There’s no denying that celiac disease (CD) is more prevalent now than ever. In the US, rates of CD have increased at least 5-fold over the past few decades, and prevalence in Finland has doubled. (1, 2, 3) The incidence of CD has also increased four-fold in the UK and three-fold in the Netherlands in the past 20 years, and the incidence of pediatric CD in Scotland has increased 6.4-fold. (4, 5, 6)
So naturally, everyone is wondering – why? We know that there’s a strong genetic component to celiac disease (and our ability to detect the disease has vastly improved), but the rising rates have occurred too quickly to be explained by a genetic shift in the population.
Besides, the genes that predispose an individual to CD are actually relatively common in the population, but only a very small percentage of those people actually develop the disease. In other words, genetics appear to be necessary – but not sufficient – for someone to develop CD.
Can the overuse of #antibiotics trigger celiac disease?
Antibiotics Can Cause Intestinal Dysbiosis and Infection
Clearly, something has changed in the environment to trigger celiac disease in a higher proportion of genetically susceptible people. Multiple factors probably play a role, but evidence indicates that one big factor is the intestinal microbiota. And a major contributor to disordered intestinal microbiota is antibiotic overuse.
In my previous article on the effects of antibiotics, I reviewed several studies that demonstrate how drastically antibiotics can alter the gut microbiome. Just a single course of antibiotics can reduce the richness and diversity of the intestinal microbiota, and in many cases, people never completely regain the diversity they lost.
Even if a person doesn’t develop an overt, clinically-diagnosable infection such as C. difficile, imbalances in the types of bacteria that colonize the gut can still cause serious problems. But to understand how antibiotic-induced gut dysbiosis could trigger celiac disease in genetically-susceptible individuals, it helps to first understand some of the basic mechanisms behind celiac disease.
Celiac Disease Involves an Immune Reaction to Both Gliadin and Tissue Transglutaminase
The biological mechanisms behind celiac disease are complicated and still not fully understood, but the general idea is that gluten – a group of proteins found in wheat, rye, and barley – triggers an autoimmune response that results in severe damage to the epithelial lining of the intestine.
Gliadins and glutenins are the two main components of gluten, with gliadins being the primary trigger for celiac disease. These proteins are very difficult for the body to digest fully, but in most people, this isn’t a problem. However, in people with celiac disease, certain cells (known as “antigen-presenting cells”) get a hold of these large, undigested fragments of protein and present them to T-cells, triggering an immune response. (7, 8)
An enzyme called tissue transglutaminase (TG2) is also important in the development of CD. This is because antigen-presenting cells only bind certain types of proteins, and they don’t usually bind normal gliadin fragments. (9) On the other hand, TG2 readily binds gliadin, and actually modifies it to make the gliadin much more attractive to antigen-presenting cells. This vastly increases the likelihood of an immune response.
Once this happens, the body starts creating antibodies against gliadin. But because the gliadin is usually bound to TG2, the body also creates antibodies against TG2, its own enzyme. This attack of “self” is what earns CD the classification of “autoimmune.”
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Intestinal Dysbiosis and Infection Can Lead to Up-Regulation of Tissue Transglutaminase
In healthy individuals, TG2 plays a role in tissue repair, as well as in other processes such as regulation of cell death; it’s not an enzyme that’s “supposed” to interact with gluten. (Interestingly, TG2 also plays a role in other diseases, such as Parkinson’s and Huntington’s, by modifying proteins that it isn’t supposed to modify.) (10)
Most TG2 appears to be either stored safely inside cells or inactive under normal conditions, and is only activated in the event of tissue injury, bacterial or viral infection, or another source of inflammation. (11, 12) This indicates that tissue damage or inflammation in the intestine (and subsequent TG2 up-regulation) might actually be necessary for the development of CD.
Without substantial TG2 activity, it’s unlikely that the antigen-presenting cells would bind and present enough gluten fragments to provoke a major immune response. But a bacterial or viral infection could create inflammation and tissue damage that would activate TG2, and thus trigger the cascade of events eventually leading to celiac disease.
Intestinal Dysbiosis and Infection Can Contribute to Leaky Gut
Another factor to consider is the location of tissue transglutaminase. Nearly all TG2 is found in the sub-epithelial region of the intestine, a place that gluten shouldn’t have access to. This means the intestinal barrier would need to be compromised in some way for gluten proteins to significantly interact with TG2. (13)
This fits with previous work done by researchers such as Alessio Fasano, who have hypothesized that a person cannot develop an autoimmune condition such as CD if they don’t have leaky gut. If the intestinal barrier is intact, the immune system will never “see” the antigens, so it won’t mount an immune response.
But one big risk factor for developing leaky gut is intestinal dysbiosis or infection. Bacterial components such as lipopolysaccharides can induce inflammation and increase intestinal permeability, which would allow gluten into the sub-epithelial region of the intestine where it could be modified by TG2 and trigger CD. (14)
Candida Infection May Trigger Celiac Disease through Cross-Reactivity
So far, we’ve been talking about dysbiosis in a general sense, but there’s evidence that specific microbes could trigger celiac disease as well. A recent study (hat tip to Questioning Answers for the find) found that an overabundance of the yeast Candida albicans could contribute to the development of CD, and unfortunately, antibiotic use is a big risk factor for developing a candida infection. (15)
Candida is a normal part of the intestinal microbiome of healthy individuals, but problems can arise when it overgrows relative to other inhabitants of the intestine. Remember how tissue transglutaminase (TG2) readily binds gliadin? Well, it turns out that candida expresses a protein named Hwp1 that also binds TG2, potentially leading to immune activation and cross-reactivity with gluten.
The study found that people without CD who had candida infections produced anti-gliadin antibodies, as well as the expected anti-Hwp1 antibodies. People with CD produced antibodies to both proteins as well. This means that in theory, a person who is genetically susceptible to CD but who doesn’t have the disease could develop the disease in response to a candida infection.
So, What Does This Mean for You?
As you can see, there are several ways in which antibiotic overuse and subsequent intestinal dysbiosis or infection could lead to the development of celiac disease. As I’ve said before, antibiotics can be lifesaving and are necessary in some situations, but that doesn’t mean they’re free of consequences.
It’s becoming more and more clear how vitally important it is to use antibiotics responsibly, whether that’s not using them at all, or properly rehabilitating the gut during and after a course when they’re deemed necessary.
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Well… this is very interesting. I’ve known about the link between candida and gut issues for a long time but didn’t know it could cause celiac-like symptoms. This might explain a lot of things about my health.
So glad this article was written. As a teen, I was put on antibiotics to help clear up my acne. I was on it a long time.
I now have three beautiful children, all with Celiac Disease ages from 20-12. Each of a host of other minor related issues. Some have anxiety, some have dairy intolerance. I also had at least 3 miscarriages and one case of thrush between pregnancies. I am so convinced this is all connected. We eat 80% paleo and 80% organic and have seen wonderful improvements. I fear my gut is still in need of help yet keeps silent. I have extremely low b12, cholesterol, and more but generally feel well. I just wonder if there is more I should be doing
Often times antibiotics are needed and a good plan for taking care of yourself afterwards is essential. Celiac testing is brutal because so many of us have figured out that gluten makes us sick. Many physicians test improperly. A very well know Celiac Center will not do the blood test if you have been gluten free unless your challenge is 10-12 weeks long. I see doctors write 4-6 weeks, this is wrong and may provide false negatives. Many people carry the gene, the blood and biopsy test is what you need. However, there is a new test coming out soon! It requires only eating gluten for 3 days and uses whole blood and is about 97% accurate! Believe it or not, the Ttg requires more skill and is open to error. So anyone reading this, there is a new possibility that is far more appealing.
@Laura. It would be good to hear more about this test. Do you know the name of it? If you say it uses whole blood, I guess you mean it uses the red blood cells, rather than plasma/serum. Cheers, Honora
One question:
Can anyone tell me for sure if one can have Celiac WITHOUT the genes.
I have all symptoms from head to toe. Was test for Celiac but was negative. I the time of the test was eating Paleo because I cannot eat normal with problems everywhere.
Tests for the genes came back negative as well.
What? For most people gluten isn’t a problem? There’s a hubris of evidence to link gluten to any other autoimmune disease aside from celiac disease and many other issues as well…I think that this two part article from Trevor Connor is one of the most well done http://thepaleodiet.com/wheat-opening-barrier-poor-gut-health/
There’s enough to blame gluten for most people, not all the other way round, considering the level if sickness around
Becky – Tests for celiac disease are ONLY effective when you are eating gluten. If there has been no gluten in your system recently (for example, because you had been eating a paleo diet for some time prior), the tests would have been ineffective. The immune response has to be actively occurring for results from the blood and the small intestine to be accurate. To be properly tested, you will have to eat gluten for some time prior to the tests. Your GI physician should have known better, so you may wish to try a different one in the future. The issue may not be celiac, but improper testing won’t tell you that, one way or another.
I was diagnosed with celiac 5 years ago after being misdiagnosed for 50+ years. I have not been on many antibiotics during my life. Found a celiac clinic recently headed by Shiela Crowe MD. She said there is recent evidence that the starch in gluten is more the problem than the gluten protein. Onion, shallots, leek and garlic are in the same category as wheat rye barley starch. You can eat the green part, but not the bulb or any of the white part. Going off of gluten brought my gut pain down about 60%, removing onion, garlic brought it down another 35%. Am currently using 1/4t (1 gram, will build up to 3 grams) of l-glutamine in water first thing in the am and wait 20 minute before eating. The l-glutamine is known for gut repair and it is making a real difference. I have weeks now with no pain at all.
This is a very interesting piece of data about the starch in gluten and the onion family plants. I just did Cyrex Labs Array 10, and came up with immune reactivity to the entire onion family. We were testing protien though, I believe. My gut pain is also improved eliminating them. I do know about FODMAPS. Is that what your doctor is refering to? I am curious about the science behind this recent evidence.
Great article!! Thankfully I don’t have celiac disease, although I am sensitive to gluten, so I stick to a paleo based diet. Oh…for all the times I was prescribed antibiotics for no good reason – my gut flora was obliterated in my early 20s. Five years later I’m trying my best to build it back up, especially before I start having children!
In 1993 I became very ill with the parasite Giardia. My Gastroenterologist said I had the worst case he’d ever seen. I took Flagyl antibiotics over and over and over. Just as I’d become better, the eggs would hatch and I’d have the terrible nausea and debilitation all over again. Finally I took lots of raw garlic and was able to halt the circle of parasitic regeneration.
Fast forward to 2007. I began to experience severe intestinal cramping for no apparent reason. In and out of Emergency rooms. Taken by ambulance one night. Gastroenterologist said it was diverticulitis. Ordered Cipro. However, my Naturopath thought differently. I had the frozen poop test (Texas) and the results showed high intolerance to gluten.
Fast forward to 2015. I have cut gluten out of my diet and hair products during the last 6 years. I get small amounts from eating out so I carry Glutenzyme for protection. Still get bouts of intestinal stress but with tea made from flax seeds, glutenzyme and a Xanax, the pain improves. The latest comfort comes from Ageless Hydro C and Ageless GI Recovery made by Ageless Nutrition. I take these supplements as drinks every morning. FAITHFULLY! If my Naturopath hadn’t discovered the gluten connection, my quality of life would have been dramatically altered.
I remember my first round of antibiotics when I was 10 years old for a skin staph infection. I will never forget the diarrhea. But that was the only round as a child and I definitely had problems years before that—and nobody took antiobiotics in our family back in those days. Fast forward to raising my kids, and all of us had multiple, multiple rounds of antibiotics for whatever. But before even that, our daughter had problems as an infant with her first solid foods—horrible face skin rash, diaper rash, clingy baby—and of course in 1992, Celiac and gluten weren’t part of our national vocabulary. When the whole family of 4 tested in 2005 because we couldn’t ignore symptoms anymore, 3/4 are positive Celiac, our son is gluten sensitive with the SAME exact symptoms as everyone else. Going GF wasn’t enough and we ended up with such severe leaky gut, we had about 6 foods to eat and were still reacting. We have been GAPS, SCD and now Autoimmune Paleo and still battle histamine issues and super sensitivity to many foods that should be safe for regular Paleo. What the hell has happened??? What is in the environment causing illness like this?? I’m convinced it’s environmental/contagious due to the nature of how it has affected my whole family. The economy took away any ability to see a FMD to find out what the heck is still going on, so we treat with very clean living and the whole, fresh foods we can eat. Would love an answer though!
I have severe allergies to antibiotics having taken so many as a child. Cypro is the only antibiotic other then Sulfa. I started having sensitivity to store bought wheat bread several years ago. I developed a cough in the winter that went away in the summer. Then the cough did not go away in the summer. I had trouble breathing mildly. Went to an allergist and my oxygen was way low. He gave me epinephrine, and a breathing treatment along with a prescription for Symbicort and Montelukast. A month later my doctor recommended a Flu shot. Within a short time I was sensitive to everything. I could not eat but a few foods. My stomach would swell after eating most food and thereafter I would have a sever asthma attack. I had only been coughing up to that point before I used all these drugs. I could eat most things except for wheat bread. Because I could not breathe after eating most foods I lost 30 pounds in four months. Coughing and chocking almost constantly became the norm. I stopped Symbicort cold turkey, which I found out was not to be done. My adrenal glands had shut down and I could not breathe. I ended up in the hospital where they put me on 160 mg of prednisone twice a day for three days. As I tried to wean down from this high dosage of Prednisone, I realized again I could not breath without it. I have spent more then two years trying to wean from prednisone and Symbicort. I have resorted to making a yeast free bread with no wheat. And am only eating organic food now. Eventually I held my weight. I believe I have developed silent acid reflux, which causes me to choke up mucus now after I eat most foods. I have found that allevira juice is helpful for relieving this symptom. These medications are not safe. They only give you short term relief then give you suppressed adrenal glands. Your adrenal glands control many of your bodily functions. Once you become dependent on steroids, such as prednisone and symbicort, the chance of death is very possible. Prednisone kills.
It could also be a parasite, such as blastocystis hominis. Parasites and other gut bacteria can cause so many Gastrointestinal problems, from food intolerances to allergies. Stool tests can be done to rule out such bacteria and/or parasites. There are a number of labs that do this: http://scdlifestyle.com/2013/04/6-gut-infection-case-studies-why-you-should-get-stool-testing-done-asap/
Google chemtrails, we are being sprayed with chemicals by aircraft everyday .Look up.
Michael, you said we are being sprayed by Chemtrails?
First off, how does that affect celiacs and if it’s real how do we protect ourselves from these “chem trails”
Raquel,I believe chemtrails are real and must therefore be taken in consideration when discussing digestive health. I believe chelation and detoxing is the best way to protect yourself.
Celiac disease is not a disease.
It is an intoxication, or poisoning. In the same way as poisoning by cyanide. Or by carbon monoxide.
Stop ingesting the poison (gluten, in this case) and the symptoms go away.
If everyone’s gut lining is compromised by gluten, then it might be viewed as a poison as you say.
However in celiac, only some 8-12% of celiacs have gut lining fully restored longer term by stopping gluten. Celiac is identified by tissue transglutaminase 2 antibodies (tTG2 Ab) that can remain to some degree for the rest of the person’s lifetime, a setup for some degree of chronic leaky gut and related low-grade systemic inflammation. I speculate that endothelial degradation from celiac can extend in many cases to a susceptibility to endothelial degradation in other parts of the body. It’s also documented that pancreatic digestive enzymes can be compromised in old celiacs, resulting in a cascade of detox, congestive, inflammatory, and degenerative problems — I speculate there is a connection to the tTG2 Ab.
I agree that this is a response to a poison and I think the increased incidence has to do with the genetic modification of our food, including gluten and other foods.
I go with Dr McBrides theory that the cause may well be mothers who have been on the pill for years and therefore have no good bacteria left in them, birthing babies who then START life with no good bacteria in them either. Mothers who have hysterectomies also give birth to babies who have a sterile gut. I think this is cause for my son, who was diagnosed at age 18, now 27, and had only 5 courses of anti biotics all his life by using natural alternatives. UK
Just checking in, Pippa. At what stage did the women who had the babies have their hysterectomies? It must have been just after they gave birth. So did the babies’ gut bacteria get wiped out from the mothers’ antibiotic-laden breast milk?
Very informative article. I too have many of the symptoms as many of the commenters. Also, I’ve had a lot of antibiotics and I’ve always thought they had something to do with my becoming disabled.
The thing that I can find no information for, is that I’m transgender. Going on testosterone made me much worse. It was like pouring gasoline on a fire. I can’t find a doctor who believes me. I see so many transgender people who are sick like me, I have to believe that there is a connection between leaky gut and HRT, not that HRT causes leaky gut, but that it keeps us from healing. I don’t want hormones, but my insurance company makes it a requirement to qualify for sex reassignment surgery. I’m risking my life if I go back on hormones, but I’m risking it if I don’t. I’m trapped….
I am a 57 year old male with CD. I am more than 50% Italian as well as Scottish. I have read that those two nationalities are the highest for CD. I had undiagnosed dermatitis herpetaformis as a young child. I was not plagued by infections and do not recall being ill much except for DH. I did not take antibiotics much as child. I self diagnosed CD at around 43 years of age that was later confirmed by a gastroenterologist.
All my life, I’ve had skin issues, bronchial asthma, yeast infections & sinusitis! Therefore, antibiotics have always been in the mix, at all levels. At age 50, my health turned crazy; not responding to ANYTHING MEDICAL! That’s when I was advised to take ALL SUGARS out of my diet; that most likely, I had an overgrowth of Candida!
I followed this process, trying to get my skin to clear up; but something was drastically wrong with my anti-inflammatory system. It was working at all; I was in serious trouble!
Months later, I saw am allergist, who ran test. The blood test showed that I was “boarder-line” Celiac! I then started removing gluten from my diet! I still have flare-ups; but I’m trying desperately to heal the lining of my stomach! My skin is the main area to which, the swelling, itching, redness, pain; is evident. My face is the other area affected, when something I’ve eaten or a product I’ve used, is not compatible to gluten free living.
try eliminating histamine enhancing foods and eat only histamine blocking foods. check on line to find the list.
I have had CD all my life but never knew it because doctors kept treating me for what they saw or guessed and not look for the root of the problem. ie growing pains, nervous stomach, allergic to something, etc. (yes I had allergy test, negative, CD is not an allergy) only after I retired, had time and the internet, started my own research. at that time large blisters with intense itching. I told the dermatologist and doctor what I had from internet info. they said had something different. I compared photos, tested each medicine and vitamins and herbs, I was on twice. photos of my skin before starting something, photos after 2 weeks on each thing. made my own medical journal. took my findings to my new doctor. she looked at the photos and my research then ordered a CD test. positive plus gastritis. my hives and itching let up about 60% only. several years earlier I had test that showed leaky gut. from my research I realized I have IBS. on internet I read if you have CD, IBS, and leaky gut, you are no doubt histamine intolerant. back to internet, researched histamine. found some foods enhance histamine and some foods block histamine. after I stopped all histamine enhancing foods the rest of my hives, rash, itching cleared up. I have found most medicines contain gluten or hi histamine in them. I cannot take any medications or pain deadeners orally as the binders or fillers cause my reactions. the steroids doctor had me on caused 60 pound weight gain, stopping them taking on the paleo plus diet, dropped those 60 pounds. I found several vitamins and herbs have one or the other in them as well. almost 80 years old and just now getting a handle on my health. sad isn’t it. by the way the CD has caused calcium loss from my bones. I also have spinal stenosis, peripheral neuropathy, effects of years of CD. on cane, canes, wheel chair, power chair, at times depending on the severity of the low back and knee problems at the time. I am hoping my story will benefit others out there. Walter Wermuth.
Vitamin C is a natural anti-histamine. Ever since I began hi dosing of Vitamin C, my “hay fever” has been stifled.
Also, there is an anti-inflammatory enzyme that reacts in the body like NSAIDs without any of the side effects. It is called Wobenzym. Available most health food stores or online. It cured my snoring, sleep apnea, chronic nosebleeds, my daughters’ carpal tunnel, wife’s sciatica.
because of my CD, vit. C burns my stomach unless I take buffered C or ester C.
I eat mostly Paleo. I take one Prescript Assist per day. I take 400mg mag glycine the per day. I am now taking basic digestive enzymes. My gut feels much better. Much less gas. But my stool still floats!
This seems to be right on point with me and my medical history, but, for me, the screaming question is–how do I improve the situation?
Hi Chris,
It seems we’ve all taken so many antibiotics- I’m the only one in my family with Celiac though. I’m wondering if it has to do with the fact that I was on heavy-duty antibiotics for being “exposed” to TB when I was younger. I had a positive skin test, then was on those antibiotics(NIH I think it was called?) for 6 months to a year.
I’m diligently following the Specific Carbohydrate Diet to heal my leaky gut at this point- hopefully once and for all. Any thoughts on that?
I am wondering how overwhelm/trauma fits into the picture. Fear has “its seat” in the gut.
I am under the impression that many people have unhealthy (getting/staying “stuck”) autonomic nervous system regulation patterns. All of them have gut problems in one way or another. I am more inclined to think that ANS dysregulation contributes to an unhealthy gut which weakens the immune system which leads to illeneses that “require” antibiotics/ stress triggers the expression of genes.
Agreed, but we maybe able to back it up one more step and looks at what causes the imbalance in the ANS. It may start with Oral Cavity https://www.youtube.com/watch?v=rOjOVtyK5Gw&sns=fb.
New research indicating a possible relationship between ANS and Rheumatoid Arthritis http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3188868/ also leads us to suspect ANS being a key component to not only RA but chronic & immune related diseases
Add to that the new finding in regards to the lymph network connecting the brain and immune system https://www.autismspeaks.org/science/science-news/discovery-brain-immune-link-could-advance-understanding-autism
So, does antibiotics have a relationship with celiac? Probably, but let’s look at root cause as to why the GUT (more nerve endings than our brain and known as our second brain) is being compromised.
Chris, are you finding any relationship here?
So true! Couldn’t agree more.
I absolutely agree and I don’t think stress relief gets another attention. I think it trumps diet.
My daughter always gets gut issues when worried about something. She calms down and her stomach problems go away.
What is the best way to get “un stuck”
We seem so bombarded with issues that overly “concern” us in this day and age.
This is a very interesting article. I have a family history of gluten intolerance and CD.
I may have always had the problem but un-diagnosed. A few years ago I had DVT (deep vein thrombosis) which was treated with a series of injections. It was after this that I realized that I could no longer eat wheat based foods.
Perhaps a coincidence Perhaps not.
I have wondered more than once if the near constant antibiotics in the first years of my life for ear infections altered something in me, or rather exposed a weakness already present in my system,
More recently I have had to take antibiotics for intestinal bugs acquired while traveling.
In the past year I have been diagnosed with lymphoma and celiac disease. Which came first? Who knows, but the bulk of my cancer is centered around my gut, in my mesentery and the paraaortic area, which I highly doubt is coincidental.
My celiac was silent, incidentally, until very recently. I thought the cancer was causing my discomfort, but now I am not sure who the real culprit is.
I am leery of antibiotics these days, but am keenly aware that my system is much more delicate and susceptible than before. Forging ahead and just doing my best.