Coeliac Disease 4 Times More Common Than Previously Thought

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Examples of macroscopic features of villous atrophy detected by wireless capsule endoscopy in coeliac disease: A) Normal villi, B) scalloping of the mucosa on circular folds, C) fissuring of the mucosa, D) mosaic pattern. © Mayo Clinic

Researchers from the USA, Europe and other research centres are suggesting that Coeliac Disease has increased up to 4 x in the last 30 years.

They suggest that as much as 1% of the adult and child populations may have CD, and as we know there are many others that have yet to have the disease diagnosed, but experience problems with gluten and are diagnosed as being intolerant or sensitive.

Let’s be clear about what gluten intolerance is. ‘It isn’t a food allergy’. It’s a physical condition in your gut. Basically, undigested gluten proteins (prevalent in wheat and other grains) lurk around your intestines and are regarded by your body as a foreign invader, irritating your gut and flattening the essential microvilli along the small intestine wall. This reduces the surface area available to absorb the nutrients from your food. This can result in symptoms of malabsorption, including chronic fatigue, neurological disorders, nutrient deficiencies, anaemia, nausea, skin rashes, depression, and more.

Whilst there are better screening techniques today than there were in the 1980’s, we must also recognise that there are many other factors at work here, one of which is the changing levels of gluten in grains from hybridisation techniques.

Mayo Clinic Research Confirms Rise in CD

Researchers at the Mayo Clinic also report an increase in CD, according to an article in the summer issue of the Mayo Clinic’s research magazine.[1]

Researchers analysed stored blood samples, taken from Air Force recruits in the early 1950s, for gluten antibodies. They assumed that 1% would be positive, mirroring today’s rate. That assumption was wrong — the number of positive results was far smaller, indicating that CD was “rare”.

What’s more, Mayo has found a fourfold higher death risk for people with undiagnosed gluten intolerance.

A further 2 more recently collected sets from Olmsted County, Minnesota confirmed this finding suggesting CD is roughly 4 times more common now than in the 1950s.

“This tells us that whatever has happened with CD has happened since 1950,” Dr. Murray said. “This increase has affected young and old people. It suggests something has happened in a pervasive fashion from the environmental perspective,” he added.

Excess Mortality Seen With CD and Latent CD

The condition of latent CD or “gluten sensitivity” was described in the  Journal of the American Medical Association as having normal small intestinal mucosa but positive CD serology and is something that is estimated to occur in at least 1 in 1000 individuals.[2]

Dr. Ludvigsson’s team has also reported evidence that in 1 year, 10 of 1000 individuals with CD will die compared with an expected 7 in 1000 without the disease. He said:

Not only is the mortality raised in patients with CD but also in those individuals with latent CD, he emphasised that “although patients with CD are at increased risk of a number of disorders, and at increased risk of death, the absolute risk increase is very small.”

A Tricky Disease

CD It can be asymptomatic; have so-called traditional symptoms such as diarrhoea, weight loss, failure to grow (in children), fatigue, and malnutrition; and have non-traditional symptoms such as osteoporosis, depression, adverse pregnancy outcome; and increased risks of both malignancy and death.

The onset of certain autoimmune disorders including autoimmune liver disease, thyroid disease, type 1 diabetes, and Addison’s disease can actually be attributed to CD and means these patients should be assessed.

Detection Methods Are Improving

I wrote a post on this called what is the Best Test for Coeliac Disease in May 2010.

Alternatives to the Gluten-Free Diet?

The gluten-free diet remains the cornerstone of treatment for CD. However, another potential treatment strategy is to ingest enzymes that digest gluten, thereby increasing the safe threshold for gluten intake. Enzymes such as those found in the supplement ‘Glutengest’.

Comment

As some ‘gluten free’ foods seem to be carriers of gluten; grains like rice, oats and millet do not normally contain gluten, but the authors learned that some of those products did have trace amounts of the protein, most likely from being grown or processed near grains like wheat that do have it.[3]

A careful assessment of a person’s diet – for life, means that careful assessments need to take place regularly to ensure the best possible clinical management. It is not good enough to simply say – right avoid gluten from here on – goodbye!

References

[1] Discovery’s Edge Newsletter – Coeliac On The Rise

[2] Ludvigsson JF, Montgomery SM, Ekbom A, Brandt L, Granath F.Small-intestinal histopathology and mortality risk in celiac disease.  JAMA. 2009 Sep 16;302(11):1171-8. View Full Paper

[3] Thompson T, Lee AR, Grace T. Gluten contamination of grains, seeds, and flours in the United States: a pilot study. J Am Diet Assoc. 2010 Jun;110(6):937-40. View Abstract

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2 Comments. Leave new

  • I would love to get your opinion on the distinct differences between gluten sensitivity and celiac disease. Many patients respond extremely well to a gluten free diet clinically, but do not have the positive lab findings or gastrointestinal symptoms associated with celiac disease. Thanks for sharing,
    Dr. Osborne

    Reply
    • Hi Peter

      This is, as I am sure you are aware a very big area of discussion and also of linguistics. Gluten sensitivity is understood to be a systemic autoimmune disease with diverse manifestations. This disorder is characterised by abnormal immunological responsiveness to ingested gluten in genetically susceptible individuals. Coeliac disease, or gluten-sensitive enteropathy, is only one aspect of a range of possible manifestations of gluten sensitivity. CD represents one end of the spectrum and I suspect many people have differing levels of GS and find significant benefits from gluten exclusion from, skin to brain and joints depite no immune antibodies or gastric architectural damage being found.
      So in a nutshell I think the difference is a grading scale due to age, genetics, infectious history etc. Your patients that do well do not need a lab diagnosis – they can tell the difference themselves. I understand from a colleague that a new salivary test may be coming out very soon to identify those people at the lower end of the scale, and I will post about it once I have seen the data.

      Reply

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