[i]. Note: You can download the entire article free.
Celiac disease is an autoimmune reaction to gluten proteins contained in wheat, rye and barley. The disease process causes inflammation and villus atrophy (which means the little hair-like projections in the small intestine that allow us to absorb nutrients become flattened and loose function). People who express the certain proteins (HLA-DQ2 or –DQ8) on the surface of their white blood cells are genetically predisposed to the disease. The condition affects approximately one percent of the population and is linked to numerous other autoimmune diseases, neurological disorders, cancers, anemia, osteoporosis, itchy dermatitis, digestive damage and digestive malabsorption.
In my book, Fast Tract Digestion IBS, I talk about the connection between celiac disease, IBS and SIBO. People with celiac disease more often diagnosed with IBS[ii] or SIBO.[iii],[iv] The question is why? What do these conditions have in common that could explain this connection? In each case, the small intestine becomes inflamed, the absorptive surface of the small intestine is damaged and foods, especially carbohydrates, are poorly digested leading to bacterial overgrowth. Like celiac disease, antibiotics can also increase the risk developing IBS.
What happens to the digestive tract and gut microbiome when people take antibiotics certainly deserves much more attention. Antibiotics dramatically change the gut microbiome by killing off many healthy bacteria. This puts people at increased risk for C diff infection, SIBO and IBS. Leaning more about the role of antibiotics in changing the gut microbiome may lead to a better overall understanding of the cause of celiac disease, SIBO and IBS leading to better treatments.
We know that gluten-free diets don’t correct the problem in approximately one third of cealics. Are there other aspects of this condition that we need to understand to help these individuals? I wouldn’t be surprised if fermentable carbs such as resistant starch, fiber, fructose and other sugars – not limited in gluten free diets – are part of the answer. But avoiding antibiotics when they are not absolutely needed should be standard practice to maintain our diverse gut microbiome providing more protection against celiac, IBS and other SIBO-related conditions.
[i] Mårild K, Ye W, Lebwohl B, Green PH, Blaser MJ, Card T, Ludvigsson JF. Antibiotic exposure and the development of coeliac disease: a nationwide case-control study. BMC Gastroenterol. 2013 Jul 8;13:109.
[ii] Nelsen DA Jr. Gluten-sensitive enteropathy (celiac disease): more common than you think. Am Fam Physician. 2002 Dec 15;66(12):2259-66.
[iii] Tursi A, Brandimarte G, Giorgetti G. High prevalence of small intestinal bacterial overgrowth in celiac patients with persistence of gastrointestinal symptoms after gluten withdrawal. Am J Gastroenterol. 2003 Apr;98(4):839-43.
[iv] Rubio-Tapia A, Barton SH, Rosenblatt JE, Murray JA. Prevalence of small intestine bacterial overgrowth diagnosed by quantitative culture of intestinal aspirate in celiac disease. J Clin Gastroenterol. 2009 Feb;43(2):157-61.