In this article, we’ll look at the link between coeliac disease and gut microbiome imbalance, also known as dysbiosis. We’ll start by looking at what coeliac disease is and how it affects the body. We’ll explore how this condition can influence the gut microbiome and why people with coeliac disease may experience changes in their gut bacteria. We’ll also look at how gluten affects the gut in those with coeliac disease and whether lifestyle changes can help support a healthier balance of gut bacteria. If you have coeliac disease or suspect you might, it’s important to speak to a healthcare professional before making any changes to your treatment or diet.

Here are the five biggest takeaways from this article about the link between coeliac disease and microbiome dysbiosis:

• Coeliac disease is a lifelong autoimmune condition triggered by gluten

• Coeliac disease is associated with gut microbiome imbalance, known as dysbiosis

• Gluten worsens gut microbiome imbalance in coeliac patients

• A gluten-free diet is essential, but it may not fully restore microbiome health

• Dietary fibre, probiotics, and personalised nutrition can support gut health

Coeliac disease is a lifelong autoimmune condition that occurs when the immune system reacts abnormally to gluten. In people with coeliac disease, eating gluten causes the immune system to attack the lining of the small intestine. This leads to damage to the villi, tiny finger-like structures responsible for absorbing nutrients from food. As a result, people with coeliac disease often experience symptoms such as bloating, diarrhoea, abdominal pain, nausea and unintentional weight loss.

The condition is thought to develop due to a mix of genetic and environmental factors. People who carry certain genes are more likely to develop coeliac disease, although having these genes does not necessarily mean someone will get it. Environmental factors, such as gluten exposure or certain infections, can also play a role in triggering the disease.

Coeliac disease can appear at any stage of life and affects roughly 1 in 100 people worldwide. It tends to be more common in people with a family history of the condition or other autoimmune disorders, such as type 1 diabetes. Women are also diagnosed more often than men, although the reasons for this are not yet fully understood.

Unfortunately, there is currently no cure. However, the condition can be managed effectively with a strict gluten-free diet. Diagnosing coeliac disease typically involves a biopsy of the small intestine. This can confirm the diagnosis and assess the extent of the damage caused [1]. 

In the video below, a dietitian from Coeliac UK provides a simple overview of Coeliac disease:

Coeliac disease not only affects the immune system and gut lining but also leads to significant changes in the gut microbiome, a condition known as dysbiosis. People with coeliac disease often show reduced microbial diversity and an imbalance in key bacterial groups, both in the small intestine and the colon. 

Studies have found that beneficial, anti-inflammatory bacteria such as Bifidobacteria and Lactobacilli tend to be lower in people with coeliac disease, while potentially harmful bacteria, such as Bacteroides, Prevotella, and certain strains of Escherichia, are often increased [2].

In one study of children genetically at risk of coeliac disease, those who went on to develop the condition had early increases in pro-inflammatory bacteria, alongside decreases in beneficial, butyrate-producing species [3]. This highlights the possible role of the microbiome in the development and progression of coeliac disease, as well as its potential as a target for future treatments.

In people with coeliac disease, gluten doesn’t just trigger an immune response, it also contributes to further disruption of the gut microbiome. When gluten is consumed, it can worsen inflammation and damage to the intestinal lining, creating an environment that supports the growth of pro-inflammatory and potentially harmful bacteria. 

At the same time, beneficial bacteria that usually help to maintain balance in the gut are reduced. These bacteria are important because they produce enzymes that can partially break down gluten. Without them, gluten remains in a more damaging form, which may lead to increased immune activation and further injury to the gut lining [4].

This interaction creates a cycle where gluten contributes to microbiome imbalance, and that imbalance worsens the body’s response to gluten.

Lifestyle changes can play an important role in supporting the gut microbiome in people with coeliac disease. While a strict gluten-free diet remains the foundation of treatment, research shows that this might not be enough to fully restore a healthy balance of gut bacteria. Because gluten-free diets often lack certain fibres, they can sometimes lead to a drop in beneficial bacteria such as Bifidobacteria [5].

To encourage the growth of protective, anti-inflammatory microbes, people with coeliac disease may benefit from additional dietary and lifestyle strategies. This could include increasing the intake of naturally gluten-free, high-fibre foods such as oats (naturally gluten-free), legumes, fruits and vegetables. Probiotics are another area of growing interest. Certain strains have shown promise in helping to restore microbial balance and reduce inflammation in coeliac disease, though more research is needed before they can be widely recommended [6].

Perhaps most exciting is the potential of personalised nutrition. Dietary advice tailored to someone’s unique gut microbiome, like you get with a Vivere membership, can offer more targeted and effective ways to manage gut health in coeliac patients [7].

Understanding the link between coeliac disease and gut microbiome imbalance gives us a more complete picture of how this condition affects the body. While a gluten-free diet is essential for managing symptoms and allowing the gut to heal, additional support may be needed to restore and maintain a healthy microbiome. 

Reduced levels of beneficial bacteria and an increase in pro-inflammatory species can contribute to ongoing gut issues, even after removing gluten from the diet. Making informed lifestyle changes, such as eating more high-fibre, gluten-free foods or exploring probiotic supplements, may help support better gut health. 

Personalised nutrition based on individual microbiome profiles, like you get with a Vivere membership, offers a different approach to managing coeliac disease more effectively.

[1] Celiac Disease - StatPearls - NCBI Bookshelf

[2] Gut Microbiota in Celiac Disease: Is There Any Role for Probiotics? - PMC

[3] Is the microbiome important in celiac disease? | Journal of the Canadian Association of Gastroenterology | Oxford Academic

[4] Dietary Gluten as a Conditioning Factor of the Gut Microbiota in Celiac Disease - ScienceDirect

[5] Dietary Modification for the Restoration of Gut Microbiome and Management of Symptoms in Irritable Bowel Syndrome - PMC

[6] Effects of a gluten-free diet on gut microbiota and immune function in healthy adult humans - PMC

[7] A low-gluten diet induces changes in the intestinal microbiome of healthy Danish adults | Nature Communications