Celiac disease, an autoimmune disease triggered by gluten, a protein found in wheat, barley, and rye, is estimated to affect about 3 million Americans, or one percent of the population. Of the celiac population, only 3% have been correctly diagnosed. These numbers may seem particularly staggering, but in fact the results of a new study are showing that the incidence of the disease may be increasing as the American population agew. Although this may seem like bad news, the new study makes it appear likely that there is a major environmental factor in developing celiac disease and that it may be preventable or have other treatment options.
According to the researchers, 3,511 patients from Washington County, Maryland were followed from 1974 to 1989 during which time the number of celiac cases doubled, as established by blood tests measuring proteins. The study was published in the Annals of Medicine with the conclusion that celiac disease doesn’t begin in childhood, as it was once believed.
The researchers offered the results as an explanation for why incidence of celiac disease has increased by several times over the past three decades. According to a news article on Medscape Today, the incidence of CD has increased measurably over the past three decades by as much as four times. In fact, studies are now showing the current incidence may actually be higher than 1% of the population. According to Dr. Jonas Ludvigsson, MD, from the Department of Medicine, Epidemiology Unit at the Karolinska Institute and Orebro University Hospital in Sweden, and a celiac expert, there could be many factors and at the root, “there is probably a true underlying increase.” The authors of the Annals of Medicine study agree that the figures haven’t changed just because of improved diagnosis. In fact, the researchers believe that the rise can be attributed to an environmental factor, giving us hope of a method of prevention.
Dr. Alessio Fasano, professor of pediatrics, medicine and physiology at the Center for Celiac Research at the University of Maryland School of Medicine, an author of the study, said in a phone interview with a Bloomberg.com reporter, “If we can understand what helps people lose gluten tolerance, we may develop tricks to retain tolerance, even if you’ve lost it already.” After all, according to Fasano, patients’ genes stayed the same during the study, and people with a genetic predisposition for celiac disease can live well into their adulthood before becoming ill.
In his article, “Surprises from Celiac Disease,” published in Scientific American, Dr. Fasano describes a triad of factors involved in the pathogenesis, or origin and development, of the disease. The first two factors are the “trigger” of gluten, which sets off the immune response, and the genetic predisposition. The third factor, according to Fasano’s research is an “unusually permeable gut.” Fasano’s research regarding this third factor of pathogenesis offers hope of new prevention and treatment methods. He says, “Treatments that reduced leakiness could potentially ease not only celiac disease but also other autoimmune disorders involving unusually permeable intestines.”
Due to the fact that celiac disease is an autoimmune disease, researchers may be able to apply some of their research findings to other autoimmune disorders such as inflammatory bowel syndrome (IBS) and rheumatoid arthritis. For instance, Dr. Fasano proposes that these three factors also underlie the pathogenesis of other autoimmune diseases, with of course triggers and genetic elements unique to these diseases. Fasano tells us that most non-celiacs have “tight junctions [that] ‘glue’ intestinal cells together.” On the other hand, in celiac patients, these links come apart, resulting in a small intestine from which pieces of gluten leak into the tissue, and stimulate a response from immune cells.
As telling as the Annals of Medicine study is, there is much more research to be conducted in the area. Fasano says he will continue to examine an environmental trigger, which may be even a virus or bacterium; he plans to compare celiac patients who developed the disease in childhood with those who developed the disease later in life. In the end, a closer examination of the environmental factor involved in the pathogenesis of celiac disease may lead to another treatment option or even in a method of prevention. The results have the potential to change the lives of millions of celiac Americans as well as those who suffer from other autoimmune diseases.
Bloomberg: Celiac Disease Incidence Increases as People Grow Older, U.S. Study Shows http://www.bloomberg.com/news/2010-09-27/celiac-disease-incidence-increases-as-people-grow-older-u-s-study-shows.html
Celiac.com: Celiac Disease Statistics http://www.celiac.com/articles/1164/1/Celiac-Disease-Statistics/Page1.html
Fasano, Alessio, MD. “Surprises from Celiac Disease: Study of a potentially fatal food-triggered disease has uncovered a process that may contribute to many autoimmune disorders.” Scientific American: August 2009.
Medscape Today: Celiac Disease Diagnosis Up 4-Fold Worldwide http://www.medscape.com/viewarticle/726127
From our home to yours, Tina Turbin
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