Sunday, April 22, 2012

Some Thoughts On Celiac Disease

I recently decided to do some research on the history of celiac disease. I had thought I'd read that celiac was discovered when grain shortages in Europe during world war two, and unexpected reduced mortality, had made it clear that some kids do better without gluten.

So I thought those would be some really neat primary sources if I could find them. Guess what? It didn't happen like that. First of all, celiac is apparently a word that used to just refer to the abdomen. Celiac sprue or celiac disease was first described in 1888 by Samuel Gee as a. disorder causing malabsorption of fat in small children.
A search for early articles on celiac disease turns up a lot of ignorance about the causes and treatment. A lot of diets were experimented with. Some of the reading is really sad. One major early strain of thought about celiac was that since a major symptom of celiac is fat malabsorption, a low fat diet should be used. Guess what? A low fat diet will decrease fat in stools, but it didn't tend to improve the condition of people with celiac. Other treatments included vitamins (malabsorption of various vitamins is typical in advanced celiac).
Somehow, I had gotten into the habit of thinking of celiac as an unpleasant and maybe long term life threatening, but not really serious disease. However, before a correct diet was known this wasn't the case. A 1939 article about 74 kids admitted to the hospital with a diagnosis of celiac said that 22 had died in that hospitalization. I can't imagine a similar mortality figure happening today.

From the late 1940s, I begin to find articles trying "low starch" or even no starch diets in the treatment of celiac disease, with great results. There's no hint that it's gluten they want to get rid of, but the sample diets make it clear that that's what they do. However, these do not catch on as quickly as they're published.
When in 1951, the Sick Kids Hospital in Toronto puts out an article on "The Coeliac Syndrome" they include a list of foods that patients can tolerate from best tolerated to worst: protein milk, curds, low fat beef, egg whites, cereals- rice, barley and wheat, chicken, fish, lamb, liver, bacon, banana, toast, jellies, pablum, applesauce, other fruits and vegetables. .
Source However, the Lancet that same year publishes an article saying that substituting soy and corn flour for wheat and rye improves the condition of youth with celiac.
 By the mid-1950s, a gluten free diet for children with celiac disease seems to have been accepted even though celiac was still almost certainly underdiagnosed.
Before there was treatment available for celiac disease, there was enough studying on the topic to link it with type 1 diabetes as definitively as it is currently linked. The affects on the small intestine had been pictured. There was a lot of knowledge about things that didn't really work. And there were sixty years of watching kids die.
Side note: This recent study on autoimmune disease prevalence in Sardinia says that in their study population only 17 men had diagnoses of celiac disease, as compared to 212 women.  Since elsewhere the ratio of women:men with celiac is closer to 4:1 than 12:1, this probably represents a very significant lack of awareness that celiac disease occurs in men, among doctors in Sardinia. Source. See table three.

Now, I don't think there's anything so simple that will treat diabetes. No dietary fix. But I just keep thinking- it took sixty years from the publication of the first article on celiac to the first article showing something that made any real difference on the prognosis of children with celiac. In 1945 there was no reason to think that a real treatment for celiac was in the eves. In 1955 a review of the literature would show the way to health for a person with celiac.

P.S. Sorry for the formatting in the post as originally posted. This new blogger editor, I don't like.

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