Celiac Disease No Longer a Rare Disorder

Celiac disease (CD), a digestive system disorder caused by intolerance to gluten, was historically thought to be rare, but it is becoming evident that is no longer the case. According to a recent study, the disorder currently affects approximately 3 million Americans, or about 1 in 100 people, making it almost as prevalent as type I diabetes. However, researchers suspect that because its symptoms are similar to other diseases, such as irritable bowel syndrome, many more cases remain undiagnosed. In fact, some studies have suggested that for each person diagnosed with CD, there are as many as 30 who unknowingly have it, putting them at risk for a variety of health problems.

In order to assess the prevalence of CD and whether it had long-term health consequences if left undiagnosed and untreated, Mayo Clinic researchers, led by Dr. Joseph Murray, tested blood samples gathered at Warren Air Force Base (AFB) in Wyoming between 1948 and 1954 for the antibody that people with celiac disease produce in reaction to gluten and then compared those blood test results with those from two recently collected sets from Olmsted County, Minnesota. The researchers found that young people today are 4.5 times more likely to have CD than young people were in the 1950s, when the first causal link between gluten and the disorder was identified. “Celiac disease is unusual, but it’s no longer rare,” Dr. Murray said. “It now affects about one in a hundred people.” 

The team also found that people who were unaware they had celiac disease were nearly four times more likely than those who were celiac-free to have died during the 45 years of follow-up. “Undiagnosed or ‘silent’ celiac disease may have a significant impact on survival,” said Dr. Murray. “The increasing prevalence, combined with the mortality impact, suggests celiac disease could be a significant public health issue.”

When a person who has CD eats foods containing gluten, a protein found in wheat, barley, and rye, their immune system responds by attacking the small intestine, destroying the intestinal villi, thus inhibiting the absorption of vital nutrients into the body. Symptoms of CD may include diarrhea, abdominal discomfort, weight loss, tooth loss, infertility, anemia, or even premature or severe osteoporosis. Left untreated, CD may increase the risk of many other conditions, including hepatitis, thyroiditis, lymphoma, diabetes, and rheumatoid arthritis.
 
Dr. Murray says the study findings highlight the need for increased awareness of celiac disease, both among health professionals and patients, and perhaps revised screening protocol. “Something has changed in our environment to make it much more common. Until recently, the standard approach to finding celiac disease has been to wait for people to complain of symptoms and to come to the doctor for investigation. This study suggests that we may need to consider looking for celiac disease in the general population, more like we do in testing for cholesterol or blood pressure.”

The findings also raise questions about the reason why prevalence of the disorder has risen so quickly. One theory is that modern, cleaner living, which has resulted in fewer infections, parasites and microbes in our bodies, causes the immune system to attack healthy tissue instead. Or it could be due to the modern diet, Murray said. “The types of food we eat now are different,” he said.

The only treatment for celiac disease is a gluten-free diet. But despite the fact that manufacturers are required to label food that contains gluten, adhering to a gluten-free diet can be tricky business. In addition to the obvious places gluten can be found in a normal diet, such as breads, cereals and pasta, there are many hidden sources of gluten. Everyday products such as medicines, vitamins and even lip balms contain gluten, as does thickening agents, emulsifiers, fillers, flavor enhancers, and food stabilizers. Gluten may even be present on surfaces used for food preparation or cooking, so there are many ways to ingest it without realizing it.

The study was published in the July edition of the journal Gastroenterology.