Now is a fascinating time to follow research about celiac disease. With the January 2014 issue of Gluten-Free Living magazine, I began contributing “Study Sessions”, a column highlighting the most recent scientific studies about celiac disease, gluten sensitivity and the gluten-free diet.
In the past few years it has emerged from a rare, little-known condition to a disorder affecting perhaps more than 1 in 100 people in North America. Amidst popular theories about what causes celiac disease (such as GMOs and glyphosphate), the most compelling data points to changes in the community of microorganisms that inhabit our gut. While diet and environmental toxins undoubtedly affect them, scientists have also found significant links to other factors such as hygiene, breastfeeding and pharmaceutical drugs. The prevailing view about what triggers someone with genetic predisposition to develop celiac disease is that we do not know yet.
The race to find a cure for celiac disease has kept pace. So far the only known treatment is life-long avoidance of gluten, a protein found in wheat, barley and rye. However, several experimental drugs are in clinical trials.
The gluten-free diet itself has become popular. Many people who have not been diagnosed with a clinical sensitivity to gluten claim cutting wheat, barley and rye from their diets makes them feel better. However, research does not support the idea that a gluten-free diet is inherently healthier, or that modern hybrids of wheat are inherently toxic. In fact our digestive systems have co-evolved with cereal crops for thousands of years. Whole wheat provides an important source of iron, fibre and plant protein, so cutting it out can present a nutritional challenge. A well-informed, well-maintained gluten-free diet can compensate. However, many commercial gluten-free products such as breads contain more sugars and fats than their wheat counterparts to make them palatable. This is not a healthier diet.
Another drawback of adopting a gluten-free diet without diagnosis is that it fails to discourage cheating. You might easily justify the occasional indulgence in regular pizza, beer or dubious restaurant food without concern for the consequences. In celiac disease such small transgressions may or may not result in symptoms but can have serious long-term health effects. The diet should not be undertaken lightly.
Anyone who suspects they experience an adverse reaction to gluten should first seek medical advice. Whether or not celiac disease is diagnosed, this will indicate appropriate medical treatment and follow-up. If this process indicates a clean bill of health but the gluten-free diet seems preferable, it should be undertaken with advice from a dietitian.
Once drug companies find a cure for celiac disease, they may spread awareness to more doctors to help find the suspected large majority of celiac disease patients who remain undiagnosed. It might mean people with celiac disease can be less vigilant about what they eat, or can safely consume gluten.
This may be a mixed blessing. Celiac disease research has shed light on the complex relationship our bodies maintain with the organisms that live inside. For decades our diet, drugs and living conditions have been altering this ecosystem.
Any new drug must be subjected to exhaustive clinical testing in patients for safety and efficacy before it becomes commercially available. But such studies cannot readily identify how another long-term drug will alter intestinal ecology.
Nutritious food is the best medicine. If we can achieve good health through diet and exercise, that is the best way.
But many people cannot. In the case of celiac disease, some patients with extreme sensitivity continue to experience life-threatening or debilitating illness despite a gluten-free diet. In the spectrum of suffering, drug treatment will provide alternatives and an improvement in the quality of life for many people.
The photo shows a tissue sample from an intestinal biopsy illustrating flattening of the villi, which is diagnostic of celiac disease. It comes courtesy of Ed Uthman on Flickr via Creative Commons.