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Isabelle Giles

Professor Roberts

Nutrition 2010

7 November 2017

Celiac Disease

Once considered a rare malady, celiac disease, also known as gluten-sensitive

enteropathy is progressing at a fast rate. According to a research done by the Mayo clinic, the

disease has gone up 400%, compared to fifty years ago, and it was then affecting 1 in 2000

people. It is estimated today that 1 in 133 people in the United States are suffering from this

disease. Many theories have been discussed to explain the reasons celiac disease is widespread

and growing at such a fast rate. David A. Van Heel, Professor of Genetics, Blizard Institute,

Queen Mary University of London stated that Celiac disease (CD) is a multifactorial disorder

involving both genetic and environmental factors.

Celiac disease is a genetically predisposed autoimmune disease, enflaming and damaging

the small intestine. When gluten, mixture of tiny protein fragments (polypeptides) most

commonly found in cereal grains such as wheat, rye, barley, spelt, faro and kamus is ingested,

the body reacts by creating an immune response attacking and leading to a severe degradation of

villi, which are finger-like folds that helps the absorption of nutrients in the small intestine. We

can classify gluten into two groups: prolamines gliadin and glutelins. Prolamines gliadin is the

instigating component of the immune response and the intestinal degradation that accompanies

the celiac disease. Once diagnosed with celiac disease, the only treatment that will reduce or

make the symptoms disappeared is to follow a strict gluten-free diet. Not eating gluten will not
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only help heal the villous atrophy in the small intestine but it will also help prevent future

complications, including malignancies. Unfortunately, many people may have the disease and

have not yet been diagnosed, which make them at risk for long-term health issues. When left

untreated, celiac disease can cause irreversible damage to the lining of the digestive tract and can

potentially lead to cancer and other related conditions. Doctor Joseph Murray, Mayo clinic

gastroenterologist pointed out:

We also have shown that undiagnosed or silent celiac disease may have a

significant impact on survival. The increasing prevalence, combined with the

mortality impact, suggests celiac disease could be a significant public health

issue.

For Doctor Murray, the most important impact would be to raise awareness of this

disease among the population but also among physicians as some of them still believe celiac

disease to be rare. As people get more educated and become more aware, they will pay closer

attention to the maladys symptoms which are, recurring abdominal pain (aggravated when

consuming food such as bread, pasta, crackers), join paints, arthritis, depression or anxiety,

mouth sores (aphtus ulcer), growth problems and failure to thrive in children, chronic diarrhea,

constipation, vomiting, bone pains, muscle cramps, skin rash (dermatitis herpetiformis), missed

menstrual periods, weight loss, seizures, and tingling and numbness in the legs due to nerve

damage. In order to diagnose celiac disease, several serologic (blood) tests are available. Those

tests screen for celiac disease antibodies. The most common test used is Ttg-igA test. It works

based on the consumption of gluten. If the result comes back positive for celiac disease, a biopsy

of the small intestine will be ordered by the physician to confirm the diagnostic.
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There are three factors associated with an increased risk of developing celiac disease. The

first factor is in the gene variation. Celiac disease is more common in people who have a relative

who has the disease. If it is a first-degree relative then there is a 1 out of 10 chances of getting it.

In fact, 95% of people suffering from celiac disease carry a specific gene called: the HLA-DQ2

gene and the other 5% carry a gene called: HLA-DQ8 gene. The gene HLA-DQ2 is the most

known and the most prevalent of the two in the celiac disease. A genetic testing can be done to

see if the gene is present in the body. The second factor is environment. The major

environmental trigger for developing celiac disease is eating gluten. In order to get a better

understanding of this condition, researchers are looking for more environmental factors that

contribute to the development of the disease. Dr Alessio Fassano, Chief, Division of Pediatric

Gastroenterology and Nutrition at Mass General Hospital for Children in Boston stated:

Is this coincidence or cause and effect? What we know is that at any time in your

life, whether through infections, traveling, antibiotics, pregnancy or whatever, the

composition of the gut can shift from a friendly balance that keeps the immune

system in check to an unfriendly place that will put the immune system on high

alert.

We can conclude that infection, illness, pregnancy, antibiotic use and so forth are environmental

factors that can lead to the potential development of the celiac disease. And the third triggering

factors are people who have an auto-immune disease such as type 1 diabetes, rheumatoid

arthritis, thyroid or liver disease, Addisons disease (progressive anemia), or Sjogrens syndrome

(malfunction of the gland creating moisture for the body). Also, people who have genetic

disorder such as Down syndrome or Turners Syndrome (chromosome condition in the women)
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are more prone to being affected by celiac disease. People who already suffer from an auto-

immune disease are more likely to develop another autoimmune disease.

Celiac disease is not only growing in the United-States. If we look at other parts of the

world, we can see that this malady is becoming more and more prevalent. For instance, if we

look at Europe, 3 in 100 people in the United Kingdom, 1 in 99 people in Finland and 1 in 370

people in Italy have been diagnosed with celiac disease. In the fifties, 1 in 8,000 people

worldwide were affected by celiac disease, today we are looking at 1 in 100. Doctor Fasano

commented:

There must be an environmental factor that explains why most people with the

predisposition eat gluten all their lives and stay healthy, and others lose their

tolerance. And it could happen at any time. Some people dont become celiac

until they are in their 70s. We also know that prevalence is rising and were in

the midst of an epidemic.

This epidemy is believed to be caused by the way wheat has been processed. Doctor William

Davis, cardiologist in Milwaukee and author of the book entitled Wheat belly pointed out:

We know that celiac disease has doubled in the last 20 years and we know that

humans have probably not changed, so the more likely culprit is the wheat itself.

The theory that wheat is at the essence of the epidemy of celiac disease is quite controversial.

Eliza Barclay, science and health editor at Vox.com commented:

Over the last 40 years, breeders have introduced new varieties of wheat that

helped farmers increase their grain yields. Those varieties now make up 90% of

all the wheat farmers grow around the world.

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While some scientists and researchers believe those new varieties are what make people sick

others do not think that it is the case. Daniel Leffler, director of research at Beth Israel

Deaconess Medical Center and on the faculty at Harvard Medical School believe that there is

not one single cause leading to the increased prevalence of celiac disease. He goes on saying:

We sort of chafe at these over simplistic theories that purport to explain an entire rise in a

disease."

More research needs to be done to really single out wheat as the number one cause of

increased prevalence of celiac disease.

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Works Consulted

Celiac disease. (2017, July 29). Retrieved November 06, 2017, from

https://www.mayoclinic.org/diseases-conditions/celiac-disease/symptoms-causes/syc-

20352220

Parker-Pope, T. (2009, July 02). Celiac Disease Becoming More Common. Retrieved November

06, 2017, from https://well.blogs.nytimes.com/2009/07/02/celiac-disease-becoming-

more-common/

Snchez, Ester, et al. Influence of Environmental and Genetic Factors Linked to

Celiac Disease Risk on Infant Gut Colonization by Bacteroides Species. Applied and

Environmental Microbiology, American Society for Microbiology, Aug. 2011,

www.ncbi.nlm.nih.gov/pmc/articles/PMC3147488/.

Dr. Alessio Fasano Speaks Out About Celebrity Gluten-Bashing, Celiac Disease

Research.Celiac Disease Foundation, 3 Feb. 2014, celiac.org/blog/2014/02/dr-alessio-

fasano-speaks-out-about-celebrity-gluten-bashing-celiac-disease-research/.

Barclay, Eliza, and Allison Aubrey. Doctors Say Changes In Wheat Do Not Explain Rise Of

Celiac Disease. NPR, NPR, 26 Sept. 2013,

www.npr.org/sections/thesalt/2013/09/26/226510988/doctors-say-changes-in-wheat-do-

not-explain-rise-of-celiac-disease.