celiac disease. However, it must be noted that despite North American gluten consumption not rising, rates of celiac disease are increasing with geographical variations between Northern and Southern zones.  

 

 

Breastfeeding, Perinatal Factors and Infections  

Guengor et al. concluded in their systematic review that children who had never been breastfed had a higher risk of celiac disease. Babies born in the warmer months of spring and summer apparently have a higher incidence of the condition. Further, the total number of viral and bacterial infections seems to impact the disease’s development. However, smoking appears to protect the adult onset of celiac disease.  

 Symptoms of Celiac Disease  

Symptoms occur when gluten (a protein found in wheat, rye, and barley) is ingested, and the body reacts with an immune response, damaging the structures responsible for digestion in the small intestine.  

The most common symptoms in adults are:  

  • Abdominal pain 
  • Bloating and gas 
  • Cognitive impairment 
  • Constipation 
  • Diarrhea 
  • Depression and anxiety 
  • Fatigue 
  • Headaches or migraines 
  • Iron-deficiency anaemia 
  • Itchy, blistery skin rash (dermatitis herpetiformis) 
  • Joint pain 
  • Missed periods 
  • Mouth ulcers and canker sores 
  • Nausea and vomiting 
  • Osteoporosis and osteomalacia 
  • Peripheral neuropathy 
  • Reduced functioning of the spleen (hyposplenism) 
  • Weight loss 

In Traditional Chinese Medicine (TCM), depending on training and style of practice, we might take different approaches to treat patients who present with these symptoms, remembering that each treatment might encumber a range of symptoms to make up for a pattern. In TCM, an interconnected framework favours treating symptoms as part of a pattern rather than addressing symptoms in isolation.  

Diagnostic Confirmation in Celiac Disease  

Earlier diagnostic methods were three sequential intestinal biopsies. Remember that celiac disease involves the degeneration of the villi (finger-like structures in the Small intestine). In the 1990s, a combination of serology (blood tests that identify antibodies) and enteropathy (particularly inflammation in the intestines) in a duodenal biopsy sample indicated the presence of the condition. Since 2020, a serology test looking at TG antibody levels has been preferred over biopsies.  

The only treatment for Celiac disease   

Only one treatment exists for celiac disease: a completely gluten-free diet. You are correct that the primary and only treatment for celiac disease is a strict, lifelong gluten-free diet. The only way to manage the condition and prevent symptoms and long-term complications is to eliminate all sources of gluten from the diet. 

Here are some key points to consider when following a gluten-free diet for celiac disease: 

  1. Gluten elimination: Avoid all sources of gluten, including foods, beverages, and products that contain wheat, barley, and rye. Read food labels carefully to identify hidden sources of gluten and cross-contamination. 
  1. Whole, naturally gluten-free foods: Eat gluten-free foods like fruits, vegetables, meat, fish, eggs, dairy products, and gluten-free grains such as rice, quinoa, and corn. 
  1. Gluten-free substitutes: Many gluten-free substitutes are available for traditional wheat-based products. These include gluten-free bread, pasta, and flour from alternative grains like rice, corn, and tapioca. 
  1. Cross-contamination: Be vigilant about cross-contamination, which can occur in kitchens, restaurants, and during food preparation. Avoid using shared toasters, cutting boards, and utensils if you have encountered gluten-containing items. 
  1. Dining out: When eating out, communicate your dietary needs to restaurant staff and ask about gluten-free menu options. Choose restaurants that are knowledgeable about accommodating celiac disease. 
  1. Medications and supplements: Some medicines and supplements may contain gluten as fillers or binding agents. Check with your healthcare provider to ensure that your medications and supplements are gluten-free. 
  1. Regular follow-up: It’s essential to have regular follow-up appointments with a healthcare provider who specialises in celiac disease to monitor your health and assess nutrient deficiencies that may arise due to malabsorption. 
  1. Support: Joining celiac disease support groups or working with a dietitian knowledgeable about celiac disease can help manage the condition. 

Remember that adhering to a strict gluten-free diet is essential for managing celiac disease and preventing associated complications. If you suspect you have celiac disease, seeking a formal diagnosis through medical testing is necessary before making dietary changes.  

Secondary treatment  

Currently, there is no known cure for celiac disease, and it cannot be treated or managed with Chinese herbal medicine or any other alternative medicine alone. Still, Chinese herbal medicine can be a complementary approach to support overall health and well-being.  

As TCM practitioners, we know that symptoms and conditions do not arise in isolation or independently. Signs and symptoms always manifest the individual’s state; thus, the treatment approach must be based on the identified pattern.  

American Dragon comprehensively summarises various patterns and corresponding herbal formula treatments. The following single herbs must be omitted and substituted in any formula for celiac patients:  

Fu Xiao Mai(Tritici Levis Fructus): According to ITM online, Fu Xiao Mai is a wheat variety grain commonly lower in gluten than other grains, like bread-making. Nevertheless, in celiac patients, it must be avoided.  

Mai Ya (Hordei Germinatus Fructus): Mai Ya is sprouted barley used in making beer. It augments the stomach, dissolves food accumulation and moves the liver Qi. It would be perfect as a digestive herb, but not in patients with celiac disease.  

Shen Qu (Massa Fermentata Medicinalis): Shen Qu are blocks of fermented wheat or malt typically combined with other digestive herbs. According to ITM online, 38% of the starting material is grain. The second step involves this grain substrate to grow yeast by fermentation. Shen Qu is used primarily in digestive formulas to aid digestion, and once again, it is a primary focus in such disorders, but not for celiac patients.  

In high-quality concentrated products such as liquid extracts, granules and other forms of Chinese herbal medicine, gluten is unlikely to enter the manufacturing process as facilities operate with a Good Manufacturing Practice (GMP) license. It’s the highest pharmaceutical standard available and will require the facility to have a line clearance process in place and test raw and finished products; hence, there’s unlikely a problem with gluten contamination.  

It would be great to hear how practitioners approach the TCM treatment for celiac patients; perhaps you have some informative cases suitable for a case report. We are happy to assist with your publication; you may find the Chinese herbal medicine case report (CHM-CARE) on the Convergent Points platform. You can also simply contact the team at Acuneeds, and we can arrange a meeting.  

 References  

  • Makharia, G.K., Singh, P., Catassi, C. et al. The global burden of coeliac disease: opportunities and challenges. Nat Rev Gastroenterol Hepatol19, 313–327 (2022). https://doi.org/10.1038/s41575-021-00552-z 
Brigitte Linder
Brigitte Linder was born in Zurich and has lived near Melbourne on the south coast of Australia since 2008. She operated Safflower – Chinese Herbs Expertly Dispensed until mid-2023. Safflower is an herbal dispensary business operating under the banner of the Therapeutic Goods Administration (TGA). It was issued a GMP licence. Acuneeds acquired the company in January 2024 and intended to offer all services to practitioners in Australia and New Zealand.Brigitte completed a master's degree in 2023 with NICM Health Research (Western Sydney University). Her thesis involved creating a case report guideline for Chinese herbal medicine. In 2019, she published her first book and has since mentored TCM graduates to better transition to full-fledged practitioners. She has been consulting patients for 20 years and enjoys working with children and patients with complex conditions. She is a diplomat of the Institute of Classics in East Asian Medicine (ICEAM) and prescribes Eastern Han-era herbal formulas, namely Shang Han Lun and Jin Gui Yao Lue. Brigitte has always been interested in uniting a strong, cohesive TCM community. She continues to invest time and effort to ensure practitioners and the profession receive support and recognition.
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