If you have coeliac disease the only treatment available is to follow a strict gluten free diet. This is because, for coeliacs, the presence of gluten causes an auto-immune response which damages the lining of the gut.

In this article, we’ll take a closer look at how the small intestine normally works, and how this auto-immune response stops those normal processes from happening.

How the gut works

The small intestine is a long tube that is folded up into the abdomen. It extends from the end of the stomach to the start of the large intestine and fills much of the abdominal cavity. If it were stretched out, the average small intestine would measure anywhere between 10 and 22 feet long, depending on your age, height and body size. This is where most of the nutrients are absorbed from your food. 

To increase the surface area available for absorption, the surface of the small intestine is covered in tiny finger-like projections, called villi. These are 0.5-1.6mm long1 and cover the whole of the surface of the small intestine. There are 10-40 villi per square millimetre or 6,000- 25,000 per square inch2. Each villi is covered in even smaller protrusions, called microvilli.

These villi and microvilli increase the surface area of the small intestine considerably. This is often quoted to be around 250m2, roughly the size of a tennis court, although a more in-depth study, by Swedish scientists Herbert Helander and Lars Fändriks, reached a more conservative conclusion of around 30m2, which they say is more like half a badminton court.

How gluten stops the gut from working

When someone with coeliac disease strays from their gluten free diet, it causes an auto-immune reaction. The immune system mistakes an element of gluten, called gliadin, as a threat, and in response, it produces antibodies that cause inflammation and damage to the villi.

As the villi become inflamed, they shorten and eventually flatten, substantially reducing the surface of the small intestine that is available to absorb nutrients. If you do not follow a gluten free diet, repeated exposure to gluten will ultimately lead to villous atrophy, where the villi can disappear completely.

Without the villi to absorb nutrients, the body suffers malabsorption, leading to nutritional deficiencies. At the same time, the inflammation, caused by the auto-immune response can cause pain and discomfort in the gut. Lack of proper digestion and absorption can also cause other symptoms of coeliac disease, such as diarrhoea and constipation.

It will recover

The good news is that cells within the gut lining are being constantly replaced. That means that if you follow a gluten free diet, your small intestine can fully recover from the damage caused by coeliac disease. You may experience improvements in a matter of weeks, and for most patients, the small intestine will be completely back to normal in three to six months. As we get older, the body takes longer to heal, and for older patients, complete gut recovery can take up to two years.

Fortunately, following a gluten free diet has never been easier, thanks to the tasty range of gluten free foods available on prescription from Glutafin (subject to local prescribing conditions). Our brand-new gluten free fresh breads have raised the bar even higher, with a choice of soft and fluffy fresh white, deliciously nutty fresh brown and scrumptiously crunchy seeded loaves.

You’ll also find loads of handy recipes to support your gluten free diet on our website. These will help you to enjoy all your old favourites in a new way that supports your gut and protects those essential little villi in your small intestine.

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