Nutritional Management of Adult Coeliac Disease: Is it Time for a New Approach? An exploratory study

By Nicky Robinson

Abstract

Background

A gluten-free diet (GFD) is currently the only available treatment for coeliac disease (CD), but symptoms, pathologies and disease risks persist in many adult patients long after gluten elimination. Recent advances in understanding of the immunopathology of CD have raised interest in alternative or adjuvant therapeutic interventions, to reduce the disease burden on patients and healthcare services.

 

Aims and Objectives

The aim of this study was to explore the potential for nutrients and dietary components, other than gluten, to modulate immune dysregulation in adult CD. The objectives were to identify the key factors that contribute to immune dysregulation, consider the potential for nutrients and dietary components to influence these factors, and make recommendations for nutritional therapy practice.

 

Methods

The exploratory study comprised a two-stage process. It commenced with a comprehensive review and synthesis of the literature on the pathogenesis and pathophysiology of CD, followed by an exploration and critical review of the evidence for the immunomodulatory effects of nutrients and common dietary components.

 

Findings

CD immunopathology is highly complex but key features include T-cell dysregulation, chronic inflammation, intestinal permeability and microbial alterations. These underlying imbalances are not fully resolved by gluten withdrawal alone. Immunonutrition research is in its infancy, but early indications suggest that a range of nutrients and common dietary components have the potential to influence immune homeostasis.

 

Conclusions

A GFD remains the essential treatment for CD at this time. However, many adults rely heavily on processed ‘free from’ products which may contribute to persistent immune dysregulation. A new nutritional approach to CD is required to support immune homeostasis and reduce future disease risks. This should emphasise strict gluten withdrawal, but go beyond that to optimise nutritional status, restore the natural microbial ecology of the gut and support wider wellbeing.