Can you develop celiac disease?

You must be born with a genetic predisposition to develop celiac disease, which can be triggered by gluten – plant proteins contained in many common grains such as wheat, barley and rye.

Gluten is a useful component in grain that causes bread dough to rise and become elastic providing that wonderful chewy texture to bagels and pizza crust.

For people with celiac disease, their body’s immune system identifies any gluten as a threat and triggers inflammation in the small intestine if ever they are exposed to it, even in tiny amounts. This causes collateral damage to the small intestinal cells, which then can’t absorb food.

So celiac disease eventually leads to malabsorption and symptoms of abdominal pain, bloating and weight loss. Thus, celiac disease is considered an autoimmune disease because the body is damaging itself in the un-winnable fight against gluten.

Gluten benefits

Most people in the world can eat bread and other gluten-rich foods with no problems at all, and even with some benefits for their health, particularly from wholegrains and fiber. Diets rich in fiber and wholegrains are associated with lower rates of heart disease, diabetes, some cancers, and even a longer life.

So giving them up is less than ideal for most people. However, this is not true for everyone. About 1-2% of people are allergic to gluten and have celiac disease.

Why this should happen in some people but not in others is still a mystery. Some of the risk is in our genes; people with a family history of celiac or other diseases associated with the immune system attacking itself, such as type 1 diabetes, are more likely to develop celiac disease.

But even with all the wrong genes, only some will develop celiac disease.

Why celiac disease seems to be increasing, despite a lack of changing genes, is also a mystery. Experts suggest different things in our diet, and even our gut microbes, may be at fault, but no one knows for sure.

Testing for celiac disease

Testing for celiac disease is probably worthwhile in anyone with unexplained gastrointestinal symptoms, including troublesome bloating, flatulence or chronic diarrhea, although most cases will have other causes. 

In people without any symptoms, screening for celiac disease is probably worthwhile in:

  • those whose first- or second-degree relative (mother, daughter, sister, grandmother, aunt or male counterpart) are diagnosed with celiac disease
  • people with type 1 diabetes
  • people with Down Syndrome

Genetic testing can identify those at risk, but cannot determine if you have celiac disease or not. Many people with the bad genes still eat bread every day and benefit greatly from eating wholegrains.

On the flip side there are some benefits from going gluten free.

Many people, especially women, feel less bloated, and don’t experience other symptoms such as an irritable bowel. This is not because of the gluten, but rather the lower intake of fermentable carbohydrates (known as FODMAPs) which means the intestines make less gas.

References

  • Brown K, Decoffe D, Molcan E, et al. Diet-induced dysbiosis of the intestinal microbiota and the effects on immunity and disease. Nutrients. 2012;4:1095-119.
  • Pozo-Rubio T, Olivares M, Nova E, et al. Immune development and intestinal microbiota in celiac disease. Clin Dev Immunol. 2012;2012:654143.
  • Riddle MS, Murray JA, Porter CK. The Incidence and Risk of Celiac Disease in a Healthy US Adult Population. The American Journal of Gastroenterology. 2012;107:1248-1255
  • Snyder CL, Young DO, Green PHR, et al. Celiac Disease. 2008 Jul 3. In: Pagon RA, Bird TD, Dolan CR, et al., editors. GeneReviews™ [Internet]. Seattle (WA): University of Washington, Seattle; 1993-.
  • National Cancer Institute. NIH Consensus Development Conference on Celiac Disease. Accessibility verified October 19, 2012.
  • Coeliac Australia. http://www.coeliac.org.au/coeliac-disease/

Last reviewed 15/May/2017

 

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