Celiac Disease
Comprehensive integrative medicine approach for lasting healing and complete recovery
Understanding Celiac Disease
Celiac Disease is an autoimmune disorder where ingestion of gluten - a protein found in wheat, barley, and rye - triggers an immune response that damages the lining of the small intestine. This immune reaction flattens and destroys the intestinal villi, which are essential for nutrient absorption. The condition affects approximately 1% of the global population, though many cases remain undiagnosed, and it can develop at any age. Left untreated, celiac disease leads to malabsorption, nutrient deficiencies, and increased risk of other autoimmune conditions and certain cancers.
Recognizing Celiac Disease
Common symptoms and warning signs to look for
Chronic diarrhea, bloating, and abdominal pain after eating gluten-containing foods
Unexplained weight loss despite adequate caloric intake
Fatigue and brain fog that doesn't improve with rest
Iron-deficiency anemia that doesn't respond to supplementation
Skin rash with intensely itchy blisters (dermatitis herpetiformis)
Bloating and distension after meals, often mistaken for IBS
What a Healthy System Looks Like
A healthy small intestine is approximately 20 feet long with millions of finger-like projections called villi that line its surface, dramatically increasing the absorptive area. These villi contain even smaller projections called microvilli (forming the brush border), where nutrient absorption occurs. Intestinal cells (enterocytes) produce enzymes like lactase, maltase, and sucrase to break down carbohydrates. The intestinal barrier is maintained by tight junction proteins (including zonula occludens), preventing undigested proteins and bacteria from entering the bloodstream. A healthy immune system in the gut-associated lymphoid tissue (GALT) distinguishes between harmless dietary antigens and pathogenic invaders. The lamina propria contains immune cells that mount appropriate responses while maintaining tolerance to food proteins.
How the Condition Develops
Understanding the biological mechanisms
Celiac Disease develops through a precise autoimmune cascade: (1) Genetic predisposition - 95% of patients carry HLA-DQ2 (DQ2.5 or DQ2.2) and the remainder carry HLA-DQ8, which present gluten peptides to T-cells. (2) Gluten ingestion - Gliadin (the alcohol-soluble fraction of gluten) enters the intestinal epithelium. (3) Tissue transglutaminase (tTG) modification - tTG deamidates gliadin peptides, converting specific glutamine residues to glutamate, dramatically increasing their immunogenicity. (4) T-cell activation - Deamidated gliadin is presented by HLA-DQ2/DQ8 on antigen-presenting cells to CD4+ T-cells in the lamina propria, triggering IFN-gamma production. (5) Autoantibody production - B-cells produce IgA antibodies against tTG (tTG IgA) and gliadin (DGP IgA/IgG). These autoantibodies are the hallmark of celiac disease. (6) Villous atrophy - Activated T-cells and autoantibodies damage the intestinal epithelium, causing crypt hyperplasia and villous flattening (atrophy). (7) Marsh classification - Type 0 (normal), Type 1 (increased intraepithelial lymphocytes), Type 2 (crypt hyperplasia), Type 3 (partial, subtotal, or total villous atrophy). (8) Malabsorption - Loss of villous surface area severely impairs absorption of fats, fat-soluble vitamins (A, D, E, K), iron, calcium, folate, and B12.
Key Laboratory Markers
Important values for diagnosis and monitoring
| Test | Normal Range | Optimal | Significance |
|---|---|---|---|
| tTG IgA (Tissue Transglutaminase IgA) | <4.0 U/mL | <4.0 U/mL (negative) | Primary screening test; sensitivity 95%, specificity 94%; elevated in active celiac disease; autoantibody targets tTG enzyme |
| tTG IgG | <4.0 U/mL | <4.0 U/mL (negative) | Used in IgA-deficient patients; detects celiac in IgA-deficient individuals |
| EMA IgA (Endomysial Antibodies) | Negative | Negative | Highly specific (98-100%); confirms positive tTG results; immunofluorescence test |
| DGP IgA/IgG (Deamidated Gliadin Peptide) | <10.0 U/mL | <10.0 U/mL (negative) | Useful in IgA deficiency; detects early celiac; targets deamidated gliadin peptides |
| Total Serum IgA | 70-400 mg/dL | 100-300 mg/dL | Screens for selective IgA deficiency (10% of celiacs); if deficient, interpret IgG-based tests |
| Hemoglobin (Hb) | 12.0-16.0 g/dL (female); 13.5-17.5 g/dL (male) | 13.5-15.5 g/dL (female); 14.0-17.0 g/dL (male) | Often low due to iron deficiency from malabsorption; microcytic anemia common |
| Ferritin | 13-150 ng/mL (female); 30-400 ng/mL (male) | 50-150 ng/mL | Low ferritin indicates iron deficiency; iron malabsorption due to villous damage |
| Vitamin D 25-OH | 30-100 ng/mL | 50-80 ng/mL | Often deficient due to fat-soluble vitamin malabsorption; bone health risk |
| Calcium | 8.5-10.5 mg/dL | 9.0-10.2 mg/dL | May be low due to vitamin D deficiency and malabsorption; osteoporosis risk |
| Albumin | 3.5-5.0 g/dL | 4.0-5.0 g/dL | Low in severe malabsorption; marker of protein-energy status |
| HLA-DQ2/DQ8 Genotyping | Negative for celiac-associated alleles | Negative for celiac-associated alleles | Negative result virtually excludes celiac disease; positive indicates genetic susceptibility |
Root Causes We Address
The underlying factors contributing to your condition
{"cause":"Genetic Predisposition (HLA-DQ2/DQ8)","contribution":"Necessary but not sufficient; 95% carry HLA-DQ2, remainder HLA-DQ8","assessment":"HLA-DQ2/DQ8 genotyping; family history of celiac or autoimmunity; genetic testing kit"}
{"cause":"Gluten Exposure","contribution":"Triggering factor; 100% of cases require gluten exposure","assessment":"Dietary history; food diary; current gluten-containing food consumption; anti-gliadin antibodies (optional)"}
{"cause":"Intestinal Permeability (Leaky Gut)","contribution":"Allows gliadin to access immune system; zonulin elevation","assessment":"Zonulin testing; lactulose/mannitol test; comprehensive stool analysis"}
{"cause":"Environmental Triggers","contribution":"Infections, stress, antibiotics can trigger onset or flares","assessment":"Infection history (viral gastroenteritis); antibiotic history; stress assessment"}
{"cause":"Gut Microbiome Dysbiosis","contribution":"Altered microbiome may influence immune response to gluten","assessment":"Comprehensive stool analysis; microbiome testing"}
{"cause":"Vitamin D Deficiency","contribution":"Impaired immune regulation; associated with autoimmunity","assessment":"25-OH Vitamin D level; target >50 ng/mL for immune function"}
{"cause":"Concurrent Autoimmune Conditions","contribution":"Shared pathogenesis; indicates systemic immune dysregulation","assessment":"Screen for thyroid antibodies, type 1 diabetes antibodies, autoimmune hepatitis markers"}
Risks of Inaction
What happens if left untreated
{"complication":"Progressive Villous Atrophy","timeline":"Ongoing with continued gluten exposure","impact":"Complete flattening of villi leads to total malabsorption; refractory celiac disease may develop"}
{"complication":"Malnutrition and Nutrient Deficiencies","timeline":"Months to years","impact":"Iron, B12, D, calcium, zinc, folate deficiencies; failure to thrive in children; osteoporosis"}
{"complication":"Osteoporosis","timeline":"Years","impact":"Calcium and vitamin D malabsorption leads to bone demineralization; 40% of untreated celiacs have reduced bone density"}
{"complication":"Infertility and Reproductive Issues","timeline":"Variable","impact":"Undiagnosed celiac in men and women; recurrent miscarriages, infertility, menstrual irregularities, low birth weight babies"}
{"complication":"Increased Risk of Other Autoimmune Conditions","timeline":"Years","impact":"Up to 10-15% develop another autoimmune disease (thyroid, diabetes, liver); risk increases with duration of untreated disease"}
{"complication":"Refractory Celiac Disease","timeline":"Years if untreated","impact":"Severe malabsorption unresponsive to gluten-free diet; requires immunosuppressive therapy; increased mortality risk"}
{"complication":"Intestinal Lymphoma and Cancer","timeline":"10-30 years if untreated","impact":"60x increased risk of small bowel lymphoma; increased risk of esophageal, colon, and pancreatic cancers"}
{"complication":"Neurological Complications","timeline":"Variable","impact":"Ataxia, peripheral neuropathy, seizures, cognitive decline; may occur even with mild GI symptoms"}
How We Diagnose
Comprehensive assessment methods we use
{"test":"tTG IgA Antibody (Primary Screening)","purpose":"Initial screening test for celiac disease","whatItShows":"IgA autoantibodies against tissue transglutaminase; sensitivity 95%, specificity 94%; elevated in active disease"}
{"test":"EMA IgA (Confirmation)","purpose":"Confirm positive tTG results","whatItShows":"IgA antibodies against endomysium (smooth muscle); nearly 100% specific for celiac disease"}
{"test":"DGP IgA/IgG","purpose":"Detect celiac, especially in IgA deficiency","whatItShows":"Antibodies against deamidated gliadin peptides; useful for early disease and IgA-deficient patients"}
{"test":"Total Serum IgA","purpose":"Screen for IgA deficiency","whatItShows":"Selective IgA deficiency occurs in 10% of celiacs; requires using IgG-based tests (DGP IgG, tTG IgG)"}
{"test":"HLA-DQ2/DQ8 Genotyping","purpose":"Genetic testing to rule in/out celiac","whatItShows":"Presence of celiac-associated alleles; negative result virtually excludes diagnosis"}
{"test":"Upper GI Endoscopy with Duodenal Biopsy","purpose":"Gold standard for diagnosis","whatItShows":"Marsh classification (villous atrophy, crypt hyperplasia, intraepithelial lymphocytes); confirms diagnosis"}
{"test":"Complete Blood Count (CBC)","purpose":"Assess for anemia and other abnormalities","whatItShows":"Microcytic anemia (iron deficiency); macrocytosis (B12/folate deficiency); leukopenia, thrombocytopenia"}
{"test":"Iron Studies, Ferritin, B12, Folate","purpose":"Assess nutrient deficiencies","whatItShows":"Low iron, ferritin, B12, or folate indicate malabsorption"}
{"test":"Vitamin D, Calcium, Bone Density (DEXA)","purpose":"Assess bone health","whatItShows":"Vitamin D deficiency; osteopenia/osteoporosis from malabsorption"}
{"test":"Liver Function Tests","purpose":"Assess liver involvement","whatItShows":"Elevated transaminases in some celiacs; autoimmune hepatitis screening"}
Our Treatment Approach
How we help you overcome Celiac Disease
Phase 1: Diagnosis Confirmation and Acute Stabilization (Weeks 1-4)
{"phase":"Phase 1: Diagnosis Confirmation and Acute Stabilization (Weeks 1-4)","focus":"Confirm diagnosis and begin gluten elimination","interventions":"Complete diagnostic workup: tTG IgA, EMA, DGP, total IgA, CBC, iron studies, vitamin D, B12, folate, liver enzymes. Upper GI endoscopy with duodenal biopsies (4-6 specimens) for Marsh classification. HLA-DQ2/DQ8 testing if uncertain. Begin strict lifelong gluten-free diet immediately. Remove ALL gluten sources: wheat, barley, rye, triticale, and derivatives. Read all food labels carefully. Ensure adequate hydration. Begin addressing acute nutrient deficiencies with supplementation. Refer to registered dietitian for GFD education.\n"}
Phase 2: Intestinal Healing and Nutrient Repletion (Weeks 4-24)
{"phase":"Phase 2: Intestinal Healing and Nutrient Repletion (Weeks 4-24)","focus":"Heal intestinal damage and correct deficiencies","interventions":"Strict 100% gluten-free diet (even cross-contamination causes ongoing damage). Comprehensive nutrient repletion: iron supplementation, vitamin D (2000-4000 IU), B12 (if deficient), calcium (1000-1200 mg), zinc, magnesium. Repeat tTG antibodies at 3-6 months to confirm declining levels (indicates healing). Gut healing supplements: L-glutamine (5-10 g daily), zinc carnosine, probiotics. Address any co-occurring conditions (thyroid, diabetes). Follow up with dietitian monthly for adherence support. Most patients see antibody reduction within 6 months.\n"}
Phase 3: Full Recovery and Complication Prevention (Months 6-18)
{"phase":"Phase 3: Full Recovery and Complication Prevention (Months 6-18)","focus":"Achieve complete healing and prevent long-term complications","interventions":"Continue strict GFD with no gluten exposure. Repeat intestinal biopsy (especially if slow responder) to confirm villous healing (usually resolves in 1-2 years). Monitor and maintain nutrient levels (iron, D, B12, calcium). DEXA scan if osteopenia/osteoporosis risk. Address any persistent symptoms: consider FODMAPs, SIBO, pancreatic insufficiency. Screen for other autoimmune conditions (thyroid antibodies annually). For refractory celiac disease: consider corticosteroids, azathioprine, or budesonide. Maintain follow-up with gastroenterologist and dietitian.\n"}
Phase 4: Maintenance and Long-Term Monitoring (Lifetime)
{"phase":"Phase 4: Maintenance and Long-Term Monitoring (Lifetime)","focus":"Sustain healing and prevent complications","interventions":"Lifelong strict gluten-free diet (no exceptions). Annual tTG antibody testing to confirm continued healing. Regular monitoring of nutrients (iron, D, B12, calcium). Bone density monitoring (DEXA q2-3 years if at risk). Ongoing screening for other autoimmune conditions. Monitor for refractory celiac disease. Follow-up with dietitian annually. Patient education on hidden gluten sources, cross-contamination prevention. Support groups and resources for GFD adherence. For dermatitis herpetiformis: dapsone or other medications may be needed in addition to GFD.\n"}
Diet & Lifestyle
Recommendations for optimal recovery
Lifestyle Modifications
Strict adherence to gluten-free diet (only treatment), Regular follow-up with healthcare providers, Meet with registered dietitian specializing in celiac, Read all food labels carefully (gluten hidden in medications, supplements, lip products), Dining out safety: Communicate gluten-free needs clearly, research restaurants, Travel preparedness: Bring gluten-free snacks, research destinations, translation cards, Mental health support: Chronic condition management can be stressful, Sleep: 7-9 hours for immune function and healing, Stress management: Chronic stress can worsen autoimmunity, Avoid medications containing gluten (consult pharmacist)
Recovery Timeline
What to expect on your healing journey
Week 1-4: Diagnostic confirmation; begin strict gluten-free diet immediately; baseline labs; address acute nutrient deficiencies; meet with dietitian; begin gut healing supplements.
Weeks 4-12: Strict GFD compliance; nutrient repletion continues; most patients see antibody decline; symptom improvement begins for most; follow-up with healthcare providers.
Months 3-6: Repeat tTG antibodies (should show significant reduction); continue healing; address persistent symptoms; monitor for complications; some patients achieve near-normalization.
Months 6-18: Continued GFD; potential repeat biopsy if slow responder; achieve optimal nutrient levels; monitor bone density if indicated; screen for other autoimmune conditions.
Month 18+: Maintenance phase; annual antibody monitoring; lifelong GFD compliance; continued vigilance for hidden gluten; regular healthcare follow-up.
Note: Individual timelines vary based on age at diagnosis, severity of damage at diagnosis, strict adherence to GFD, and presence of other conditions. Lifelong monitoring is essential.
How We Measure Success
Outcomes that matter
tTG IgA normalized or dramatically reduced (<4.0 U/mL)
Negative or minimal EMA on repeat testing
Resolution of GI symptoms (diarrhea, bloating, abdominal pain)
Improved energy and reduced fatigue
Normalized hemoglobin and iron studies
Improved vitamin D, B12, and calcium levels
Weight stabilization (healthy BMI)
Improved mood and cognitive function
Normalization of liver enzymes
Improved bone density on DEXA scan (if osteopenia present)
Resolution of dermatitis herpetiformis (if present)
No new autoimmune conditions developed
Frequently Asked Questions
Common questions from patients
What is Celiac Disease?
Celiac Disease is an autoimmune disorder where consuming gluten - a protein found in wheat, barley, and rye - triggers your immune system to attack and damage the lining of your small intestine. This damage flattens the villi (tiny finger-like projections that absorb nutrients), leading to malabsorption of vitamins, minerals, and calories. It affects approximately 1% of the population and can develop at any age. The only treatment is a strict, lifelong gluten-free diet.
How is Celiac Disease diagnosed?
Diagnosis requires blood tests and intestinal biopsy. Blood tests include tTG IgA (primary screening), EMA IgA (confirmation), and DGP antibodies. Total serum IgA is checked to rule out IgA deficiency. Genetic testing (HLA-DQ2/DQ8) can help rule out the condition. The gold standard is an upper endoscopy with duodenal biopsies showing villous atrophy (Marsh 3 classification). Important: You must continue eating gluten for accurate testing.
Can Celiac Disease be cured?
There is currently no cure for Celiac Disease. The only treatment is a strict, lifelong 100% gluten-free diet. When gluten is completely eliminated, intestinal healing typically begins within weeks and most patients see significant improvement in 3-6 months. Complete villous healing may take 1-2 years. Following a strict GFD dramatically reduces the risk of complications including osteoporosis, infertility, other autoimmune conditions, and intestinal lymphoma.
What happens if I eat gluten accidentally?
Even small amounts of gluten trigger an autoimmune response in celiac patients. Reactions vary: some experience immediate GI symptoms (bloating, diarrhea, pain), while others have no obvious symptoms but still suffer internal damage. Repeated small exposures accumulate and delay healing. Cross-contamination is a major concern - even toaster crumbs or shared condiments can contain enough gluten. Strict adherence to the GFD is essential for healing and preventing complications.
Is a gluten-free diet healthy for people without celiac?
For individuals without celiac disease or non-celiac gluten sensitivity, a gluten-free diet offers no proven health benefits and may increase risk of nutrient deficiencies. However, for those with celiac, the gluten-free diet is medically necessary and life-changing. Some patients also have non-celiac gluten sensitivity (NCGS), which causes symptoms without intestinal damage. If you suspect celiac, get tested before eliminating gluten.
What are the long-term risks if celiac is left untreated?
Untreated celiac disease leads to serious complications: (1) Severe malnutrition from malabsorption - deficiencies in iron, B12, D, calcium, zinc. (2) Osteoporosis from vitamin D and calcium malabsorption. (3) Infertility and reproductive issues. (4) Increased risk (up to 10-15%) of developing other autoimmune conditions (thyroid, diabetes, liver disease). (5) 60x increased risk of small bowel lymphoma. (6) Neurological complications including ataxia and neuropathy. Early diagnosis and treatment prevent these outcomes.
Medical References
- 1.Lebwohl B, Sanders DS, Green PHR. Coeliac Disease. Lancet. 2018;391(10115):70-81. doi:10.1016/S0140-6736(17)31796-4 - Comprehensive review of celiac disease epidemiology, pathogenesis, and management.
- 2.Rubio-Tapia A, Hill ID, Kelly CP, et al. ACG Clinical Guidelines: Diagnosis and Management of Celiac Disease. Am J Gastroenterol. 2013;108(5):656-676. doi:10.1038/ajg.2013.79 - Evidence-based clinical guidelines for diagnosis and treatment.
- 3.Silvester JA, Kurada S, Sadowski C, et al. Tests for Serum Antibodies to Deamidated Gliadin Peptide and Tissue Transglutaminase for Diagnosis of Celiac Disease. Clin Gastroenterol Hepatol. 2018;16(10):1477-1488. doi:10.1016/j.cgh.2018.04.006 - Analysis of serologic testing accuracy.
Ready to Start Your Healing Journey?
Our integrative medicine experts are ready to help you overcome Celiac Disease.