Some don't recover fully on a gluten-free diet alone. Photo: CC-Evil Erin
This article originally appeared in the Spring 2010 edition of Celiac.com's Journal of Gluten-Sensitivity.

Celiac.com 10/22/2010 - More and more we’re hearing from frustrated patients who, despite being vigilant about their gluten-free diet, continue to suffer health problems.

I have been involved in the field of celiac and gluten sensitivity for over 15 years and am delighted by much of the recent increased awareness and attention given to the area.  But I’m also concerned about the lack of assistance given to many patients who have been definitively diagnosed with either celiac disease or gluten sensitivity.  While being correctly given the advice to not eat gluten, they are not provided with a follow-up program to address and treat the secondary effects of gluten sensitivity.  This oversight condemns many to ongoing ill health.

The focus of this article is on the types of conditions we see clinically with our patients, some of the recent research that corroborates our findings, and steps you can take to address the underlying root cause of these problems.

Leaky Gut

Also known as increased intestinal permeability, a leaky gut refers to a loss of integrity of the lining of the small intestine.  Recall that the small intestine is approximately 23 feet in length and has the surface area of a tennis court.

Gluten, in the sensitive individual, is a known cause of leaky gut, but in a perfect world the elimination of gluten would allow healing to occur resulting in an intact, healthy intestinal lining.

Alas, we do not live in a perfect world and other factors contribute to the health of the gut.  Infections in the form of parasites, amoebas, bacteria, and the like, can certainly contribute to continued increased permeability.  Likewise, other food reactions, chief among them dairy, can cause persistent irritation and thereby prevent healing.  Imbalance of the beneficial bacteria or microbes that comprise the microbiota of the intestine, as well as nutritional and pancreatic enzyme deficiencies, are also suspected to limit healing.

Let’s take a look at each of these individually:

Infections

Whether one has celiac disease or is gluten sensitive, one thing is for sure, one’s immune system has been overtaxed due to the presence of gluten in the diet.  Depending on the age at diagnosis, it is often several decades of stress that the immune system has undergone.

Such an overburdened immune system is unable to be as vigilant as a healthy one and as a result it allows such organisms as parasites, amoebas or bacteria to infiltrate the body.  Some estimates suggest that the digestive tract is normally exposed to a pathogenic organism every 10 minutes.  A healthy intestinal immune system is able to identify and eradicate those organisms as part of its normal activities.  An unhealthy immune system often “misses” such organisms and they happily take up residence in the small intestine.

Interestingly, some of these organisms create crypt hyperplasia and villous atrophy that appears the same as that caused by gluten.  Imagine the frustration of a patient who is being told by their doctor that they are not following their diet when indeed they are.  What’s being missed?  The presence of an infectious agent.

In the 2003 American Journal of Gastroenterology, researchers reported a large percentage of