Coeliac disease & gut health connection

As awareness of coeliac disease and interest in gut health grows, patients increasingly seek guidance on how their gut health impacts their condition. Here is what GPs should know. 

What is coeliac disease?

Coeliac disease is an autoimmune condition where the ingestion of gluten — a protein found in wheat, barley, and rye — triggers an immune response that damages the small intestine. This damage results in inflammation and can damage the villi that line the small intestine, impairing nutrient absorption [1].

The connection between gut health and coeliac disease

Intestinal damage

In coeliac disease, gluten causes the immune system to attack the intestinal lining. This leads to villous atrophy, reducing the surface area available for nutrient absorption and can lead to gut symptoms such as diarrhoea and abdominal pain [2].

Microbiota changes

Research indicates that individuals with coeliac disease often have an altered gut microbiota. Multiple studies have shown variations in gut microbial populations, in response to ingestion of gluten, genetics, as well as environmental triggers [3]. For example, studies have found that children and adults with untreated coeliac disease had reduced diversity in their gut microbiota compared to healthy controls [4,5].

Intestinal permeability

Increased intestinal permeability is another important factor. Defects in intestinal barrier function are associated with a number of diseases affecting the gastrointestinal tract, including coeliac disease, and there is some evidence that increased intestinal permeability may play a role in coeliac disease, triggering the immune system [6].

What can patients with coeliac disease do to support their gut health?

Strict gluten-free diet

The cornerstone of managing coeliac disease is a strict, lifelong gluten-free diet. This prevents further damage and can alleviate gut symptoms. Avoiding gluten also supports a healthier gut microbiota and reduces inflammation [2].

Nutritional considerations

Due to potential nutrient malabsorption, patients may need supplements for deficiencies in iron, calcium, and vitamin D, particularly among patients who were recently diagnosed. Regular monitoring is important to address these nutritional needs [2].

Incorporating whole grains

For individuals with coeliac disease, it’s important to replace gluten-containing grains with naturally gluten-free whole grains like brown rice, quinoa, millet, and sorghum. While wheat-based whole grains are significant sources of fibre and nutrients for many Australians, gluten-free products on the other hand often offer limited nutritional value and may not provide the same benefits. Whole grains are important for their fibre content and other nutrients, which support overall health and digestion. For example, quinoa and sorghum are not only gluten-free but also rich in essential nutrients and fibre, making them valuable alternatives. Research has shown that incorporating these grains can help improve nutritional intake and overall gut health in individuals with celiac disease [7]. Patients with coeliac disease can support their gut health by including a variety of gluten-free grains.

Understanding the interplay between gut health and coeliac disease is important for effective patient management. A strict gluten-free diet, attention to nutritional needs, and incorporating gluten-free whole grains are essential components of effective coeliac disease management. By focusing on these strategies, general practitioners can help patients achieve better gut health and improve their quality of life.

– Sarah Marko, Accredited Practising Dietitian

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References

1.    Lebwohl, B., Sanders, D. S., & Green, P. H. R. (2018). Coeliac disease. The Lancet, 391(10115), 70-81. 
2.    Caio G, Volta U, Sapone A, Leffler DA, De Giorgio R, Catassi C, Fasano A. Celiac disease: a comprehensive current review. BMC Med. 2019 Jul 23;17(1):142. doi: 10.1186/s12916-019-1380-z. PMID: 31331324; PMCID: PMC6647104. 
3.    Yemula N. Gut microbiota in celiac disease. Ann Gastroenterol. 2024 Mar-Apr;37(2):125-132. doi: 10.20524/aog.2024.0862. Epub 2024 Feb 9. PMID: 38481782; PMCID: PMC10927630.
4.    Collado M.C., Donat E., Ribes-Koninckx C., Calabuig M., Sanz Y. Specific duodenal and faecal bacterial groups associated with paediatric coeliac disease. J. Clin. Pathol. 2009;62:264–269.
5.    Collado M.C., Donat E., Ribes-Koninckx C., Calabuig M., Sanz Y. Imbalances in faecal and duodenal Bifidobacterium species composition in active and non-active coeliac disease. BMC Microbiol. 2008;8:232.
6.    Camilleri M, Madsen K, Spiller R, Greenwood-Van Meerveld B, Verne GN. Intestinal barrier function in health and gastrointestinal disease. Neurogastroenterol Motil. 2012 Jun;24(6):503-12. doi: 10.1111/j.1365-2982.2012.01921.x. Erratum in: Neurogastroenterol Motil. 2012 Oct;24(10):976. Van Meerveld, B G [corrected to Greenwood-Van Meerveld, B]. PMID: 22583600; PMCID: PMC5595063.
7.    Bascuñán KA, Vespa MC, Araya M. Celiac disease: understanding the gluten-free diet. Eur J Nutr. 2017 Mar;56(2):449-459. doi: 10.1007/s00394-016-1238-5. Epub 2016 Jun 22. PMID: 27334430.