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Going against the Grain

Riva Pomerantz

Not so long ago, few people had even heard of celiac. But since 1974, the rate of the disease has doubled every 15 years. What’s behind the staggering rise, where gluten hides out, plus ways to treat the condition.

Wednesday, August 01, 2012

bread Nearly three million Americans suffer from celiac disease, also known as celiac sprue, which is an inherited autoimmune disorder that causes the body’s immune system to attack the small intestine when gluten is consumed. A protein found in grains such as wheat, rye, spelt, barley, and often oats, gluten also lurks in the least likely places — ranging from vanilla extract to lipstick, and many ubiquitous medications.

Not so long ago, gluten (or more precisely, gluten-free) wasn’t a household term. And it was not for lack of marketing: going as little as ten years back, the disease was simply far less common. Today, however, nearly everyone knows someone with celiac disease. It’s so commonplace that the Israeli Knesset has even approved a new law to subsidize the price of gluten-free bread.

The celiac statistics are pretty staggering: Nearly five times as many Americans have the disease today than in the 1950s, shows a recent large-scale study at Warren Air Force Base. And according to the Center for Celiac Research at the University of Maryland School of Medicine, the rates of celiac disease have doubled every 15 years since 1974.

“There’s no question about it: celiac disease is on the rise,” confirms Dr. Robin Baradarian, chief of gastroenterology at Beth Israel Medical Center, Kings Highway and assistant professor of medicine at the Albert Einstein College of Medicine. “Actually, when researchers examined the blood of patients from 50 years ago, they see that there is a fourfold increase in terms of positivity for celiac amongst similar groups today.”

Is the seemingly sharp rise a matter of good old-fashioned awareness? Perhaps.

“One of the theories is that doctors are simply picking it up more,” says Dr. Baradarian. “Not only doctors, but patients are thinking about it as well. People who suffered for 30 or 40 years with the diagnosis of IBS are finally getting tested and diagnosed with celiac. The numbers out there show that about 1 in a 100 people has celiac disease, which is one percent of the population, so it’s a very common disease.”

Still, the “awareness hypothesis” doesn’t explain the physiological rise in celiac tendency. Possibly to blame, suggest researchers, is the food we eat. An oft-touted theory revolves around the amount and type of gluten found in today’s products, which may be more concentrated or altered than it was several years ago. Nowadays, in our global village, we import more foods from countries which may be lax about monitoring regulations, which means the composition and production of these foods is a real wildcard. Add to that the genetic modification and engineering that is de rigueur today, and it’s not difficult to see how a gluten allergy like celiac could spike.

Another theory attributes the rise of celiac on too-early introduction of grain-based solids to infants. But while researchers may have found some evidence for this claim, the American Association of Pediatrics has not changed its recommendations and does not caution parents against feeding gluten-containing foods to babies.

While the medical community had also wondered whether increased vaccines could be a culprit in increased celiac incidence, a team of researchers inSwedenlaid that hypothesis to rest — inSweden, at least.

In a twelve-year period between 1984 and 1996, an “epidemic” of celiac took hold inSwedenamong children younger than two. Because the sharp rise seemed to coincide with changes toSweden’s vaccination program, researchers pounced on the possible correlation. But a carefully conducted study demonstrated that the increase in childhood vaccines was not to be blamed for this phenomenon, which dropped off just as suddenly as it set in, shortly afterwards. Although vaccinations were cleared from suspicion, the true cause, unfortunately, could not be pinpointed.

Could your much-worshipped antibacterial hand sanitizer be making you sick? That’s what Christina Tennyson, MD of the Celiac Disease Center atColumbiaUniversityinNew York City, is suggesting. In an interview with USAToday, Dr. Tennyson cites the “hygiene hypothesis,” the theory that we are too clean for our own good, which may result in weaker immune systems because society, as a whole, is not exposed to as many diseases as we used to be.

No matter what the cause, celiac is here to stay, and it’s only becoming more prevalent. The Universityof Chicago Celiac Disease Centerestimated, in 2009, that a shocking 97 percent of celiac disease has not yet been diagnosed.


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