Lung Disease, Celiac Disease, Gluten Sensitivity, and Smoking Tobacco

Celiac.com 11/19/2021 - The association between celiac disease and a range of respiratory diseases has long been recognized(1).  An exploration of the literature on this point brought me several new insights.  For instance, I learned that gluten sensitivity is also an important risk factor for certain lung disorders.  Although celiac disease was only slightly more frequent (one of 29 subjects had celiac disease) a whopping 40% (12 of 29) of patients with sarcoidosis showed gluten sensitivity(2).  I also learned that some researchers are even pointing to celiac disease as an underlying cause of some cases of lymphocytic bronchoalveolitis(3) which is an inflammation that narrows the airways in the lungs.  Perhaps the most startling new insight I gained was that despite compliance with a gluten-free diet, patients with celiac disease continue to show signs of a mucosal defect in the lungs(4).  

From a personal standpoint, although I experienced asthma and many breathing problems as a child, I have blamed my 25 years of smoking cigarettes for the bulk of my lung problems.  While I remain confident that this is a large factor in the lung disease I have today, I am also realizing that my celiac disease is a contributing factor.  I have made some important strides in improving my lung function as a result of my studies, and it is these that I would like to share with you here.  

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Although my memory is vague on this point, I’m sure I experienced improvement from the celiac diagnosis and subsequent gluten-free diet.  I’m also sure that food allergy testing, and subsequent avoidance of problem foods, helped stabilize my breathing to the point where I have rarely experienced breathing crises in the last six years.  Nonetheless, I have been limited by a very small capacity for exercise and the predictable losses in conditioning.  In the process of researching ketogenic and low carb dieting for a video I am working on, I chanced upon a reference(5) to a study of healthy women that claimed a 5% increase in peak flow and a 10% improvement in pulmonary function after one week on a low carbohydrate diet(6).  

I have now been following a low carbohydrate diet for more than a month.  My average peak flow has increased by about 15%.  Far more importantly, my tolerance for exercise has increased quite dramatically.  Although I still become breathless after vigorous exercise, I can engage in mild to moderate exercise for considerable periods without any breathing difficulty.  This constitutes a considerable improvement in my breathing and provides an important increase in the quality of my life.  

I realize that smoking is a foolish habit to start.  Despite many warnings I continued this habit for many years, until six months prior to my celiac diagnosis.  I know I am fortunate in not having contracted any of the deadly diseases caused by smoking.  Thus, I take solace in the research that shows that tobacco smoking is a way of self-treating the symptoms of celiac disease(7,8,9,10).  These publications have helped me deal with the self-recrimination that accompanies the knowledge that I created my own breathing problems.  It has also led me to a deeper understanding of the powerful addiction I experienced, the illness I felt after I did finally quit, and the recognition that celiac disease has shaped a great deal of my life.

References:

1. Stevens FM, Connolly CE, Murray JP, McCarthy CF.  Lung cavities in patients with coeliac disease.  Digestion.  1990;46(2):72-80.
2. Papadopoulos KI, Sjoberg K, Lindgren S, Hallengren B.  Evidence of gastrointestinal immune reactivity in patients with sarcoidosis.  J Intern Med.  1999 May;245(5):525-31.
3. Brightling CE, Symon FA, Birring SS, Wardlaw AJ, Robinson R, Pavord ID.   A case of cough, lymphocytic bronchoalveolitis and coeliac disease with improvement following a gluten free diet.  Thorax.  2002 Jan;57(1):91-2. 
4. Robertson DA, Taylor N, Sidhu H, Britten A, Smith CL, Holdstock G.  Pulmonary permeability in coeliac disease and inflammatory bowel disease.  Digestion.  1989;42(2):98-103.  
5. The Ketogenic Diet: A Complete Guide for the Dieter and Practitioner by Lyle McDonald. 1998.
6. Kwan RM, Thomas S, Mir MA.  Effects of a low carbohydrate isoenergetic diet on sleep behavior and pulmonary functions in healthy female adult humans.  J Nutr.  1986 Dec;116(12):2393-402.  
7. Suman S, Williams EJ, Thomas PW, Surgenor SL, Snook JA.  Is the risk of adult coeliac disease causally related to cigarette exposure? Eur J Gastroenterol Hepatol.  2003 Sep;15(9):995-1000. 
8. Austin AS, Logan RF, Thomason K, Holmes GK.  Cigarette smoking and adult coeliac disease.  Scand J Gastroenterol.  2002 Aug;37(8):978-82.  
9. Vazquez H, Smecuol E, Flores D, Mazure R, Pedreira S, Niveloni S, Maurino E, Bai JC.  Relation between cigarette smoking and celiac disease: evidence from a case-control study.  Am J Gastroenterol.  2001 Mar;96(3):798-802.  
10. Snook JA, Dwyer L, Lee-Elliott C, Khan S, Wheeler DW, Nicholas DS.  Adult coeliac disease and cigarette smoking.  Gut.  1996 Jul;39(1):60-2.