Celiac is the most common hereditary autoimmune disease in which the body damages or destroys the villi of the small intestine leading to malabsorption. The cause of the destruction is a group of proteins called gluten. And the fractions of gluten responsible for the devastating symptoms of Celiac are gliadins, scalins ( in rye) and hordeins (in barley).
In parts of England, the incidence of Celiac is 1 per 100. In Finland, the incidence is 1 per 99. The United States is just starting to study the incidence of Celiac. It is also one of the most under diagnosed diseases. It is more common in women. In fact, when men are diagnosed, they tend to have more severe symptoms such as greater malabsorption, worsening bone density, iron deficiency anemia and other autoimmune diseases.
Delayed Diagnosis of Celiac Disease: A Common Problem
If the diagnosis is not made until adulthood, this increases the chances of developing other autoimmune diseases. We know for instance that 8-10% of people with type 1 diabetes have Celiac Disease. If the diagnosis is delayed we also know that the patient will have many years of problems from chronic inflammation and nutritional deficiencies. There is also an increase in the risk of osteoporosis, anemia, malignancies, peripheral neuropathies, dental enamel defects, hyposplenism and infertility with delayed diagnosis. In the USA the average time to diagnosis of Celiac is 9 years! Patients with Celiac have an increased mortality rate: 33 times greater risk for small bowel adenocarcinoma, 11.6 times greater risk for esophageal carcinoma, 9.1 times greater risk for non- Hodgkin’s lymphoma and 23 times greater risk for papillary thyroid cancer!
Normally protein is broken down in the stomach and intestines into amino acids and then absorbed by the small intestines. However, with gluten, the molecule is not broken down well because it is resistant to the enzymes that break down proteins. In other words, gluten is not digested well and it leaves a toxic fraction of amino acids. This fraction can get into the lining of the intestines and some people begin to develop an autoimmune reaction to the toxic fraction.
It’s All in the Genetics
The patient has to have a genetic predisposition in order to develop Celiac. Thus Celiac is an abnormal reaction to food! Two alleles have been found so far that predispose people to Celiac that are part of the HLA class II DQ genes ( HLA-DQ2 and HLA-DQ 8). The substance that damages the villi is a cytokines called interferon gamma which releases chemicals that cause inflammation and atrophy. Antibodies are then produced which propagate the process. Studies have shown that breast fed children have a lower rate of Celiac and if they do get Celiac they have less symptoms. Studies have shown that delaying the introduction of gluten in the diet until four months of age while still breast feeding may be protective for genetically predisposed people.
See the second part of our series on Celiac’s Disease: Testing for Celiac’s