Once considered a rare childhood disorder, celiac was frequently misdiagnosed and just as frequently overlooked. Today, doctors are more attuned to the seemingly vague symptoms that can signal celiac disease, and diagnose it frequently in children as well as adults.
“Celiac disease is now estimated to be four times more common than it was 50 years ago,” Nacouzi says. “And more advanced diagnostic tests may be the reason it seems to be on the rise.” But researchers also believe that the way wheat is now grown, the proliferation of processed foods, and the use of gluten in medications and vitamins, toothpaste, and lip balms, are all responsible for the increase in cases.
The main culprit in celiac disease is gluten, a protein found in wheat-, rye-, and barley-based products. Gluten triggers an immune response that makes it difficult for the body to absorb essential nutrients. In a healthy body, long, fingerlike protrusions called villi line the small intestine and aid in the absorption of nutrients into the bloodstream, explains Nancy McGreal, MD, a pediatric and adult gastroenterologist at Duke University Hospital. The gluten-triggered immune response damages the villi and inflames the intestinal wall. “Patients end up malnourished no matter how much they eat,” McGreal says. “They experience anemia, as well as deficiencies in vitamin D, vitamin B12, and folate.”
Genes play an important role in the development of celiac disease, but environmental exposures can also contribute. “Research is looking into whether being exposed to gluten as an infant predisposes you to getting celiac later in life,” McGreal says. Childhood intestinal infections may be a factor, too. People who have autoimmune disorders like type 1 diabetes and Down syndrome are at greater risk. Researchers are looking into whether breastfeeding may offer protection against the disease later in life.