I was asked to do a radio show this past weekend on gluten and celiac disease. So, to prepare for the radio show I had to do some research of statistics and the impact of gluten in the diet of celiacs and non-celiacs. I find myself astounded by the statistics, which is why I chose to write a blog post about it.
Just some quick background information, there is a difference between being diagnosed and having celiac disease and being ‘gluten-sensitive’, which has been coined non-celiac gluten sensitivity (NCGS). Celiac disease is estimated to affect about 1 in 133 people (about 0.75% of people, but is suspected to be closer to 1 in 100), while NCGS is estimated to affect about 5-10% of people. Celiac disease is now recognized as one of the most common chronic diseases in the world, but yet, there are currently 0 drugs available to treat it! (For resource purposes, check out Health Canada’s report on celiac disease here.)
Non-celiac gluten sensitivity is significantly less severe in terms of damage done to the body than celiac disease. NCGS lacks the same antibodies and intestinal damage seen in celiac disease. Early research suggests that NCGS is an innate immune response, as opposed to an adaptive immune response (such as autoimmune) or allergic reaction that occurs in celiac disease. NCGS is not accompanied by the “enteropathy, elevations in tissue-transglutaminase, endomysium or deamidated gliadin antibodies, and increased mucosal permeability that are characteristic of celiac disease” (Ludvigsson et al, 2009). In other words, individuals with NCGS would not test positive for celiac disease based on blood testing, nor do they have the same type of intestinal damage found in individuals with celiac disease.
Now here are the statistics that astound me about celiac disease and why I think we need to take this condition more seriously:
- Rates of celiac disease have nearly doubled in the last 25 years in western countries (more detection methods have become available over the years).
- The risk for developing celiac disease is increased 20 times for those who have a 1st degree relative with the disease.
- More than 330,000 Canadians have been diagnosed with celiac disease. More than 73,000 are children. EVEN MORE DISTURBING:
- It is estimated that only 1 in 4,700 people with celiac disease have received an official diagnosis!
- Nearly 30% of Canadian children with celiac disease are initially misdiagnosed.
- From the first recognizable onset of symptoms, it takes an average time of 1 year to obtain a diagnosis of celiac disease. In some cases, the time to diagnosis may take as long as 12 years.
- Due to under-recognition of celiac disease in pediatric patients, $2.5 million has been spent in the health care system as families consulted 2 or more physicians before receiving a diagnosis for their child!
These statistics baffle me, which is why I encourage those who may have unresolved digestive disorders to have a conversation with their doctor about the possibility of celiac disease. The only known treatment for celiac disease is to go completely gluten-free. To put it into perspective, one slice of wheat bread contains ~3–4 g of gluten, whereas the threshold of ‘‘safe’’ gluten for celiac patients is estimated to be in the ~10–100 mg range, making avoiding gluten-containing foods even more important due to the low “safe” threshold.
For those celiacs out there and those who are sensitive to gluten, here is a small piece of helpful information (I say this with an understanding that all celiacs should ABSOLUTELY AVOID GLUTEN at all times.) The damage to the intestines, and part of the immune reaction that occurs, is due to undigested proteins (including gluten). Sometimes, it can be quite difficult for those with celiac disease to be able to eat at restaurants or at a friend’s/family’s place due to cross-contamination of food with plates, cooking surfaces, cooking utensils, etc., that have been in contact with gluten-containing foods (since the threshold for gluten ingestion for celiacs is so low), making life very difficult to eat outside of their homes where they have personally prepared the foods without the risk of having a ‘Celiac Attack’.
DPP IV (one of the activities of ANPEP, which is one of the active ingredients in AOR's IBD Relief), a protease enzyme that helps break down proteins, a protease enzyme that helps break down proteins, is especially important in people with compromised gap junctions (or intestinal permeability/leaky gut, which is present in celiacs), allowing less filtering of proteins through the intestines to cause an immune reaction, inflammation and resultant intestinal damage. Lower protease levels (found in digestive disorders like celiac) reduce the body's ability to metabolize proteins, especially proteins containing proline, because DPP IV is needed for their assimilation. Gluten contains proline.
This is quite possibly something celiacs should carry with them at all times, especially when eating food prepared away from home where contamination is a concern. It will not reverse or cure or prevent a celiac attack, but it will help assimilate the breakdown of the proteins that can cause damage in celiac disease and possibly reduce symptoms of the attack. It needs to be taken with a meal, ideally right before a meal (ie. If you’re at a restaurant or a friend’s and are concerned about contamination or if you’re unsure that your food is gluten-free), to be able to breakdown proline-rich gluten peptides. It needs to be ingested, ideally, within 10 minutes of starting your meal, since the stomach starts emptying its contents to the intestines after about 20 minutes and time is needed for DPP IV and proteases to breakdown proteins in the stomach.
This is merely a small suggestion for those who may be affected by conditions in this blog post. The rule of thumb is always, “WHEN IN DOUBT, LEAVE IT OUT”.
Have you gone gluten-free due to various symptoms? Share your journey with us in the comments below!
Health Canada 2009 http://www.hc-sc.gc.ca/fn-an/pubs/securit/gluten_conn-lien_gluten-eng.php)
Ludvigsson JF et al. (2009) Small-intestinal histopathology and mortality risk in celiac disease. JAMA 2009; 302: 1171–8.
Canadian Digestive Health Foundation (http://www.cdhf.ca/digestive-disorders/statistics.shtml)
Ehren J, Morón B, Martin E, Bethune MT, Gray GM, et al. (2009) A Food-Grade Enzyme Preparation with Modest Gluten Detoxification Properties. PLoS ONE 4(7): e6313. doi:10.1371/journal.pone.0006313
AOR Website – DPP Zyme (http://aor.ca/html/products.php?id=55)