Celiac Disease

What is Celiac Disease?

Celiac disease is an autoimmune disorder in which eating gluten, a protein in wheat, barley and rye, triggers an immune attack on the lining of the small intestine in people who are genetically predisposed. It is lifelong, and the damage can lead to poor absorption of nutrients such as iron, vitamin B12, folate and fat-soluble vitamins.^[1] It affects roughly 1% of the general population, and women are affected more often than men.^[2]

Common symptoms

Typical digestive symptoms include diarrhea, abdominal discomfort, bloating and constipation.^[1] The disease can also show up outside the gut, as fatigue, weight loss, skin rashes, anemia and osteoporosis, and children may fail to grow normally.^[1]

Some people have few or no symptoms. Because the picture varies so much, diagnosis is often delayed, and nearly any organ can be involved.^[3]

Causes and risk factors

Celiac disease needs a genetic background, mainly the HLA-DQ2 or HLA-DQ8 gene types, together with environmental factors such as viral infections and changes in gut bacteria.^[2] Having the genes does not mean a person will develop the disease. The reasons for the rise in celiac disease in recent decades are unknown.^[4]

How it is diagnosed and treated conventionally

Diagnosis starts with blood tests for antibodies such as tissue transglutaminase IgA, and most adults then need a biopsy of the small intestine to confirm damage to the lining.^[1] In adults, diagnosis depends on finding villous atrophy while the person is still eating gluten, so gluten should not be removed before testing unless your physician says so.^[4]

The only effective treatment is a strict, lifelong gluten-free diet, with regular medical follow-up to check adherence and look for complications.^{[1, 2]} The diet is restrictive, can be low in some nutrients and can raise the risk of overweight, so a dietitian's assessment is recommended.^[5] Whether oats are safe is debated, partly because of possible contamination with other grains.^[6]

If symptoms continue, the first step is looking for hidden gluten exposure and other conditions that mimic celiac disease. Rare refractory celiac disease needs specialist treatment.^[7]

Why Celiac Disease calls for a whole-person approach

Celiac disease is an immune condition driven by gluten, and the gluten-free diet is the treatment. Alongside it, many people live with ongoing symptoms, dietary burden and stress.

Supportive care can address some of those day-to-day factors. It does not treat the intestinal damage or the autoimmune process, and no study has shown that it does.

Persistent digestive symptoms

IBS-type symptoms are common in celiac disease. A meta-analysis found them in about 38% of patients with celiac disease, more than in people without it, and adherence to the gluten-free diet might be associated with fewer symptoms.^[8] Persistent symptoms can come from gluten exposure, complications or functional gut disorders, and each needs medical assessment.^[9]

Nutrition and diet burden

A gluten-free diet can be nutritionally inadequate, with vitamin and mineral deficiencies, so nutritional status should be checked at diagnosis and during long-term follow-up.^[5]

Stress, mood and quality of life

A systematic review of 14 studies found that depression, anxiety, illness perceptions and coping were associated with quality of life in adults with celiac disease, possibly also by affecting adherence to the diet.^[10] Stress support is a reasonable aim of supportive care.

Other autoimmune conditions

Celiac disease can occur with other conditions, and some of these do not improve on a gluten-free diet.^[3] That is another reason to keep regular medical follow-up.

Acupuncture as supportive care in Celiac Disease

What the research shows

No clinical trials of acupuncture in celiac disease were found, so nothing is known about whether it affects the disease or the intestinal lining. Any benefit would be for symptoms, and research on symptoms comes from other digestive conditions.

In a sham-controlled trial of 278 adults with meal-related functional dyspepsia in China, 12 acupuncture sessions over 4 weeks gave a higher response rate than sham acupuncture, with the effect maintained at 12 weeks. The authors noted a high dropout rate.^[11] For IBS, a meta-analysis of 17 trials found no benefit over credible sham acupuncture, although patients in non-placebo trials reported more benefit than with some medicines.^[12] An umbrella review rated the reviews of acupuncture and moxibustion for IBS as low or very low quality.^[13]

These results come from people without celiac disease and cannot be assumed to apply to it.

How acupuncture may work

We did not find research on how acupuncture might act in celiac disease, and none of the sources used here establishes a mechanism for digestive symptoms, so we make no claim about how it may work.

What treatment involves

Treatment uses fine, sterile, single-use needles placed at points on the abdomen, arms, legs and sometimes the back, usually left in place for about 20 to 40 minutes, with reassessment after a short course of visits. It is aimed at symptoms such as discomfort and stress and does not replace the gluten-free diet.

In prospective studies, about 9 in 100 patients had a minor reaction such as bleeding, soreness or redness at a needle site, and serious events occurred in about 1 in 10,000 patients.^[14] Tell the practitioner first if you have a bleeding disorder, take blood thinners, are pregnant, or have a pacemaker (relevant to electroacupuncture). People with celiac disease and low blood counts from anemia should tell the practitioner.

Ayurvedic medicine as supportive care in Celiac Disease

The Ayurvedic view

Ayurveda has no concept equivalent to celiac disease. Chronic diarrhea with poor absorption has traditionally been described under Grahani, a weakness of the digestive fire (agni), and the build-up of undigested material (ama). These are traditional categories, not biomedical diagnoses, and they do not diagnose celiac disease.

Therapies that may be used

Supportive care is chosen for the individual and may include:

• Meal timing and cooking guidance, always inside a strict gluten-free diet
• Stress-reducing practices such as breathing exercises and steady sleep hours
• Gentle abdominal oil massage
• Herbs prescribed individually by a qualified practitioner

Any dietary guidance must fit inside the gluten-free diet, since strict exclusion of gluten is the only effective treatment.^[1] Every food, spice blend, herbal powder and oil used must be confirmed gluten-free, because many traditional preparations use wheat or barley flour or other fillers. Panchakarma is not appropriate during pregnancy, acute illness or frailty, and cleansing therapies should not be used where malnutrition, anemia or low body weight are present. Fasting or restricted diets that add to the restrictions of a gluten-free diet are not suitable without a dietitian's input.^[5]

What the research shows

No clinical studies of Ayurvedic treatment for celiac disease were found, so its effect on the condition is unknown. Ayurvedic practices cannot be said to help intestinal healing, and there is no evidence that they do.

Herbal medicine as supportive care in Celiac Disease

Herbs and formulas that have been studied

No herb or formula has been tested in clinical trials in people with celiac disease that we could find. Herbs have been studied for related digestive symptoms, including peppermint oil for IBS and several herbs for functional dyspepsia, but not in people with celiac disease.^{[15, 16]}

What the research shows

There is no evidence in celiac disease. A meta-analysis of 10 trials found peppermint oil better than placebo for global IBS symptoms and abdominal pain, though adverse events were more frequent and the quality of evidence was very low.^[15] A Cochrane review of non-Chinese herbal medicines for functional dyspepsia found some may improve symptoms, with mostly low to moderate certainty.^[16] These findings come from people without celiac disease.

Safety and herb-drug interactions

Herbs are active substances and can interact with medicines. Case reports describe bleeding when warfarin was combined with herbs including dang gui (Angelica sinensis), dan shen (Salvia miltiorrhiza), ginger, ginseng and Boswellia.^[17] People taking blood thinners need a practitioner's review before using herbs.

In one study, about one fifth of Ayurvedic medicines bought online contained detectable lead, mercury or arsenic.^[18] Herbs should come from tested sources and be prescribed individually. Because gluten can hide in capsules, tablets, powders and tinctures, a preparation must be confirmed gluten-free before use. Tell us if you are pregnant or breastfeeding, have liver or kidney disease, take prescribed medicines or supplements, or have surgery planned.

Translating traditional medicine into modern biological language

The links drawn here are interpretation, not equivalence. Chinese medicine often describes chronic diarrhea and tiredness as spleen deficiency with dampness. Researchers describe related ideas in modern terms such as nutrient malabsorption, which is how celiac disease damages the gut lining's ability to absorb food.^[1]

Ayurveda's weak agni and ama describe poor digestion and the build-up of undigested food. No study has shown that these traditional concepts correspond to a specific biological process, and none relates to the autoimmune reaction to gluten.

How this care fits with your medical care

Complementary care for celiac disease is supportive only. For a condition like this, we ask that you are under a physician's care for it and that your treating team knows you are receiving complementary care.

Keep your gluten-free diet, your follow-up blood tests and visits, and any supplements your physician or dietitian recommends. Do not stop or change prescribed medicines without your prescriber. We do not diagnose or manage celiac disease.

Please bring your diagnosis and biopsy or antibody results, your medication and supplement list, and the ingredient lists of any products you use.

When to seek urgent medical care

Some symptoms in a person with celiac disease need prompt medical assessment, because they can signal complications or another condition.^{[3, 7]}

• Symptoms that continue or return despite a strict gluten-free diet
• Unplanned weight loss, or ongoing severe diarrhea
• Blood in the stool or black stools
• Severe or worsening abdominal pain, or repeated vomiting
• Numbness, tingling or unsteadiness when walking
• Signs of dehydration or severe weakness, such as dizziness on standing or fainting

If any of these are severe, or you have severe abdominal pain or fainting, call 911 or go to the nearest emergency department.