Celiac Disease is Not Pretend – May is Awareness Month!
A few decades ago, celiac disease (CD) was considered an uncommon condition affecting children, mainly limited to European descent. However, over the past several decades, the rate of CD has increased about 7.5% per year. In Canada, 1 in 114 Canadians receives a diagnosis. Yet, in 2018, Health Canada stated that 90% of CD cases go undiagnosed. In the United States and Canada, rates have increased 5-fold. 4-fold in the UK, 3-fold in the Netherlands, 2-fold in Finland. At the same time, Scotland has seen a staggering 6-fold increase. Thus, making celiac disease a significant public health issue around the globe.
CD is an autoimmune disease characterized by an inflammatory immune response to two particular components of gluten – gliadin and glutenin. These proteins are found in grains such as wheat, barley, Kamut, spelt and rye. Antigen-presenting cells get a hold of these specific proteins and present them to T-cells, which are critical for their role in immunity to foreign substances. Then, the body creates antibodies against gliadin. Gliadin is often bound to an enzyme called TG2, implicated in the regulation of cell growth, cell differentiation and cell destruction. The body then creates antibodies against it, resulting in the “attack of self” at the gut level. Hence, the classification of celiac disease as an autoimmune condition.
This chain of events triggers a response that results in severe damage to normal gut tissue, including atrophy of villi in the small intestine, inhibiting the absorption of nutrients. If undiagnosed or untreated, CD will lead to malabsorption of nutrients, osteoporosis, other autoimmune conditions and failure to thrive.
A genetic component will predispose an individual to celiac disease, and actually, those genes are relatively common in the population (about 30%). However, only a tiny percentage of those who carry the HLA-DQA1 and HLA-DQB1 genes will develop the disease. Since CD is genetic, it runs in families. Those who have parents, siblings or children with the same genotype as the family member with CD have a 40% greater risk of developing the disease. Alternately, a negative gene test will exclude the possibility of developing CD.
Individuals who suspect CD will require appropriate genetic and antibody testing. Blood screening for tTG-IgA is the first step. Additional antibody tests are used to check for potential false negatives or false positives, especially in those with other pre-existing autoimmune conditions. The only way to confirm a celiac disease diagnosis is to biopsy the small intestine. For those who test positive for CD, lifelong avoidance of all gluten-containing foods is the only viable treatment. Careful cleaning of shared food prep areas at home and in restaurants is essential. Continued exposure (with or without symptoms) will further damage the intestinal lining and increases the risk for more severe complications.
With proper support and guidance, leading a life without gluten can be easy and delicious! Many innovative brands have emerged in recent years, bringing various gluten-free products with them. For those looking to substitute items like bread, wraps and pizza crusts, Unbun is a fan favourite. Their 100% gluten and grain-free products are available in all major grocers across Canada and the US, making it easy for anyone navigating a gluten-free lifestyle to enjoy them!
Written by Cait Mizzi for Unbun Foods