Celiac Disease Results in Inflammation, Malabsorption, and Malnutrition
A Low-Fat Diet Can Help Relieve Many Symptoms
Celiac disease is an immune system dysfunction and chronic digestive disease that requires you to stick to a very strict gluten-free diet. When you have celiac disease and eat wheat, barley, or rye, it sets off an autoimmune response resulting in the immune system attacking the hair-like villi that line the small intestine.
Part of this attack includes inflammation, which can interfere with the way the body absorbs nutrients. When the malabsorption is severe, malnutrition can result. Although a gluten-free diet is the only way to heal the intestinal damage, a temporary low-fat diet can help ease the discomfort.
Celiac Disease Damage Causes Malabsorption
The villi projections inside the small intestine resemble folds. Their outer surface is covered in columnar epithelial cells that absorb nutrients, but that cannot occur if these specialized cells are not healthy. The purpose of the villi is to increase the surface area of the small intestinal wall, allowing the body ample space to absorb proteins, carbohydrates, fats, vitamins, and minerals.
As a result of the inflammation that occurs during an autoimmune attack, the villi become seriously damaged. The degree of damage differs from individual to individual and depends on the length of time you’ve gone undiagnosed, how much gluten you were eating before diagnosis, and how sensitive to gluten you are. Gluten sensitivity in this case, determines how much gluten it takes to set off an autoimmune reaction.
The villi, cell, and intestinal damage causes complications and gastrointestinal symptoms due to malabsorption and its resulting malnutrition. Despite a strict adherence to a gluten-free diet, when vital organs and body tissues are deprived of essential nourishment, celiac disease symptoms will continue. That can keep you exhausted and feeling ill.
While the absorption of all macronutrients (protein, carbohydrates, and fats) can be significantly impaired when you have celiac disease, fat absorption is generally affected the most.
Fat Malabsorption Results From Impaired Fat Digestion
There are three phases of fat digestion. Unlike proteins and carbohydrates, fats are not broken down in the stomach. They remain completely undigested until they reach the upper small intestine. In the first phase of fat digestion, the gallbladder empties its stored bile into the small intestine to make dietary fats more soluble. Fat and water do not mix very well, so bile helps water and fat to mix together better.
Next, the pancreas releases enzymes that travel to the small intestine where they can break down the dietary fats into fatty acids and phospholipids. Without these pancreatic enzymes, fat cannot be absorbed through the intestinal wall because the fat molecules would be too large. Neither can they be absorbed if the intestinal wall is inflamed or the cells of the villi are damaged.
Once these fatty acids are absorbed by the small intestine and pass into the bloodstream, they are synthesized into triglycerides and combined with protein, cholesterol, and phospholipids for transport by the lymphatic system to the body’s cells or liver. Fat malabsorption can occur when any of these phases are impaired. In fact, according to the Kaplan Medical Center, there are only two disease states that result in fat malabsorption: celiac disease or pancreatitis.
Raising your fat intake will not help increase fat absorption. Eating too much fat can result in diarrhea, bloating, and gas, thus causing even more discomfort.
Malabsorption Leads to Vitamin and Mineral Deficiencies
Malabsorption and diarrhea leads to severe vitamin and mineral deficiencies. Along with fat deficiency, these micronutrient inadequacies can cause serious health issues such as:
- chronic fatigue syndrome
- oxalate-type kidney stones
- bone abnormalities (osteomalacia or osteoporosis)
- neurological problems (peripheral neuropathy)
A gluten free diet is the only way to heal the fat malabsorption that accompanies celiac disease, but the problem is more complex than just staying away from gluten-containing foods. As long as the intestinal villi remain damaged or the small intestine remains inflamed, dietary fat intake needs to be lowered to a level where gastrointestinal symptoms subside. Otherwise, symptoms and complications will continue even while following a gluten-free diet.
Gastrointestinal Symptoms Caused by Fat Malabsorption
While celiacs also struggle with malabsorption issues associated with protein and carbohydrate digestion, most gastrointestinal symptoms are due to inadequate fat absorption. These gastrointestinal symptoms will vary, depending upon the size of the villi, degree of intestinal damage, and amount of inflammation that continues after going gluten free.
As the Kaplan Medical Center said above, gluten antibodies can remain in the body for weeks after going onto a gluten-free diet, causing fat malabsorption issues to continue. Some of these gastrointestinal symptoms include:
- fatty stools (steatorrhea)
- abdominal bloating
- intestinal inflammation
- belly pain or cramping
- foul smelling gas
Diarrhea develops when unabsorbed dietary fat bypasses the upper intestine and is broken down into fatty acids at the end of the small intestine and colon. Intestinal inflammation causes excess liquid to be secreted. Undigested fatty acids also draw more water into the colon. If food being digested passes through the colon too quickly, before the excess water can be reabsorbed, diarrhea will result.
Gluten Free Diet Doesn’t Always Heal Fat Malabsorption
Some people tend to heal extremely quickly once gluten is removed from the diet. Inflammation subsides, the villi grow back, and the columnar epithelial cells heal and begin absorbing nutrients properly. These individuals are able to quickly return to a fairly normal lifestyle, but many other celiacs continue to experience the uncomfortable digestive symptoms associated with celiac disease.
The reasons for that vary, but continued symptoms almost always point to continued gluten contamination, additional food sensitivities, or intestinal problems such as leaky gut syndrome or yeast overgrowth. Gluten in personal care products such as shampoo and hair conditioners can also be a problem.
Extensive damage can take several years to heal, especially if you’re older. The longer you’ve had untreated celiac disease, the longer it will take your body to repair the damage. Although a biopsy looks at the upper small intestine in order to make a celiac diagnosis, the villi can be damaged anywhere along the entire length of the intestine.
As long as the lining remains inflamed or damaged, fat malabsorption issues will continue, so it’s a good idea to look into additional food sensitivities, allergies, and other potential problems in addition to hidden sources of gluten cross contamination.
Corn and soy are typical food sensitivities often found in those with celiac disease. In addition, dairy products and dietary sugars can also play a role in fat malabsorption, at least temporarily. Since dairy and sugar is digested by the tips of the villi, eating dairy or sugar before your intestine heals can keep it inflamed. Lactose intolerance can also become exaggerated when the intestine is inflammed.
- live in a non-gluten-free home
- eat out at restaurants, even occasionally
- attend social events
- are older
- continue to eat foods they are sensitive or allergic to
- or have grown lax at reading food labels
can continue having problems with digestive upsets and fat malabsorption despite a strict adherence to a gluten-free diet.
What You Can Do
While problems persist, a low-fat diet, in addition to a gluten free one, will help to relieve a lot of the discomfort. The degree to which you have to lower the fat in your diet, however, will differ between individuals depending on the degree of inflammation and damage, so there isn’t a set guideline.
Reversing the inflammation and healing the villi will relieve the gastrointestinal symptoms and allow you to eat additional healthy fats, but healing often takes time, so don’t rush the process. In addition, an accidental glutening can also require you to lower your fat intake temporarily for a few weeks until your body heals.
While eliminating dairy or sugar is recommended for at least the first six months for all individuals recently diagnosed with celiac disease, for those with persistent gastrointestinal issues, you may need to eliminate foods you’re sensitive to for a year or even more.
A lot depends on how much of the small intestine is damaged, and how well your body has been able to heal. A nutrient dense, low-fat, gluten-free diet that focuses on fresh, whole foods, and limits processed foods to a bare minimum will lessen the inflammation and create a proper environment for the villi to begin to heal.