Do Specific Gut Bacteria Have A Role In The Development Of Celiac Disease?

Celiac disease is an auto-immune disease in which a person reacts to gluten - a protein found in grains including rye, wheat, barley and also oats. It is estimated that about 1% of the American population has celiac disease. Around 80% of Americans with celiac disease are undiagnosed or misdiagnosed with other conditions.

When a person with celiac disease eats gluten, their immune system produces antibodies against gluten which can also causing damage to the small intestine. This leads to the symptoms of celiac disease including abdominal pain, diarrhea, bloating, malnutrition and fatigue. The only existing treatment for celiac disease is a gluten-free diet.

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 A large proportion on people with celiac disease have a specific gene which pre-disposes them to celiac disease. Around 5-25% of people with celiac disease have a first-degree relative with the condition. But why is it that only a small proportion of individuals who are genetically susceptible to celiac disease actually develop the disorder?  Certain gene mutations are known to trigger celiac disease, yet, only 2-3% of people who possess such mutations actually develop the condition.

The answer to this has been uncertain, but recent study suggests it may be explained by how specific gut bacteria respond to gluten. Some researchers have proposed that the presence of specific gut bacteria may have a role in the development of celiac disease.

Dr. Elena F. Verdu, of the Digestive Health Research Institute at McMaster University in Canada, and her colleagues have investigated how the immune responses to gluten varies with different populations of gut bacteria in mouse models with gluten intolerance. Their findings were published in The American Journal of Pathology.

The team assessed three groups of mice that expressed a gene called DQ8, which is also found in humans and makes them genetically susceptible to gluten intolerance. Each group of mice had different gut bacteria compositions, or gut microbiomes. The researchers exposed each group of mice to the same amount of gluten.

•  Group 1 mice were germ free
• Group 2 mice had specific, pathogen-free flora which possessed a wide range of normal gut bacteria; their gut microbiomes were free of Proteobacteria; and did not have any opportunistic pathogens present
•  Group 3 mice, also had specific, pathogen-free flora (as for group 2), but it also included Proteobacteria such as Escherichia coli and Helicobacter; and also included other opportunistic pathogens such as Staphylococcus and Streptococcus

Note:

1.  The Proteobacteria are a major group of gram negative bacteria. They include a wide variety of pathogens, such as Escherichia, Salmonella, Vibrio, Helicobacter, and many other notable genera
2. Opportunistic pathogens are bacteria which live normally on/in the body and cause disease in people with a compromised immune system or other pre-existing disease.

Gram negative bacilli

.           Results: Group 1 – The Germ Free Mice

The germ- free mice exhibited signs of celiac disease. The germ-free mice showed increased levels of intraepithelial lymphocytes in the gut. The proliferation and activation of intraepithelial lymphocytes is an early indicator of celiac disease. The germ-free mice also experienced increased death of cells called enterocytes that line the gastrointestinal tract, as well as anatomical alterations of the villi, the small, finger-like projections that line the small intestine.

The researchers also identified that the germ free mice in group 1 developed antibodies in response to gliadin, a component of gluten. These mice also demonstrated T-cell responses specific to this component.

Results: Groups 1 mice with specific, pathogen-free flora

Increased intraepithelial lymphocytes levels were not seen in group 2, the mice with specific, pathogen-free flora only

 Results: Groups 2 mice with specific, pathogen-free flora, Proteobacteria and opportunistic pathogens

The group 3 mice demonstrated greater gluten-induced pathology than the group 2 mice, according to the researchers, so the team set out to investigate whether the presence of Proteobacteria, such as Escherichia and Helicobacter, plays a role.

The team found that development of gluten-induced pathology was NOT halted if the mice were also inoculated with entero-adherent Escherichia coli isolated from a patient with celiac disease.

They found that the presence of Proteobacteria worsened gluten-induced pathology. On increasing the presence of Proteobacteria in new born mice, the researchers found that gluten-induced pathology got worse. Specifically, the team identified an increase in levels of intraepithelial lymphocytes.

Conclusions

"These studies demonstrate that perturbation of early microbial colonization in life and induction of dysbiosis (microbial imbalance inside the body), characterized by increased Proteobacteria, enhances the severity of gluten-induced responses in mice genetically predisposed to gluten sensitivity," says Dr. Verdu. "Importantly, our data argue that the recognized increase in celiac disease prevalence in the general population over the last 50 years could be driven, at least in part, by perturbations in intestinal microbial ecology. Specific microbiota-based therapies may aid in the prevention or treatment of celiac disease in subjects with moderate genetic risk."

In an editorial linked to the study, Dr. Robin G. Lorenz, of the University of Alabama at Birmingham, notes that while these findings suggest the presence of Proteobacteria may play an important role in celiac disease pathology, they do not mean that Proteobacteria causes the condition. An alternative, he suggests, is that Proteobacteria somehow boost the immune response to gluten or gliadin.

Is Chocolate Gluten-Free?

Discovering you need to have a gluten-free diet can be overwhelming and you can become unsure about what you can and can’t eat. I had to search the town this Easter to find her an Easter egg that was gluten-free. I found one eventually in a delicatessen. The fact is that my celiac daughter loves chocolate, but the question is – Is chocolate gluten-free or does it contain gluten? The answer is that it depends on the chocolate and you must check the label.

Not all chocolate can be included in your gluten-free diet, even if gluten isn’t listed as a deliberate ingredient on the ingredients list. But chocoholics don’t despair — there are some gluten-free chocolate candies on the market. Although many chocolate products you see in stores won't be considered gluten-free, it's still possible to get your chocolate fix even if you're following a strict gluten-free diet by checking the labels carefully.

Do not purchase any chocolate with gluten ingredients, or labels which say ‘manufactured in the same facility where gluten has been processed”, or ‘may contain gluten” statements, because the manufacturer has decided that there is a risk that the product could be contaminated with gluten. With this in mind, it’s important that you carefully select your chocolate products to make sure they are gluten-free and safe for your diet.

Pure chocolate (usually dark chocolate) and cocoa beans do not contain gluten. Pure, unsweetened chocolate, made by liquefying roasted cacao beans and containing nothing but those roasted beans, should be completely gluten-free. But pure, unsweetened chocolate also doesn't taste very good so manufacturers add sweeteners to it.

To make the purest version of the sweetened, smooth candy we know as "chocolate," manufacturers take what's called "chocolate liquor" which is the liquefied cacao beans or "cocoa mass" and blend it with cocoa butter (fat from the cacao beans), plus sugar. All of which should be gluten-free. Some of the highest-quality chocolates available include only these three ingredients, and it's this combination that makes " dark chocolate" such a taste sensation.

High quality milk chocolate contains these same three ingredients but also has just powdered milk added. These 4 ingredients should be gluten free.

But unfortunately, the problem is that most chocolate brands are often mixed with ingredients that do contain gluten. For example, a chocolate candy bar that contains a wafer or other ingredient made from wheat would definitely contain gluten, whereas a plain chocolate bar, or a chocolate bar containing fruit and nuts may not.

Gluten containing ingredients that may be added to chocolate bars, include pretzels, cookies, maltodextrin from wheat and barley malt. So when buying chocolate, it is important to always READ THE LABEL to check for signs of wheat, barley, rye or oats and their derivatives.   It is not very often that a manufacturer will claim that their chocolate is gluten free.

For example, one of my favorite chocolate brands is Lindt Chocolates, but unfortunately a celiac cannot eat it because Lindt uses barley malt which does contain gluten in many of its products.

Cross Contamination

Not only can chocolate contain gluten if gluten containing ingredients are added, it may also contain gluten if it is contaminated with wheat, barley or rye during processing. For example, if a chocolate bar is manufactured on the same equipment as liquorice, which usually contains wheat, it may contain trace amounts of gluten picked up on the equipment. For this reason, many companies that produced wheat products in their facility do not label their chocolate as “gluten-free.”

For example, two of the big chocolate producers Nestle and Cadbury provide lists of products that contain no gluten ingredients. They produce numerous products that do not have gluten ingredients. But keep in mind that both of these companies also produce products that contain gluten ingredients, so cross contamination may be an issue.

In fact, Cadbury has updated their packaging to say 'may contain wheat or gluten'. This means that is it no longer deemed gluten free or safe to eat, for a person requiring a gluten-free diet.  

Certified Gluten-Free Products

A few chocolate products are certified gluten-free by Gluten Free Certification Organizations, which inspect facilities and test products to ensure they are gluten-free. Chocolate labelled “gluten-free” must meet the gluten-free standard for gluten-free labeling regulated in the country it is to be sold. In most countries this is less than 20 parts per million of gluten. But some countries such as Australia and NZ have tighter limits.

For example, Haigh’s chocolates in Australia make a range of “Free Of Gluten” chocolates.

Other Confectionery.

So much confectionery is off limits to a celiac due to gluten being used in the actual product and/or the manufacturing process.  Cross contamination seems to be a big concern for most candy manufacturers. So the same rules discussed with chocolate apply to confectionery. 

Chocolate Drinks

Pure cocoa powder is gluten-free but hot chocolate powders, chocolate sprinkles and toppings for cappuccinos need to be checked because they often contain gluten. Also milkshake syrups are often not gluten free so you need to check the ingredients for these as well.

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Is Coffee Gluten Free?

 Many people love to wake up to their morning cup of coffee. They simply cannot get going until that first cup has passed their lips. But is safe for celiacs to drink coffee? Coffee fanatics love the taste, they love the aroma and they love to routine; not to mention they love the morning caffeine hit. Some of my customers when I owned Bacio Café would come back for 3-4 cups in the morning!

Well the fact is that pure coffee beans are gluten free and perfectly safe for celiacs. You can buy them as beans or pure ground beans and they will be safe. If you make your coffee at home you are in control of what goes into it. And you can easily read the label on the packet to see if there are any other additives. Using organic, whole-bean is definitely recommended.

But it is a bit more difficult if you get your coffee from the local café, because the problem is that many coffees are NOT pure, not organic and they can pose a risk to the celiac. There is also a risk of gluten cross contamination if the barista does not understand what it means to be gluten free. I have highlighted some of the things to watch out for when ordering your coffee.

Many of the coffee flavorings also known as monins, such as caramel (caramel latte) and vanilla, (vanilla latte) are NOT gluten free. It is essential to check the label to ensure any additives to your coffee are gluten free.  This also applies to milkshake flavorings - they are often NOT gluten free either.

Plain unadulterated milk is also gluten free, but when it comes to soy milk you need to be very careful. Not all soy milk is gluten free, and so once again, you need to find out the brand you or your local café is using and check the label.

The other additive commonly added to coffee is chocolate, either sprinkled on the top of a cappuccino, or mixed in a mocha, or even just pure hot chocolate could be the source of gluten contamination so a celiac must check it all out. Not many baristas will be aware of the hidden sources of gluten when they make your coffee, mocha or hot chocolate so it is up to you to check it all out.

But recently, there have been some reports that perhaps those with celiac disease should not drink coffee. An article on Facebook titled “Gluten Issues or Celiac: Don’t Drink Coffee” reports:

“In a nutshell, fairly recent lab research has revealed that 10% of coffee is a protein that cross reacts with gluten antibodies.”

But is this really true?  If you’ve been eating a 100% gluten free diet and are still experiencing gluten related symptoms, the problem may be your coffee intake.  That being said, there are actually several foods that cause some sort of reaction in those who are sensitive to or intolerant of gluten. This is because the proteins in these foods are perceived by the body as invaders in the same way gluten is.

There are several foods that cause what’s called a gluten cross-reactivity in those who are sensitive to or intolerant of gluten. This is because the proteins in these foods are perceived by the body as invaders in the same way gluten is.

Dairy is the most common cross-reactive food for those with gluten issues, because of its casein proteins. But coffee also contains problematic proteins and the cross reaction to coffee has actually been found to be one of the most severe.

In a study published in Food and Nutritional Sciences, researchers found this reaction was limited to highly-processed coffee, such as instant coffee, ground coffee and flavoured coffee. What researchers believe is that the processing itself contributes to the problem because organic, whole-bean coffees do not produce cross-reactivity issues. While more research is needed, it’s thought that the proteins in coffee are changed in such a way during processing that the body perceives them as a threat, which causes the same inflammatory responses and symptoms as gluten in those that are sensitive or allergic to it. 

But this same reaction can also occur in people who do not have celiac disease so is it caused by a gluten reaction or a totally unrelated reaction to coffee proteins?  The processing of dairy products is also known to cause a gluten-like reaction due to the changes to dairy protein.

Common coffee symptoms include migraine, mental fogginess and fatigue. Unfortunately, when people experience these symptoms, they reach for yet another cup, which leads to more symptoms. Add to this the fact that most people also add some form of dairy to their coffee, and you now have two potential ways they could be having cross reactive gluten like inflammatory damage.

The possibility is that you are actually allergic to some other sort of food or coffee additive is also a possibility. Contaminants in the coffee could also be a cause of the symptoms.

Mycotoxins

Another possible problem with coffee is that they may be contaminated with mycotoxins. Coffee beans are often contaminated by a toxic mould known as ochratoxin A, which produces these mycotoxins. Roasting the coffee tends to reduce the natural levels. Most people do not react to it, but some others can have a severe reaction to it. It seems to affect people with celiac disease more often than the normal population. But once again this is not a reaction to gluten but a totally unrelated reaction.

Pesticides

Coffee crops are often heavily loaded with pesticides.  Pesticides can cause intestinal damage, leaky gut, and disrupt hormones (especially estrogen). That is why it is best to drink organic coffee only.

Caffeine

The caffeine content in coffee ranges from 100-200 mg per serve depending on the type and strength of the brew.  Caffeine is a common gastric irritant and can lead to mucosal degradation in the stomach and oesophagus. Some people who have gluten induced gastrointestinal damage may also have problems with regular coffee consumption.  Caffeine can also overstimulate the adrenal glands which can be very detrimental for someone already suffering with adrenal burnout or adrenal insufficiency.  You may need to eliminate caffeine for several months while your body is recovering.

It can be hard for people to pinpoint the problem, because pure coffee is a gluten free food.  So if you are not feeling better on a 100% gluten free diet coffee is a factor you need to consider. Stay off coffee for 2-3 weeks to allow the coffee residues to be eliminated from your body. Hopefully you will show some improvement.

Then do a challenge test by introducing coffee back into your diet. Start with just one cup in the morning, but make sure you use pure, organic, whole-bean coffee. If your symptoms diminished or went away entirely after a couple of weeks without coffee and your one cup of whole-bean coffee doesn’t produce any symptoms, then it’s safe to say that you can go back to your normal coffee intake, but stay away from instant and ground coffees and make sure that any flavorings and chocolate sprinkling is gluten free.

Using organic, whole-bean is definitely the better choice, and there are plenty of interesting and exotic organic beans for you to discover. The upside of this is that freshly ground coffee is superior in taste and aroma, and so, you can remove your symptoms and still enjoy a great cup of coffee. 

If you want to make sure your local cafe of restaurant is preparing your gluten free coffee and food correctly, pass on this book which details all the procedures they need to take to achieve 100% gluten free. Many of them certainly need this education to ensure you are safe!

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