Nearly five times as many Americans have celiac disease today than in the 1950s, a recent study of 9,133 young adults at Warren Air Force Base found. Another recent report found that the rates of celiac disease have doubled every 15 years since 1974. The debilitating digestive disease is now estimated to afflict about 1 in 100 Americans. Why is exposure to gluten--a protein in found in barley, wheat, rye, and possibly oats, as well as other everyday products, including some brands of lipstick, vitamins and lip balms—making more people sick than ever before?
To find out more about celiac disease and the health effects of gluten-free diets, I talked to Christina Tennyson, MD of the Celiac Disease Center at Columbia University in New York City.
What is celiac disease? A debilitating digestive disorder, celiac disease is a chronic autoimmune disorder triggered by gluten. When people with the disease eat foods that contain gluten, a damaging reaction occurs in the lining of the small intestines, blocking its ability to absorb certain nutrients. This can lead to vitamin deficiencies and malnutrition, even if the person is eating a seemingly healthy diet.
What are the symptoms? One reason why this autoimmune disease often goes undiagnosed for as long as 10 years is that symptoms can vary from person to person. Among the more common warning signs of celiac disease are abdominal pain, bloating, gassiness, diarrhea, constipation, lactose intolerance, nausea and fatigue.
How serious is it? Because celiac disease robs the body of vital nutrients, people who have it are at increased risk for anemia and osteoporosis. People who have celiac disease and don’t eat a gluten-free diet also face a higher threat of bowel cancer and intestinal lymphoma. The Air Force Base study found that during 45 years of follow-up, those with undiagnosed celiac disease were four times more likely to die.
What causes it? Although the cause isn’t fully understood, two genes are known to play a role, says Dr. Tennyson.
Why are rates rising? One theory is that today’s grain-based foods contain more gluten than they did in the past. Another is that kids are exposed to gluten at an earlier age, contributing to increased risk. A frequently proposed explanation is the “hygiene hypothesis,” the theory that we are too clean for our own good, resulting in weaker immune systems because we’re not exposed to as many diseases.
Does a gluten-free diet help people lose weight? Many gluten-free foods are actually higher in calories than their gluten-containing counterparts and therefore lead to weight gain, reports Dr. Tennyson. “One of the pitfalls is that these foods are often highly processed and high in fat. Some ingredients that are used are low in fiber, such as white rice flour, tapioca and corn starch, causing constipation.” To avoid these problems, people with celiac disease should work with a nutritionist, she advises.
Does a gluten-free diet have any health benefits if you don’t have celiac disease? Possibly. In a randomized study in which neither the researchers nor the participants knew if the foods they were eating contained gluten or not, 68 percent of people who thought that a gluten-free diet improved their GI symptoms reported worsening of their symptoms when they were fed gluten-containing foods without their knowledge. However, the study only looked at 34 patients. Use of gluten-free diets for other conditions, such as autism, is highly controversial.
How trustworthy is gluten-free labeling? While products as diverse as lipstick brands to chocolate and many types of groceries carry gluten-free labeling, right now, there are no legal standards that have to be met in the US. In 27 other countries, food labeled as gluten-free food can’t have more than 20 parts of gluten per million. Nearly three years after the FDA’s deadline for a rule to define “gluten-free,” the agency is finally getting serious about tackling the dangerous risks people with celiac disease can face due to misleading labeling.
What’s the treatment? Although there’s no cure, symptoms can be effectively controlled through dietary changes to avoid all foods with gluten. However, if you think you might have celiac disease, don’t start a gluten-free diet until you’ve been tested for the condition, since eliminating gluten can cause misleading test results, cautions Dr. Tennyson. Because the disease can also spark vitamin and mineral deficiencies, patients may also need supplements. For people with severe small intestine inflammation, doctors sometimes prescribe steroids.
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