Celiac Disease More Common than Thought

May 22, 2003—Celiac disease, an intestinal disorder caused by intolerance to gluten grains, is a much more common condition than researchers had previously thought, according to a report in Archives of Internal Medicine (2003:163:286–92). In addition to being a cause of intestinal symptoms such as chronic diarrhea, abdominal pain, or constipation, celiac disease may be a contributing factor in some cases of unexplained osteoporosis, anemia, arthritis, or infertility. Because doctors have been taught that celiac disease is a rare condition, many people with the disease are not being diagnosed properly or receiving effective treatment.

People with celiac disease are unable to tolerate three gluten-containing grains: wheat, barley, and rye. A small proportion of people with the disease are also intolerant to oats. Consumption of these foods causes severe damage to the lining of the small intestine, frequently resulting in diarrhea, constipation, abdominal pain, bloating, and weight loss. The damage to the intestine results in malabsorption of many nutrients, leading in some cases to anemia, osteoporosis, infertility, and poor growth in children. Arthritis probably results from an autoimmune reaction in the joints caused by the ingestion of gluten grains.

Not everyone with celiac disease experiences intestinal symptoms, however, and doctors rarely consider testing for the disease when these symptoms are absent. Making the diagnosis is extremely important because the initiation of a gluten-free diet can reverse bone loss and infertility, correct anemia, improve arthritis, and promote catch-up growth in children.

In the new study, researchers performed a screening test for celiac disease (anti-endomysial antibodies) on 13,145 people. Approximately 4,000 of these individuals were considered not to be at risk for the disease (blood donors, schoolchildren, and patients seen for routine checkups). The others were considered to be at risk because they either (1) were a close relative of a person with celiac disease, (2) experienced the typical intestinal symptoms of the disease, or (3) had a condition associated with celiac disease, such as anemia, arthritis, osteoporosis, infertility, or short stature. Individuals who tested positive on the screening test underwent confirmatory tests in order to obtain a more definitive diagnosis.

In the at-risk groups, the prevalence of celiac disease was 4.5% for first-degree relatives, 2.6% for second-degree relatives, 4.2% for those with anemia, 3.0% for those with arthritis, and 2.6% for those with osteoporosis. Among the relatives of celiac disease patients who also were found to have the condition, approximately half had no symptoms at all. For those considered not-at-risk, the prevalence of celiac disease was 1 in 133 individuals (0.8%), more than 34 times higher than earlier studies had suggested.

The new study should alert doctors to the importance of testing for celiac disease. The availability of a new blood test (tissue transglutaminase IgA antibodies), which is more accurate than the better-known anti-endomysial antibody test, should improve the reliability of testing, without having to resort to an invasive intestinal biopsy.

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Alan R. Gaby, MD, an expert in nutritional therapies, testified to the White House Commission on CAM upon request in December 2001. Dr. Gaby served as a member of the Ad-Hoc Advisory Panel of the National Institutes of Health Office of Alternative Medicine. He is the author of Preventing and Reversing Osteoporosis (Prima, 1994), and co-author of The Natural Pharmacy, 2nd Edition (Healthnotes, Prima, 1999), the A–Z Guide to Drug-Herb-Vitamin Interactions (Healthnotes, Prima, 1999), Clinical Essentials Volume 1 and 2 (Healthnotes, 2000), and The Patient’s Book of Natural Healing (Prima, 1999). A former professor at Bastyr University of Natural Health Sciences, in Kenmore, WA, where he served as the Endowed Professor of Nutrition, Dr. Gaby is the Chief Medical Editor for Healthnotes, Inc.

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