Have you ever wondered what caused your celiac disease? After all, how can you have a happy and healthy relationship with gluten for years before it suddenly turns on you?
Currently, there are 4 major elements that the medical literature suggests as necessary to ignite the autoimmune disease : Genetics, environmental triggers, intestinal permeability (known as “leaky gut”), and gluten. These come together to create a “perfect storm” situation.
As with all autoimmune diseases, research is rapidly evolving and there is always more to be done, but this is the most current understanding of factors that influence celiac disease development.
Certain genes are needed to develop celiac disease. These two genes are HLA-DQ2 and HLA-DQ8 and about a third of the population has one or both of these genes. However, approximately 1% of the population has celiac disease. This means that, just because you have the genes, it doesn’t automatically mean that you’ll develop celiac. This is where the other pieces of the puzzle can come into play.
These events can occur in either childhood or adulthood, and in most cases, individuals have likely encountered more than one. They are considered “triggers” because they can dysregulate the immune system and/or disrupt the microbiome, meaning that inflammatory species of microorganisms start to outnumber beneficial ones.
The main factors that we currently know of are:
- Viral infections, including common viruses such as Epstein-Barr (otherwise called “mono”) , rotaviruses, reoviruses, etc.
- Bacterial infections, e.g. Campylobacter spp. (a common source of foodborne illness or “food poisoning”)
- Significant and/or frequent stressful life events, including pregnancy, losing a loved one, making an academic or career change, perceived lack of safety in a long-term living situation, marital problems, the diagnosis of other chronic conditions, alcohol and drug dependency, surgery, and more. These events cause high, chronic levels of stress, which have an enormous impact on the composition of the gut microbiome (not in a positive way!).
- Toxic chemical exposures including pesticides, nonstick cookware, and flame retardants.
- Antibiotic use in infancy and childhood
- Childhood trauma
These triggers can cultivate an inflammatory and imbalanced gut microbiome, which sets up an optimal stage for an autoimmune disease like celiac to steal the show.
Intestinal Permeability (“Leaky Gut”)
An imbalanced gut microbiome and chronic stress can cause increased intestinal permeability, otherwise known as “leaky gut.”
The lining of your gut is your first line of defense in your body because when you eat, you are bringing the outside world in. This is why nearly 70% of your immune system is in your gut!
The gut lining acts as barrier to the outside world, and an important component is the “glue” holding cells together, known as tight junctions. These usually stay closed, but if something looks like a threat, the tight junctions open. This can allow larger molecules to get into the blood stream, which the body then sees as foreign and mounts an attack against (in the form of inflammation). This process is what we deem “leaky gut.”
Occasional leakiness is a normal occurrence, but chronic leakiness is another story. When we add in a celiac genetic predisposition, an imbalanced gut microbiome, immune dysregulation, and exposure to environmental triggers, trouble is on the way.
Even worse, you start to experience a nasty feedback loop. The more (and longer) you have leaky gut, the more the immune system is alerted to ramp up inflammation, which then causes a negative shift in the makeup of the gut microbiome. This shift then triggers more leakiness.
This unfortunate series of events is the ultimate priming step before we add the final component to trigger celiac disease…
Gluten is the last straw. It’s what activates the autoimmune response where your body starts attacking itself, specifically in the small intestine. The autoimmune reaction that damages your gut also leads to nutrient malabsorption and causes inflammation that affects other parts of the body.
What’s more, gluten itself causes leaky gut! It actually causes leaky gut in everyone but does so in an extended and exaggerated way in celiacs, which becomes pathological BECAUSE of the previous factors.
Simply put, gluten is the final “ingredient” in the “recipe” to cook up celiac disease.
This cascade of event is thought to culminate in celiac disease, although the process and exact factors involved differ greatly for each individual. If you’re reading this and thinking “this sh*t sounds complicated,” that’s because it IS complicated!
Regardless of how your celiac disease came into fruition, the only treatment at this point is a lifelong, completely gluten-free diet. Beyond that, it’s also necessary to address what has been going on in the body leading up to diagnosis: i.e. intestinal permeability and microbiome imbalances. Eliminating gluten is the first and very significant step in cultivating a favorable gut microbiome for celiacs, but further diet and lifestyle strategies are often needed to kick the inflammation and achieve full symptom relief.
While it can be interesting to ponder the lead-up to celiac disease, it’s important to keep in mind that this disease is not your fault, and there is a path forward to feeling well again. I’ve done it myself and I see it all the time with those that I help. Take heart!