Celiac Disease and Gluten Intolerance: When Enzymes Can and Can't Help
What is Celiac Disease?
Celiac disease is caused by an immune system reaction to gluten proteins found in wheat and a number of other grains. It is an autoimmune disorder that primarily affects the small intestine. It often appears in children between the ages of 6 months and 2 years and may be diagnosed in children with chronic diarrhea, abdominal distension, malabsorption and “failure to thrive”.1
For many years, celiac disease was thought to be primarily found in children and thus was not often screened for in adults. Along with the aforementioned symptoms, other “non-classic” symptoms that result in both gastrointestinal distress plus a wide number of other issues that involving other parts of the body may occur. Thus, the prevalence of celiac disease has been under diagnosed and under-reported. A further complicating factor is that celiac disease can develop at any age. There is likely a genetic predisposition to developing celiac disease.
Because of these factors, many people suffer from a variety of symptoms caused by celiac disease but go undiagnosed for many years before proper tests are run. What was once thought to be a relatively rare condition, improved screening for celiac disease has steadily determined that more people are affected by this condition than was once thought. In the USA, for example, it was thought that celiac disease affected 1 in 1750 people. With improved screening, this has been lowered to 1 in 105 people. It is believed that 85% of people who are affected by celiac disease remain undiagnosed.
For an excellent overview of celiac disease in greater depth, please see the article noted in citation1.
What is Gluten Intolerance?
Gluten intolerance or sensitivity is a non-celiac condition triggered by exposure to gluten proteins, producing only occasional digestive discomforts and distresses. It is considered to be a non-autoimmune, non-allergic sensitivity. Science has yet to prove the exact cause of gluten intolerance, though the immune system is likely involved2. It is currently estimated that the prevalence of gluten intolerance is 6-10 times higher than full on celiac disease.
People with gluten intolerance may develop a variety of occasional intestinal and systemic symptoms that improve when gluten-containing foods are eliminated from the diet. It has been linked with a wide variety of digestive complaints. It is often linked with occasional gas, bloating, stomach pressure, fatigue, and irregularity. Unlike celiac disease which is a severe lifelong autoimmune condition, gluten intolerance is less severe and may be transient.
Gluten intolerance is diagnosed by first testing for celiac disease and if proven negative, other tests may indicate the presence of gluten intolerance. For example, a test we frequently use in my clinic to screen for both conditions is the Genova Diagnositics Celiac & Gluten Sensitivity Profile3. Once celiac disease is ruled out, elimination of all gluten products an patient response is another method of determining gluten intolerance.
What is the treatment for Celiac Disease and Gluten Intolerance?
The fundamental treatment for both Celiac Disease and gluten intolerance is the avoidance of gluten and gliadin in the diet. For celiac disease this avoidance must be complete and lifelong. For gluten intolerance, the amount of reduction or avoidance of gluten and gliadin varies from person to person, and some people may develop a tolerance of gluten and gliadin after a 6 month to 2 year period of avoidance.
Can Digestive Enzymes help people with Celiac Disease and Gluten Intolerance?
In the case of Celiac Disease, the answer is no. Enzymes cannot treat or cure Celiac Disease. Unlike gluten intolerance, Celiac Disease is a severe autoimmune disorder. Avoidance of gluten and gliadin are the best treatments for both of these conditions, but in the case of celiac disease a gluten free diet is non-negotiable. Enzymes in general have limited usefulness in people with Celiac Disease.
For gluten intolerance, enzymes may provide some support. Digestive enzymes in general can naturally promote the body’s ability to break down food and absorb nutrients efficiently. This is no different for people with gluten intolerance. DPP-IV is the enzyme that breaks down gluten, and the addition of this enzyme specifically can improve the digestion of gluten proteins for occasional exposures.
At SFNM, for people with gluten sensitivity who may be exposed to wheat and other gluten-gluten-containing foods on an occasional basis such as eating out, we always give Enzyme Science's Intolerance Complex to our clients as a way of naturally supporting the digestive system in these situations. Intolerance Complex solves many common digestive complaints for our clients.
Carl Hangee-Bauer, ND, LAc
Clinic Director, San Francisco Natural Medicine