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There may be a relationship between celiac and pancreatitis. That’s because celiac has been linked to pancreatic conditions and symptoms.
In this post, we’ll be diving into the relationship between these two conditions, why it might happen, and what you might do about it.
As always, this post is written for educational purposes only. If you have any questions or concerns about your health, diagnoses, and/or treatment, be sure to talk to your healthcare team.
Before we get into why pancreatitis can happen with celiac disease and what to do about it, we need to understand what celiac is.
Celiac is a serious autoimmune disease that occurs in genetically predisposed people where the ingestion of gluten leads to damage in the small intestine. When people with celiac disease eat gluten (a protein found in wheat, rye, barley, and contaminated foods like oats), their body mounts an immune response that attacks the small intestine.
These attacks lead to damage to the villi, small fingerlike projections that line the small intestine, that promote nutrient absorption. When the villi get damaged, nutrients cannot be absorbed properly into the body.
This inflammatory response to gluten and related nutrient deficiencies can cause a wide variety of symptoms in people with celiac. From bloating, headaches, constipation, joint pain, bone health complications, infertility, weight gain, weight loss, and more.
According to the Celiac Disease Foundation, celiac disease is estimated to affect 1 in 100 people worldwide, but only about 30% are properly diagnosed. Celiac disease is hereditary, meaning that it runs in families. People with a first-degree relative with celiac disease (parent, child, sibling) have a 1 in 10 risks of developing celiac disease.
Now that we know what celiac is, we know what the pancreas is so we can understand the relationship between the pancreas and celiac disease. The pancreas is a small long organ tucked beside the stomach. It produces insulin to absorb blood sugar into the cells and pancreatic enzymes to help digest food.
The cells of the body need sugar to generate energy for the cells to function making the insulin function of the pancreas essential. Without insulin to help absorb blood sugar, the cells starve and cannot perform their functions.
Pancreatic enzymes break down food into small enough molecules that the blood can absorb them and the cells can use them. The pancreatic enzymes include trypsin and chymotrypsin to digest proteins; amylase for the digestion of carbohydrates; and lipase to break down fats. Without enzymes, food goes undigested, and malnutrition can occur.
Understanding the pancreas is one thing, and understanding terminology around it is another when it comes to talking about the connection between pancreatitis and celiac.
Pancreatitis is inflammation of the pancreas. Pancreatitis may start suddenly and last for days, or it can occur over many years. It has many causes including gallstones and chronic, heavy alcohol use.
Symptoms can include
There are many ways pancreatitis can show up with celiac, which takes us to exploring the relationship between the two.
Now that we know what pancreatitis is, how is it different from autoimmune pancreatitis? Pancreatitis is caused by physical things such as too much alcohol or gallstones blocking the pancreas duct.
An autoimmune pancreatitis is where the pancreas cells are under attack from the body’s own immune system. This condition is often linked with celiac disease.
According to the Cleveland Clinic, autoimmune pancreatitis is rare, occurring in less than 1 in 100,000 people. It accounts for only 2% of all cases of long-lasting (chronic) pancreatitis.
There are many ways celiac and pancreatitis are related. From autoimmune forms to insufficiencies from damage… celiac can wreak havoc not just on the small intestine but other areas of the body too if unmanaged. This is one of many reasons why celiac disease is dangerous if untreated.
So we know what celiac and pancreatitis are, what’s the link between celiac and autoimmune pancreatitis?
A refresher, pancreatitis refers to the general inflammation of the pancreas. It is generally caused by physical things such as too much alcohol or gallstones blocking the pancreas duct.
An autoimmune pancreatitis is where the pancreas cells are under attack by the body’s own immune system. This condition is often linked with celiac disease but research is mixed on if there is an actual relationship.
According to the Cleveland Clinic, autoimmune pancreatitis is rare, occurring in less than 1 in 100,000 people. It accounts for only 2% of all cases of long-lasting (chronic) pancreatitis.
Celiac can cause pancreatitis in people with celiac. This basically just means eating gluten when you have celiac can cause inflammation of the pancreas.
Remember, celiac disease can cause damage to the small intestines when gluten is consumed. Specifically, it can cause gaps between the cells of the intestinal wall (also known as leaky gut). These gaps could allow gluten particles (among other things) to flow straight into the blood.
Because gluten could flow straight into the blood due to the damage to the intestinal wall, some research articles suggest that this could allow the gluten to enter the pancreas which could affect its structure and can stress the cells to overproduce insulin. This can ultimately lead to inflammation and damage impacting the overall function of the pancreas.
Because gluten can impact the pancreas with celiac disease, one of the side effects can be pancreatic insufficiency. This is where the pancreas is not producing enough enzymes.
According to some sources, between 10 and 20% of patients with newly diagnosed celiac disease are likely to experience pancreatic insufficiency. Another study published in 2010 concluded that there is an association between celiac disease and exocrine pancreatic insufficiency.
The study, “reported that in 30% (20/66) of adult celiac patients with current or persistent diarrhea the underlying cause was exocrine pancreatic insufficiency. Of these 20 patients, 19 initially improved on pancreatic enzyme supplementation.”
Now, this does not immediately mean you have pancreatic insufficiency or need a digestive enzyme, but it is something to consider if you’re not feeling better. Additionally, through my own work with patients, I have seen pancreatic insufficiency go away as patients heal from gluten damage.
If you have pancreatitis with celiac disease, depending on the form, you may benefit from different nutrition habits. Enzyme supplements provided to you by your doctor may be one form of treatment to replace what is not being produced by the pancreas.
There may be a surgery, a sphincterotomy, to address the pancreatic duct but studies show it may not be effective in chronic pancreatitis. A gluten-free diet is another part of the treatment if pancreatitis is related to gluten and celiac.
Now, I’m not a doctor, and this likely does not include all potential treatments for pancreatitis, so be sure to consult your doctor about your treatment plan. However, as a dietitian, there are some ways I can support you through food depending on the situation.
If you have pancreatitis with celiac, there are many treatment options. And food is one of the ways you might support what may be going on in the body.
Please note that just because something is listed as a potential approach does not mean it’s the right approach for you. Nutrition is highly individualized and these are just some things a dietitian may consider but may not actually be necessary.
A dietitian may help you to determine whether it would be beneficial to take an enzyme supplement. This is important to review with a professional because enzymes can cause side effects when taken unnecessarily.
A dietitian may guide you on how to follow a gluten-free diet safely in order to stop continued damage from gluten to the body and allow the body to heal. (I also cover general celiac safety for this in my Celiac Crash Course – which covers what would take 12 sessions with a dietitian for a fraction of the cost if you’re interested).
A dietitian may guide you to eat a low-fat diet depending on what’s going on with your fat digestion and stool – so as to put less stress on the pancreas to produce the lipase enzyme that breaks down fat.
You may also be told to eat small frequent meals so that the pancreas doesn’t have to work as hard to digest big meals. This will also help prevent overeating at specific times during the day which will reduce stress on the pancreas.
You also may be guided on how to adapt your current food preferences and habits to include more fruits, vegetables, and gluten-free whole grains to build out a balanced diet. This will also help support the pancreas and overall health.
All of that said, remember, just because something is listed as a potential approach does not mean it’s the right approach for you. Nutrition is highly individualized and these are just some things a dietitian may consider but may not actually be necessary. Be sure to consult your dietitian if you have any concerns or questions about your current diet plan.
Celiac, pancreatitis, and pancreatic insufficiency can be related. Celiac has been linked to triggering pancreatitis and pancreatic insufficiency. A gluten-free diet seems to help improve pancreatic celiac-related symptoms.
And if you have celiac with pancreatitis side effects, avoiding gluten will be important in healing. Make sure you’re doing everything you can to make sure gluten and cross-contact aren’t sneaking into your diet. If you need help with this or no one told you how to do this, I break it down into simple steps in the Celiac Crash Course. Learn more about the course here.