Tag Archives: cause of celiac disease

Why do we get celiac disease?

I know why I got celiac disease. Do you?

We all have our special origin stories when it comes to why we are the way we are. Humans love to reach back through the strands of our past and attempt to reweave them retrospectively into a narrative we can understand. “X happened, and Y happened, and Z happened” isn’t an appealing way to view our life story: it’s disorganized and random. “X happened, and therefore Y happened, and it all came to a head with Z” is neater and much more satisfying.

So, I know why I have celiac—or, at least, I like to believe I do. I’ve taken all my precious, faulty memories and molded them into a story that makes sense.

My Theory

It’s simple enough: I was born with the celiac gene and lived happily in my glutenous environment, eating whatever I darn well pleased, without so much as a twinge from my cast-iron stomach. Then, I lost sixty pounds in a year, messing with my gut bacteria in ways not even scientists understand. Immediately after I stopped losing and started maintaining, I got sick. Eventually, I learned it was celiac.

To me, the timing is too coincidental to be coincidence. Thus, with no hard evidence whatsoever, I’m convinced: I wreaked havoc on my body’s bacteria, then I gave them some gluten and ruined everything—all in pursuit of thinness. (How many pounds my body has reacquired in revenge is not an important part of the story.)

“But Molly,” you may protest, “I’m a naturally svelte god/goddess who has never actively tried to lose a pound in my life, yet I too have celiac disease. How can this be?”

If that’s so, then after mumbling something less polite, I would thank you for the insightful question, because it leads nicely into the second half of my post.

The Pie Theory

One of the best parts of the recent Columbia conference was Dr. Benjamin Lebwohl’s discussion of causal pies. This is a yummier name for a fundamental principle of epidemiology known as “the sufficient-cause model.” According to it, multiple risk factors for a disease come together in one person, like pieces of a pie. Once the sufficient factors (or ingredients) are there, the person gets the disease.

However, more than one set of ingredients can be combined to make a pie (as any gluten-free baker who has ever had to choose between all-purpose blends knows all too well). Similarly, most diseases have more than one sufficient cause; there’s more than one way to develop them.

For celiac disease to develop, two pieces of the pie must be there: genes (HLA DQ2 or DQ8), and gluten. But by themselves, they’re insufficient cause; almost a third of the US population has the gene and eats gluten, but most of them don’t have celiac. (There could be other universally necessary causes, but no one’s found them yet.) The rest of the pie needs to be filled in, perhaps completely differently for you and for me, with other causes.

causal-pies The other pieces might include:

  • early OR late gluten introduction by parents (which I have complained about before)
  • spring or summer birthday (because you probably started eating gluten in the winter, when infections were going around)
  • microbiotic dysbiosis (messed-up gut bacteria)
  • antibiotic usage (possibly insofar as it contributes to the above)
  • GMOs (but I doubt it. As Dr. Alessio Fasano pointed out, “There are no GMOs in Europe, but we still have celiac disease!”)
  • leaky gut (which Dr. Fasano talks up in his new book, Gluten Freedom)
  • headache medication (possibly because it makes your gut leak; the aspirin-based ones I regularly overused in high school before discovering caffeine are not included here)
  • other autoimmune diseases (though they may in fact be consequences of the same factors as celiac—pies rather than pieces)
  • excessive hygiene (which I’ve joked about before)
  • and so on.

Why all the theories?

It’s important to determine causes of celiac disease not only because humans hunger for coherent life stories, but also because discovering causes could help us prevent, treat, or even cure future cases. This is particularly crucial because celiac disease is increasing in prevalence.

Plus, differently constructed pies may require different treatments. The baking metaphor breaks down a bit here, but we know that some people take longer to heal than others, and that some people must adopt additional measures beyond the gluten-free diet to get well, while others get cross-contaminated regularly with no consequences. Maybe that’s because their identical disease has different causes.

Why do we get celiac disease? (It's all because of pie.)

Original photo of a probably glutenous lemon pie © speedbug | Flickr

Dr. Lebwohl did not make any jokes about a) the gluten content of causal pies, or b) celiac disease being “easy as pie” to develop, so please consider those bad jokes my contribution to the scientific conversation.

Now, it’s your turn to contribute: Why do you think you got celiac disease, or another GRD? Do you have a pet theory about why they are increasing in prevalence?

This is the latest installment in my Sprue/False series of simple but difficult-to-answer questions about celiac disease. (See also Is a Gluten-Free Diet Good Enough? and More on Drugs.) By the way, although “Why do we get other gluten-related disorders?” is a great question too, I focused on celiac because, unfortunately, we’re even farther from answers when it comes to other GRDs.

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Scientists say: schedule gluten, save babies.

Hey new moms and moms-to-be, great news! Scientists have pinpointed the precise moment in your baby’s life when it’s acceptable to introduce gluten to his or her diet.

As long as you administer just the right dose of gluten no earlier or later than 3:42:18 a.m. exactly 126 days after your baby is born, he/she can’t possibly get celiac disease. (We don’t know yet about gluten sensitivity, sorry.) On the other hand, if you jump the gun or miss your cue, Baby is almost guaranteed to develop an autoimmune response to gluten, so get it right.

Don't mess up, now. Photo © Donnie Ray Jones | Flickr

Don’t mess up, now.
Photo © Donnie Ray Jones | Flickr

Sure, feeding gluten at that time goes against the World Health Organization (WHO)’s suggestion to breastfeed exclusively for six months to protect against gastrointestinal infections, decrease your baby’s chances of becoming obese, increase your baby’s likelihood of school success, and reduce your own risk of ovarian and breast cancer. But WHO are they to tell you what to do? You need to look at the big picture, and introduce gluten while you still can!

Oh, and should you follow the WHO’s other recommendation to continue to breastfeed for up to two years, then you’ll really seal the deal: the study demonstrates that babies who still latch on at age one may also be more likely to come down with a case of the celiac. Bummer!

The point I’m making, ladies, is that it’s up to you to prevent the spread of this celiac epidemic. So whatever you do, don’t focus on what seems right for your child’s and your own individual well-being. Your son wants to gum on a crust before the precise moment when it’s acceptable for him to do so? Tell him no! It’s how kids learn. Your eleven-month-old daughter still thinks breast is best? Wean her fast! Keep in mind that mother knows best, except when science does.

It’s too late to avoid passing your child the celiac genes. But you can make it right by timing it right. When it comes to introducing gluten, you must delay, delay, delay, and then ACT FAST. Keep that bread box stocked, and don’t be caught sleeping at the appointed time. In fact, set your alarm now.

Don't let Baby be caught sleeping, either. Photo © Yoshihide Nomura | Flickr

Don’t let Baby be caught sleeping, either.
Photo © Yoshihide Nomura | Flickr

The fate of your child is in your hands (and breasts). Celiac disease prevalence is increasing, and it seems mothers are to blame. Don’t become part of the problem.

If today marks day 127 of Baby’s life, then sorry, you’ve already flubbed it. You can always try again on your next child; science is all about learning from mistakes. Then again, having a sib with celiac disease will pretty much doom any future offspring, too, so you’d better not worry about it too much. After all, when it comes to ruining Baby’s life, getting stressed out is another surefire way.

For more totally-not-overstated headlines about the latest too-small-sample-sized study of a possible celiac risk factor by not-even-completely-convinced-themselves researchers, check out:

I’m glad research on causes of celiac disease continues. Still, I think sometimes we get so excited that science is paying attention to us that we give studies more weight than they deserve (even more than the researchers tell us to give them).

Confusing, isn't it? Photo © Alpha | Flickr

Confusing, isn’t it?
Photo © Alpha | Flickr

This was the latest in a patchwork of conflicting, insufficient studies on celiac disease triggers (and on breastfeeding). Most of the articles do include cautions about study limitations and conflicting existing research. But the headlines are pure mommy (sorry, “parent”) guilt.

Don’t you just love journalism?

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