Beyond Gluten-Free: A Functional Medicine Approach to Celiac Disease

If you’ve been diagnosed with celiac disease, you know that eating gluten free is essential. A gluten-free diet is the first line and most important treatment for celiac disease as well as non-celiac gluten sensitivity (NCGS), no matter who you talk to. 

But there’s more to healing than just avoiding gluten. By the time celiac disease is diagnosed, the immune system and digestive system have reached a point where they need some targeted support. 

In order to restore wellbeing and gut health and reduce the risk of worsening autoimmunity, I always recommend a holistic, functional medicine approach that goes beyond gluten-free. Today, I’m going to break it down for you. 

Celiac Disease: An Overview

Celiac disease is an autoimmune condition in which the immune system reacts abnormally to gluten (a protein found in some grains including wheat, rye, spelt, and barley), eventually leading to damage to the small intestine and the villi of the intestinal lining (the villi are finger-like extensions that help us absorb nutrients). 

When this happens, the increased space between the cells brought on by atrophied villi allows food particles to enter the bloodstream (leaky gut syndrome or increased intestinal permeability) and can result in impaired nutrient absorption and ongoing systemic inflammation. 

It’s important to underscore that celiac disease is not an allergy to gluten—in other words, we can’t just remove the allergen and move on. We have to address the widespread inflammation, autoimmunity, and other systemic effects of the condition as well. 

Symptoms of Celiac Disease + Why Is It So Often Undiagnosed? 

It’s been estimated that over 80% of those with celiac disease are undiagnosed or misdiagnosed, and many people experience symptoms for several years before the problem is ever found. (1) 

Why is this? There are a few reasons. One is that the symptoms are nonspecific and not always easy to connect to celiac disease. While gastrointestinal symptoms are common, research also now shows that some cases present purely with neurological or psychiatric symptoms such as anxiety and brain fog. (2, 3) 

Reactions to gluten with or without celiac disease are not always obvious and usually aren’t immediate. So if gluten is a regular part of your everyday diet, it can be hard to pinpoint the problem. 

And then there’s the general matter of how autoimmune conditions are currently diagnosed. In order to be diagnosed with celiac disease, significant destruction of the intestinal microvilli needs to have already occurred. 

LISTEN: Gluten-Free Pro-Tips, Autoimmune-Inflammation Genes, Best Microbiome Tests + How To Recover From Unhealthy Food Choices (Ask Me Anything Episode! Special Guests: Functional Medicine Team) | Dr. Will Cole 

Celiac disease tends to be talked about as a completely distinct entity from non-celiac gluten sensitivity, but there is almost always an autoimmune component to NCGS, too—I think of these as existing on the same spectrum. (4) Celiac diagnosis or not, for a significant number of people gluten can lead to leaky gut syndrome, immune system reactivity, and systemic inflammation. 

Symptoms of celiac disease vary widely but may include: 

• Bloating
• Abdominal pain
• Diarrhea
• Constipation
• Fatigue
• Brain fog
• Anxiety 
• Dermatitis or other skin issues 
• Joint pain 
• Unexplained weight loss 
• Acid reflux or GERD 
• Nutritional deficiencies 
• Headaches or migraines 
• Menstrual cycle irregularity 

Those with celiac disease are also more likely to be diagnosed with additional autoimmune conditions, as well as other conditions related to nutrient deficiencies, leaky gut, or microbial imbalance. (5) 

What Causes Celiac Disease? 

Like most autoimmune diseases, celiac disease is brought on by a combination of genetic and environmental factors. There is a strong genetic component to celiac disease, but some people have the genetic susceptibility and never develop the condition. 

Environmental factors that can trigger or lead to an increased risk of celiac disease include chronic stress, eposure to toxins, chronic viral infections, dietary factors, gut microbiome imbalances, and use of certain medications including non-steroidal anti-inflammatory drugs (NSAIDs). (6, 7) 

A Holistic, Functional Medicine Approach 

A comprehensive, holistic, whole-body approach to celiac disease can help to restore the integrity of the gut lining, regulate immune system function, correct nutritional deficiencies and underlying imbalances, and restore overall wellness. 

Specialized Testing Options

One of the most important components of a personalized, comprehensive approach to treating celiac disease is running specialized tests to get a more complete picture of what’s going on in the body. 

This is separate from diagnostic testing for celiac disease, which involves blood testing for antibodies called anti-tissue transglutaminase (tTGA) and an upper endoscopy and biopsy to assess damage to the small intestine. 

Depending on the individual, tests I might run with my telehealth functional medicine patients include: 

• Comprehensive blood tests including complete blood count (CBC), nutrient testing to identify any deficiencies, and additional markers of autoimmunity
• Comprehensive stool testing to assess gut microbiome balance and look for any pathogenic viruses, yeasts, or parasites
• Zonulin testing for intestinal permeability (leaky gut) 
• SIBO breath testing 
• Testing for toxin buildup 
• Food sensitivity testing

READ MORE: Should You Get A Food Sensitivity Test? Here’s What To Know 

The information we get from tests combined with symptom profile, health history, and other individual factors can help us put together an individualized plan for healing. 

Removing Gluten Completely 

Complete avoidance of gluten is essential if you have celiac disease.  It might sound simple, but there are a few keys to really getting this right.  

The basic step is to avoid all gluten-containing grains including wheat, spelt, rye, and barley. These are present in many breads, baked goods, pasta, crackers, cookies, pizza, as well as packaged foods of all kinds. 

This is where hidden sources of gluten often sneak in—you wouldn’t necessarily think of it, but there’s often gluten in store-bought salad dressings, sauces, marinades, and other packaged items. (Both to avoid unexpected gluten and for overall health, I always recommend eating primarily whole, unprocessed foods). 

Even supplements and medications can contain gluten, so look or ask for options that are labeled gluten-free. 

The other important thing to keep in mind is the possibility of cross-contamination and accidental exposure at restaurants or when eating at other people’s houses. (8) When gluten-free foods are prepared or cooked near gluten-containing foods, the gluten-free items can become cross-contaminated, and this is enough to trigger inflammation and symptoms for those with celiac disease. 

I’m not saying any of this to make you fearful of eating out once in a while, but because I do think it’s important to be aware. I’ve also noticed that in the last few years many restaurants have become much more conscious of celiac disease and the risks of cross-contamination. Asking and planning ahead can help you have more confidence about what to expect. 

Removing Cross-Reactive Foods

Beyond cross-contamination, an important consideration that’s often overlooked is cross-reactivity. This happens when the body mistakes components of specific foods for gluten even when they don’t contain any. 

Foods that can cause cross-reactivity may include oats, other gluten-free grains, milk, eggs, chocolate, coffee, and others. I often run a gluten cross-reactivity panel with my telehealth patients, which is a blood test that looks specifically at foods that might be causing this issue. 

I know a strictly gluten-free diet can already feel restrictive, and it can be disheartening to learn that other foods may also be triggering immune system reactivity. 

The good news with cross-reactivity is that in most cases, your immune system isn’t actually sensitive to the cross-reactive food (like eggs), it’s just a case of mistaken identity. It’s a gluten sensitivity to eggs, rather than an egg sensitivity. And over time, with gut and immune system restoration, many people are able to reintroduce these non-gluten foods without issues.  

It’s also worth experimenting with a broader elimination diet to identify any other food sensitivities, which may also be temporary but still important to address. Those with gluten sensitivities and celiac disease are more likely to have other sensitivities, intolerances, and allergies. (9) The more you know about which foods your body loves, the better you have the power to feel. 

Anti-Inflammatory Diet

Yes, I’m still talking about food! So far, we’ve been focusing on what to avoid, but it’s equally important to consider what you’re including in your diet. Eating nutrient-dense, anti-inflammatory foods including a variety of healthy fats, proteins, and colorful plants is one of the best ways to support healthy digestion and immune system function, and replenish low nutrients. 

One thing about the increased awareness of celiac disease and gluten sensitivities is that there are many more options available today for those who don’t eat gluten. But part of that landscape is that we’re seeing more and more processed, packaged foods labeled gluten-free. 

The important thing to keep in mind is that just because something is gluten-free, that doesn’t make it healthy. Gluten-free processed foods are still loaded with sugar, additives, industrialized seed oils, and other problematic ingredients. Again, focus as much as possible on whole, unprocessed foods. 

Supporting Gut and Immune System Function

This is where we really go beyond gluten-free and work towards deeper healing. Outside of dietary strategies, targeted herbs and supplements can help to rebuild, support, strengthen, and heal the body as a whole. 

Exact protocols will look different for everyone, but here are some of the most beneficial options. 

• Micronutrients including iron, vitamin B12, vitamin D, and folate. Many individuals with celiac disease have nutrient deficiencies because of damage to the intestinal lining. (10) Testing can help determine which micronutrients, if any, you may need to supplement with while working to restore the integrity of the gut lining. 
• Supplements and herbs to heal the gut lining. Some of the best options include glutamine, slippery elm, marshmallow root, aloe vera, zinc, licorice, and goldenseal. Try my supportive blend, GI Calm. 
• Digestive enzymes. Celiac disease has been linked to exocrine pancreatic insufficiency (EPI) which causes a decrease in the ability to produce digestive enzymes. (11) Supplemental enzymes can help to fill the gap. 
• Prebiotics, probiotics, and postbiotics. Probiotics (supplemental beneficial bacteria), prebiotics (which feed beneficial bacteria), and postbiotics (byproducts of beneficial bacteria consuming prebiotics) can help to rebuild a diverse and healthy gut microbiome and improve immune system health (remember the majority of the immune system is found in the gut!). (12, 13) You can find all of these in Longevity RX Probiotic Trillion.

Looking At the Whole Picture

Removing gluten is one piece of the puzzle, but it’s not the whole story when it comes to effective management and treatment of celiac disease. A holistic, functional medicine approach considers the entire landscape of the digestive system, immune system, mind, and the whole body in order to restore wellness. 

As one of the first functional medicine telehealth clinics in the world, we provide webcam health consultations for people around the globe. 

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Sources

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• Jackson, J. R., Eaton, W. W., Cascella, N. G., Fasano, A., & Kelly, D. L. (2012). Neurologic and psychiatric manifestations of celiac disease and gluten sensitivity. Psychiatric Quarterly, 83(1), 91-102.
• Sapone, A., Bai, J. C., Ciacci, C., Dolinsek, J., Green, P. H., Hadjivassiliou, M., … & Fasano, A. (2012). Spectrum of gluten-related disorders: consensus on new nomenclature and classification. BMC medicine, 10(1), 13.
• Cojocaru, M., Cojocaru, I. M., & Silosi, I. (2010). Multiple autoimmune syndrome. Maedica, 5(2), 132.
• Silvester, J. A., & Leffler, D. A. (2017). Is autoimmunity infectious? The effect of gastrointestinal viral infections and vaccination on risk of celiac disease autoimmunity. Clinical Gastroenterology and Hepatology, 15(5), 703-705.
• Sander, S. D., Andersen, A. M. N., Murray, J. A., Karlstad, Ø., Husby, S., & Størdal, K. (2019). Association between antibiotics in the first year of life and celiac disease. Gastroenterology, 156(8), 2217-2229.
• Syage, J. A., Kelly, C. P., Dickason, M. A., Ramirez, A. C., Leon, F., Dominguez, R., & Sealey-Voyksner, J. A. (2018). Determination of gluten consumption in celiac disease patients on a gluten-free diet. The American journal of clinical nutrition, 107(2), 201-207.
• Kim, H. S., Unalp-Arida, A., Ruhl, C. E., & Murray, J. A. (2019). Autoimmune and allergic disorders are more common in people with celiac disease or on a gluten-free diet in the United States. Journal of clinical gastroenterology, 53(10), e416-e423.
• Di Nardo, G., Villa, M. P., Conti, L., Ranucci, G., Pacchiarotti, C., Principessa, L., … & Parisi, P. (2019). Nutritional deficiencies in children with celiac disease resulting from a gluten-free diet: a systematic review. Nutrients, 11(7), 1588.
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• Khorzoghi, M. S., Rostami-Nejad, M., Yadegar, A., Dabiri, H., Hadadi, A., & Rodrigo, L. (2023). Impact of probiotics on gut microbiota composition and clinical symptoms of coeliac disease patients following gluten-free diet. Contemporary Clinical Trials Communications, 35, 101201.
• Håkansson, Å., Andrén Aronsson, C., Brundin, C., Oscarsson, E., Molin, G., & Agardh, D. (2019). Effects of Lactobacillus plantarum and Lactobacillus paracasei on the peripheral immune response in children with celiac disease autoimmunity: a randomized, double-blind, placebo-controlled clinical trial. Nutrients, 11(8), 1925.