Celiac Disease, the Immune System, and Lupus

Many Lupus Warriors also have celiac disease, an autoimmune disease that manifests as an abnormal sensitivity to gluten. The two diseases can be intertwined – with one’s symptoms affecting the other. 

Having a sensitivity to gluten is a common experience. Gluten is a protein found in wheat, rye, and barley.

Sensitivities are much like allergies. A person with a sensitivity has antibodies that attach to harmless substances and signal the immune system to attack. Instead of causing a short, localized symptom like a rash, sensitivities trigger a more general immune response. It doesn’t just attack the substance; instead, the immune system puts itself on high alert and attacks the body’s own cells.

You can read more about the immune system here. 

What Is Celiac Disease?

Celiac disease causes body-wide inflammation, though its effects are often most prevalent in the gut and intestines, where the immune system is most likely to come into contact with gluten. Specific genes (HLA-DQ2 and HLA-DQ8) appear to predispose a person’s immune system to produce antibodies to gluten. These antibodies bind to the gluten molecule and signal the immune system to attack – an inflammatory response. 

As inflammation increases, the disease progresses and worsens. The exact cells involved can vary, but the result is the same: damage to the gut. The pillar-like structures in the wall of the small intestine that the body uses to absorb nutrients, known as “villi,” become stressed and flattened out. As they flatten, the body has less surface area to absorb nutrients and begins to suffer. 

Celiac disease can develop at any age in people who eat diets containing gluten. Most of the symptoms are gastrointestinal (the stomach and guts) and include:

• Abdominal pain
• Swelling
• Other food intolerances
• Weight loss due to diarrhea and poor nutrient absorption
• Pale, foul-smelling stools

People with lupus can also have celiac disease. Since the two diseases are both autoimmune diseases, they interact with each other and can make each other worse. They are also both often misdiagnosed or not diagnosed for years, because both can be “great mimickers.”

Learn more about a blood test used to diagnose both conditions, here. 

However, they also are treated in similar ways, and treating one can help reduce the symptoms of the other.

Celiac Disease and Lupus: The Connection

Both systemic lupus (SLE) and celiac are chronic autoimmune disease. In celiac disease, the autoantibodies focus on the cells of the gut. But, in SLE, autoantibodies against many different types of cells.

The immune system marks cells in the kidneys, skin, heart, lung, joints and sometimes even the nervous system itself as enemies and, when riled up, targets and attacks those cells. Lupus can affect the gut, too, but the main interaction between celiac disease and lupus is the focused trigger: gluten.

The immune system then goes on the offensive and increases the symptoms. Diet can be affected by the pain and fatigue of lupus, which can lead to a worsening of celiac… and so the cycle continues.

There are other interesting similarities: both celiac and lupus have genetic components. This could point to the idea that people who have both celiac and lupus start out with similar immune system malfunctions, that are then brought to the fore by stress, environmental factors, and other factors.

The Gut and Lupus

Another interesting overlap is that the gut is an important area for people with lupus, as well. For some, a condition colloquially called “Leaky Gut” increases inflammation throughout the body. Also called “Intestinal permeability,” this condition involves the seals between the cells of the intestine becoming irritated and weakening.

Partially-digested food particles, toxins, pieces of the normally good bacteria in the gut, and even viruses can slip through these weakened seals into the bloodstream. Typically, these particles do not themselves cause disease – instead, they activate the immune system. It does not recognize these particles, and so it activates itself to deal with the “invaders.”

Because the “invasion” of these particles doesn’t stop, the immune system ends up set to a higher alert level throughout the body. This increases inflammation and inflammation-related symptoms. This may be part of the reason why celiac and lupus are so linked. In both cases, diet plays a major role.

You can read more about intestinal permeability and lupus, here. 

Treating Celiac Disease

Both diseases can be treated with medications that modulate, suppress, or interfere with the immune response. This includes medications commonly used for lupus including:

• corticosteroids
• azathioprine
• budesonide

You can read more about lupus medications here.

However, for celiac’s disease, strict diet control is much more important. With celiac’s disease, antibodies bind to proteins on the surface of gluten. Foods that contain gluten must be completely excluded from the diet. That means no:

• wheat
• barley
• rye
• oats

This can be tricky, as these grains are used in many different foods or as additives to others.  They can give food a pleasant, gummy consistency. But, these days there are many alternatives that provide that texture, and the technology is improving. 

Dietary Treatments

Anti-inflammatory diets are often recommended. In addition to eliminating sources of gluten, the diet also restricts high-sugar, high-fat, dairy products, processed foods, and other food types that have been linked to inflammation. The diet consists of fresh fruits and vegetables, lean meats, non-dairy fermented foods, and most herbs and spices. It is very similar to a “Paleo” diet, and you can read more about what you can and cannot eat on an anti-inflammatory diet, here. 

Such a diet keeps your body nourished and lowers inflammation overall, reducing your symptoms. In the case of celiac, giving your body a break from gluten. Additionally, reducing your inflammation also gives your gut a chance to heal. Which will reduce the symptoms of both conditions. Over time, foods can be re-introduced into the diet. But do not start such a diet or begin reintroduction of foods without speaking with your doctor. If you are thinking of starting such a diet, a meal plan can help.

Probiotics – found in the form of fermented foods and in the form of supplements – can also help. The idea behind probiotics is that they bring in new populations of “good bacteria” to re-populate the gut. These bacteria help digest food, produce vitamins, prevent pathogens from entering the body, and secrete substances that calm the immune system. You can read more about probiotics here.