One of the neglected areas of my medical education was “ethnic” and “racial” aspects of medicine.
One example of this is lactose intolerance.Only IndoEuropeans (and one small tribe in Uganda) are able to digest milk without problems.In the modern world, this means a lot of folks diagnosed with “irritable bowel” syndrome were actually lactose intolerant; and often a careful genealogy study showed that great grandmom was Native American (or Jewish or Black) but no one wanted to talk about it in polite society.
A similar problem is now being recognized in medicine: Gluten intolerance.Hunter-gatherers of ancient times did not eat a lot of grain, butÂ with the neolithic revolution and the development of farming, being able to grow grain meant a population explosion,Â and ultimately the development of civilizations, with governments to regulate the irrigation ditches and armies to stop the outside tribes from stealing your food.
But eating wheat did have a downside: Some people had a genetic tendency to develop an “auto immune” problem when exposed to wheat gluten.
The CDC has a lot of ongoing studiesÂ trying to figure out the biological aspects of the disease, because like many “auto immune” problems, such diseases are seeming to be more common nowadays, and celiac disease overlaps other autoimmune diseases and symptoms.(In “autoimmune” diseases, your body’s immune system attacks your own tissues Â and causes disease.)
In Celiac disease, Gluten seems to be the trigger, but why is the big question.
OnceÂ Gluten intoleranceÂ or Celiac disease, was considered as rare, and mainly diagnosed in children with “inability to thrive”; nowadays, doctors are recognizing that it has been under-diagnosed, and is seen in almost one percent of the American population.
Celiac disease involves an gene present in one third of the population that, given the right environment, can cause diarrhea.So maybe the question is not “why is Celiac disease so common?” but should be “Why is Celiac disease so rare?”Â And that is a big question.
Why, despite the fact that 30% to 40% of the population worldwide has the necessary HLA DQ2/DQ8 genes (ie, class II human leukocyte antigen HLA genes DQ2 or DQ8) and despite that virtually everyone is exposed to gluten, do only 1% of individuals develop celiac disease? Several studies presented at this year’s DDW meeting attempted to answer this question. Three of these studies advocated a third element, the loss of the intestinal barrier function, as an integral part of the problem.
Actually, that might overestimate the problem, since those genes are rare in Oriental Asians, where rice, which does not contain gluten, is consumed.
Yet recent reports suggest that with the increase of wheat consumption in the Asia Pacific region, and anÂ increased awareness of the problem, more cases may be diagnosed in the future.
So if you investigate people with chronic diarrhea,Â even in Asia, doctors are now finding that many have intestinal changes of Celiac disease, and find relief by eliminating gluten from their diet.
Does this mean I stop eating wheat, or blame all my neurotic symptoms on bread?
No, but as a woman cursed with both a neurotic personality and a tendency toward food allergies, I suggest that if you have irritable bowel symptoms and other vague medical problems, you might want to try the diet. Don’t go overboard on this, but on the other hand recognize that a trial of diet might help.
Ironically, in a study of severe cases of celiac disease, the diet improved the diarrhea but not other “quality of life” symptoms.Is this related to the “autoimmune” problems not relalted to the gluten? Or is it related to other problems?Â One study puts it this way:
Â Moreover, these data show that health-related quality of life in coeliac disease is impaired by poor compliance and by co-morbidity with irritable bowel syndrome-type symptoms.
In other words, if you don’t stick with your diet and like to blame something for all your problems, the diet won’t be a cure all..Luckily, for us docs, the majority of our patients stay on the diet and do well.
There are all sorts of sites on the internet that show you tricks on where to buy gluten free foods, or how to make foods without the gluten (and remember, it’s the gluten, not the wheat, that is the problem here). There areÂ sites telling you where to buyÂ gluten free beer, and find recipes to bake gluten free substitutes for your favorite foods.
Yes, you can even bake your very own gluten free twinkies. YUM.