The Rise of Celiac Disease Still Stumps Scientists
from Time magazine: Oct. 27, 2014
Two new studies in the New England Journal of Medicine rocked the world of celiac research, both proving that scientists have a ways to go in their understanding of celiac
One Italian study wondered if the age at which gluten is introduced into the diet could affect a person’s likelihood of developing the autoimmune disease—so they kept gluten away from newborns for a year. To the shock of the researchers, delaying exposure to gluten didn’t make a difference in the long run. In some cases it delayed the onset of the disease, but it didn’t stop people from developing the disease, for which there is no cure.
The second study, of almost 1,000 children, introduced small amounts of gluten into the diets of breastfeeding infants to see if that fostered a gluten tolerance later on in those who were genetically predisposed to celiac disease. No such luck for them, either. Though both studies were excellently designed and executed, says Joseph A. Murray, MD, professor of medicine and gastroenterologist at the Mayo Clinic in Rochester, each was “a spectacular failure.”
What is it about gluten that causes so many people to double over in pain? How could the innocent, ancient act of breaking bread be so problematic for some?
It’s a question researchers are actively trying to answer. “I think of celiac disease now as a public health issue,” Murray says. He’s been researching the bread protein for more than 20 years and has seen the incidence of celiac disease rise dramatically; celiac is more than four times as common as it was 50 years ago, according to hisresearch, which was published in the journal Gastroenterology. Even though awareness and testing methods have dramatically improved, they can’t alone account for all of that increase, he says.
About 1% of Americans have celiac disease, and it’s especially common among Caucasians. There’s a strong genetic component, but it’s still unclear why some people get it and other people don’t. It seems to affect people of all ages, even if they’ve eaten wheat for decades. And you can’t blame an increased consumption of the stuff; USDA data shows we’re not eating more of it.
Something else in the environment must be culpable, and theories abound about possible factors, from Cesarean sections to the overuse of antibiotics and the hygiene hypothesis, which suggests that as our environment has become cleaner, our immune system has less to do and so turns on itself—and maybe particular foods like gluten—as a distraction.
Or maybe there’s something different about gluten itself. The wheat seed hasn’t changed all that much, but the way we process and prepare gluten products has, Murray says. “There have been some small studies looking at old forms of bread-making…that have suggested it’s not as immunogenic, it doesn’t drive the immune response as strongly as more modern grain or bread preparations,” Murray says.
A small 2007 study found that sourdough bread, when fermented with bacteria, nearly eliminates gluten—but we need much more research before the truly allergic should be reaching for a slice of the stuff.
Dr. Alessio Fasano, MD, director of the Center for Celiac Research and chief of the division of pediatric gastroenterology and nutrition at Mass General Hospital for Children, was a co-author of that recent study about breast-feeding and timing of gluten introduction. He says he found the “major, unpredictable results shocking. The lesson learned from these studies is that there is something other than gluten in the environment that can eventually tilt these people from tolerant to the immune response in gluten to developing celiac disease,” he says.
He suspects it may come down to how the modern, hyper-processed diet has influenced the makeup of our gut bacteria. “These bacteria eat whatever we eat,” Fasano says. “We’ve been radically changing our lifestyle, particularly the way that we eat, too fast for our genes to adapt.” Fasano hopes to explore the microbiome in his next study, in which he says he’ll follow kids from birth and search for a signature in their microbiome that predicts the activation of their gluten-averse genes, which leads to a child developing celiac disease. The hope, then, is that a probiotic or prebiotic intervention will bring the troubled guts back from “belligerent to friendly.”
“That would be the holy grail of preventive medicine,” he says.
Diane Kress response:
Gluten is a protein found in wheat, rye, and barley. There has been a very sharp spike in the incidence of true Celiac disease (also known as gluten enteropathy). It is important to confirm if you have real Celiac disease or a wheat allergy or non-Celiac gluten sensitivity.
Non-Celiac Gluten Sensitivity
Many people avoid gluten, but not all people have Celiac Disease ( gluten enteropathy). Although these people assume they have Celiac and eliminate wheat, rye, and barley, the ingestion of these grains will not cause their body to turn on itself and damage the GI tract.
Symptoms of non-Celiac Gluten Sensitivity may be similar to Celiac disease, but they do not produce antibodies to gluten. The response in their body is not directed toward self tissue destruction and does not cause an autoimmune response. They do not develop intestinal damage from gluten.
Their symptoms are often NOT in the GI tract, they include headache, foggy mind, dizziness, joint pain, and numbness in the extremities. They may also experience some gas and bloating, but the main symptoms are not of the GI tract.
This is NOT Celiac disease….this is a sensitivity to gluten. If they introduce a small amount of wheat at any given time, they may feel nothing or very slight symptoms. If they have an “overdose of wheat” like a pizza, soft pretzel, sub roll, pasta….they meal feel VERY uncomfortable hour or days after consuming wheat. So, for the sake of feeling better, they should minimize these grains.
In non-Celiac gluten sensitivity….there is no autoimmune response, no increased incidence of autoimmune disease, no increased permeability of the intestines. Non-Celiac Gluten Sensitivity is not a wheat allergy.
Those with a wheat allergy would test positive to a skin prick test after ingestion of wheat and their IgE assay would rise. Individuals who test negative for a wheat allergy but have gluten related symptoms may have Non-Celiac gluten sensitivity.
Celiac Disease (Gluten Enteropathy)
Celiac disease IS an autoimmune digestive disease. When gluten is ingested, the disease process damages the villi of the small intestine and interferes with the absorption of nutrients from food. The body attacks itself every time the person with Celiac disease consumes wheat, rye, or barley.
One of the damaging factors of Celiac disease is increased intestinal permeability that allows toxins, bacteria, and undigested proteins to enter the GI tract and bloodstream. Current research points to this permeability of the intestines, and allowing toxins, bacteria, and undigested proteins into the bloodstream may lead to other autoimmune diseases.
Left untreated, Celiac disease can lead to other autoimmune diseases (rheumatoid arthritis, type 1 diabetes, lupus, thyroid diseae), malnutrition, osteoporosis, and cancer.
Treatment for Celiac Disease (Gluten Enteropathy)
The only treatment for Celiac disease is a strict, lifelong, gluten-free diet. This is a diet with the absence of wheat, barley, and rye. (this includes the avoidance of spelt, triticale, and khorasan)
Here are some gluten-free alternatives for these grains:
Brown rice, quinoa, corn flour, corn starch, guar gum, amaranth, tapioca starch, potato flour, potato starch. Almond flour, soy flour, buckwheat, xanthum gum, lentils.
Some hidden sources of gluten:
Semolina, spelt, durum, malt
Getting tested for Celiac Disease:
If you have symptoms of Celiac Disease, don’t assume you have it. You should have a diagnosis. There is a major difference between non-celiac gluten sensitivity and Gluten enteropathy. The former does not lead to other autoimmune diseases and does not damage the GI tract. Celiac disease is an autoimmune disease and will damage the GI tract and can lead to other health issues if a gluten free diet is not adopted for a lifetime.
The blood tests that are ordered to determine Celiac disease include:
Total IgA, IgA-tTG, IgA-EMA, IgG-AGA
It’s VERY important that you do NOT switch to a gluten free diet BEFORE you are tested for Celiac disease. Going without gluten before you are tested may impede diagnosis. If you are already on a gluten-free diet, your physician will request a “gluten challenge” before the blood test. If you test positive, it is possible your physician will recommend a biopsy of the intestine to confirm the diagnosis.
Why do I think there is an upsurge in Celiac Disease:
As with any autoimmune disease, the potential to develop the disease is genetically mediated. (You may have the genetic predisposition to rheumatoid arthritis, but never develop the disease). It seems that the perfect storm of the genes for the autoimmune disease and certain environmental stressors must occur to trip the gene and allow the autoimmune disease to develop.
Some environmental stressors: Overweight, lack of physical activity, food additives, high carbohydrate intake, stress, illness, chronic pain, certain medications.
I am leaning toward the idea that one of the reasons for the upsurge in Celiac disease has to do with our fiddling with wheat. The use of GMOs most likely has to do with triggering this disease.
We have also interfered with natural whole wheat to make refined flour (germ and bran removed to make white flour) and bleaching the refined flour with a whitening agent.
A bleaching agent affects gluten development. A maturing agent may strengthen or weaken gluten development.
Potassium bromate (maturing agent that strengthens gluten but does not bleach)
Benzoyl peroxide (bleaches but does not mature or affect gluten strength)
Ascorbic acid (maturing agent that strengthens gluten but does not bleach)
Chlorine gas (maturing agent, weakens gluten, bleaches)
There is no indication what method was used to whiten or mature the grain/flour, but back in the day, none of these processes affected our bread and bread products.
The food industry has been messing with Mother Nature. Additives, preservatives, GMOs, stripping food, processing food….all with the aim of making more money with longer shelf life, “better appearance”, but to what end? The human body was not designed to accept this lower grade fuel. And now, just now, we are beginning to see the damage this altered, processed, preserved, modified food can do.
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