Gluten is Critical for Celiac Disease, But is it Really the Trigger?
By: Peter Olins, PhD on February 11, 2013.
It’s common for people to say that gluten “triggers” celiac disease, but I think the gun/trigger analogy is mistaken.
Some background:
- Almost everyone in the U.S. eats wheat and gluten their whole lives
- Celiac disease (CD) can develop in infancy or at the age of 80
- About 40% of the general population has a genetic risk of CD because they have the DQ2 or DQ8 genes
So why does only about 1% of the population actually develop celiac disease?
Clearly, something other than gluten must provide the initial “trigger” for the disease.
What IS the Initial Trigger for Celiac Disease?
There have been many ideas about this, but we really don’t know for sure. Since gluten itself is not the actual trigger, it’s seems reasonable that different factors might be important for different individuals. One idea is that damage to the cells lining the small intestine (either due to injury or disease) could be the trigger. For example, there is some evidence to suggest that intestinal infections might be the initial trigger (Ref. 1). For CD that develops early in childhood, breastfeeding practices and the timing of introduction of wheat into the diet may make a difference for some children, but the evidence is still fuzzy (Ref. 2). Another trigger of CD in some women appears to be pregnancy and childbirth (Ref. 3).
A big problem in this field is that CD can take years to develop, and it is typically diagnosed after the disease has reached a late stage. This means that the trigger may have disappeared long before the disease actually shows up: the actual trigger for CD has never been “caught in the act”.
Something has Changed Dramatically Over the Past Few Decades
One study of U.S. airmen found that the prevalence of CD appears to have increased about 4-fold over a period of 50 years (Ref. 4); while another in Finland found a 2-fold increase over a period of about 20 years (Ref. 5). This is puzzling, since:- Humans still have the same set of genes
- Wheat has been a staple in the Western diet for a very long time
- There’s little evidence to show that the amount of gluten consumed is critical for CD to develop
So something else must have changed radically over the past few decades. Of course, thousands of things have changed over the past half-century, so it is going to be quite tough to sort this out. But what I find exciting about this idea is that, if we can discover the actual trigger for CD, most people might be able to prevent the occurrence CD to begin with, and not have to rely on a strict gluten-free diet.
In my next blog, I will discuss the idea that our level of gluten consumption has caused the increase in celiac disease prevalence.
References:
Ref. 1: Troncone, et al. Rotavirus and Celiac Disease: Clues to the Pathogenesis and Perspectives on Prevention. Journal of Pediatric Gastroenterology & Nutrition:
May 2007 - Volume 44 - Issue 5 - p 527-528
doi: 10.1097/MPG.0b013e31804ca0ec
Ref. 2: Szajewska H, et al. Systematic review: early infant feeding and the prevention of coeliac disease. Aliment Pharmacol Ther. 2012 Oct;36(7):607-18. doi: 10.1111/apt.12023. Epub 2012 Aug 21.
Ref. 3: Smecuol E, et al. Gynecological and obstetric disorders in coeliac disease: frequent clinical onset during pregnancy or the puerperium. Eur J Gastroenterol Hepatol 1996;8: 63–89.
Ref. 4: Rubio-Tapia A, et al. Increased prevalence and mortality in undiagnosed celiac disease. Gastroenterology, 2009 Jul;137(1):88-93. doi: 10.1053/j.gastro.2009.03.059. Epub 2009 Apr 10.
Ref. 5: Lohi S, et al. Increasing prevalence of coeliac disease over time. Aliment Pharmacol Therap (2007) 26: 1217-1225. DOI: 10.1111/j.1365-2036.2007.03502.x
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This is a thought provoking question and one that I have thought about before. Would like to have someone find an answer.
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