Is Celiac Disease on the Rise?

Celiac disease is an autoimmune disorder that causes the intestines to react to gluten, which is found in wheat, barley, and rye. For a brief history of celiac disease, check out this post. Here’s the highlights: the symptoms of celiac disease were first diagnosed in Ancient Greece nearly 2000 years ago. It wasn’t until the 20th century that these symptoms were actually connected to bread intake, and then decades later it was connected specifically to gluten. In the past 10 years, celiac disease has gained (and is continuing to gain) attention and awareness, due to improvement in diagnosis techniques and the efforts of many individuals and organizations to spread information.

Discoveries in the United States

This increase in awareness has, in turn, increased diagnosis rates. Take, for example, what happened in the United States in the 1990s. At that point in time, celiac disease was largely considered to be a European phenomenon, with only 1 in 10,000 Americans supposedly suffering from it, compared to the 1 in 138 today. But Dr. Alessio Fasano, one of the fathers of celiac research in America, didn’t believe it. In his home country of Italy, rates were much higher, and it didn’t make any sense that the US should be any different.

After several studies and years of spreading awareness, Fasano slowly discovered that the rates were much lower because doctors did not know enough about the disease. This is still the case in many instances, but it’s getting better. The rate of diagnosis has increased greatly in the past decade, but many researchers wonder whether this is due to awareness alone.

Is Celiac Disease on the Rise?

Several recent developments indicate there has been an increase not only in diagnosis, but also prevalence of the disease, but the cause is still unclear. One critical study, performed by the Mayo institute, found that the celiac disease quadrupled over the past 60 years. This research was based off of blood samples taken from Air Force recruits in the 1950s. The samples showed the rate of Celiac disease to be significantly less at that time than the approximately 1% it’s at today.

Potential Explanations for the Increase

This appears to indicate some sort of significant shift in environmental factors in the past 50 years. There’s been several different hypotheses that could explain this change:

  1. Hygiene Hypothesis: This has been used to explain a variety of allergy increases over the past few decades. It argues that due to increases in general hygiene, children are exposed to fewer pathogens, inhibiting the development of the immune system, which causes the body to react to otherwise harmless substances. A related hypothesis is that, due to hygiene in industrialized countries, the types of bacteria living in the intestine has changed, potentially contributing to celiac disease
  2. Diet: Another possible cause are the changes in diet that have occurred over the past several decades. Though general wheat consumption has remained relatively constant, the way in which wheat is processed has changed. Foods are processed more and wheat has actually been hybridized to form new strains. The grains we eat today actually have higher levels of gluten than ever before.
  3. Breastfeeding: Somewhat surprisingly, an “epidemic” of celiac disease in Sweden 30 years ago lead some researchers to pay closer attention to breastfeeding. At the time, the government began advising parents to delay the introduction of gluten until their children were 6 years old. But this actually increased the rates of celiac disease. Further analysis revealed that introducing small amounts of gluten into the child’s diet while breastfeeding decreased rates of celiac disease, and that the longer the child breastfed after their first introduction to gluten, the less susceptible they were. This appears to have ties to microbes in the intestine (similar to the hygiene hypothesis).

Other theories have also been proposed, but there’s still a tremendous amount unknown about celiac disease, including whether it’s actually on the rise, and why. It will unfortunately take years of study to reach a satisfactory answer, but in the meantime…we can all drink some gluten-free beer from Aurochs Brewing Co.