Celiac disease and the gluten-free diet

Celiac disease: main indication for a gluten-free diet

Celiac disease is thought to affect up to 2% of the population (in Europe, India, Middle East, North Africa and the United States). It is rarer in Asia and Sub-Saharan Africa, probably due to differences in diet. This condition (affecting predominantly women) is probably underestimated, due to the diversity of symptoms and the many asymptomatic forms. The main indication for the gluten-free diet (together with gluten/wheat allergy), celiac disease can lead to the shortening of the villi lining the small intestine (villous atrophy), which causes deficiencies and malabsorption that cannot be ignored.

Is it a genetic disease?

Genetic predispositions have been identified in most cases of celiac disease (95%): in particular, patients are carriers of specific genes (HLA-DQ2 and/or HLA-DQ8). For example, being part of a close family (father, mother, siblings and children) exposes an individual to a 10% risk of developing the disease from the outset. However, being a "carrier" does not necessarily mean that one will be intolerant to gluten: 20% of carriers of these genes do not have symptoms of celiac disease. The causes and origins of this disease remain difficult to identify because the involvement of non-genetic external factors is not negligible in the evolution of the disease.

How is celiac disease diagnosed?

Diagnosis of celiac disease (often based on suggestive clinical findings) is based on the level of antibodies (anti-transglutaminase antibodies) and is confirmed by an intestinal biopsy. However, sometimes the antibody assays are negative, despite "obvious" clinical symptoms. In this case, it is possible to carry out genetic research (on the carrying of the HLA-DQ2 and/or HLA-DQ8 genes) and confirm the diagnosis by intestinal biopsy. On the other hand, an intestinal biopsy cannot be conclusive if the patient has already started a gluten-free diet. The characteristic lesions of the intestinal mucous membrane fade in the absence of contact with gluten, which makes histological diagnosis difficult.

In fact, after one year of a gluten-free diet, negative antibody tests and a complete disappearance of symptoms will confirm the diagnosis.

How does celiac disease manifest itself?

Celiac disease manifests itself via a pattern of malabsorption (significant weight loss) with chronic diarrhea, abdominal pain and bloating. The classic form starts in infants as early as 6 months of age, when the mother's immunoglobulins (antibodies) disappear and gluten-containing foods are introduced into the diet. The infant is often tired, listless and sad. A break in the infant's growth chart (height and weight) is significant in view of the suggestive clinical picture.

However, most affected subjects report few symptoms or present atypical extra digestive symptoms (muscle cramps, aphthous stomatitis (recurrent canker sores), menstrual irregularities, or even repeated miscarriages). The number and intensity of symptoms varies from person to person. Thus, the majority of these atypical or silent cases go undiagnosed, which explains why the prevalence (number of cases) of celiac disease is quite variable around the world (0.7 to 2% of the population in Europe, the United States, India, the Middle East and North Africa). It can be noted that celiac disease affects three women for every one man.

How is celiac disease treated?

At present, there is no treatment other than a strict gluten-free diet for life. The only mandatory indication for the diagnosis of celiac disease is the complete elimination of gluten. This diet must be followed for life to ensure that the antibodies remain negative and to prevent complications (osteoporosis, anemia, malnutrition). For silent or asymptomatic forms (in the case of incidental screening), the introduction of this strict gluten-free diet is debated: with no or only minimal clinical signs pointing to the disease, regular clinical and biological monitoring may be considered.

The gluten-free diet: therapeutic solution or trendy diet?

Why does gluten have such a bad reputation?

Today it is often identified as an "enemy" for purely medical and sometimes nutritional reasons.

Faced with the emergence and worldwide distribution of products containing gluten, many cases presenting digestive symptoms have been reported. It should be noted that gluten-related diseases have always existed, but it is since these products have flooded the agri-food market that these conditions have become widespread.

Indeed, between the 19th and 20th centuries, many doctors (notably Dutch pediatrician Dr. Willem Karel Dicke) noted that similar digestive disorders in their patients could be alleviated by avoiding wheat. This theory is supported and proven by scientific publications which classify these disorders into three types of illness: celiac disease, gluten allergy and "non-celiac" gluten sensitivity. The only treatment that has been proven to be effective is gluten avoidance.

For whom is the gluten-free diet recommended?

The main patients for whom the gluten-free diet is officially recommended are those with celiac disease or gluten allergies. More controversially, individuals with "non-celiac" sensitivity to gluten are also concerned. However, it should be noted that despite the numerous studies in favor of extending the recommendations of a gluten-free diet to these patients or to certain psychiatric or endocrine conditions, the present knowledge makes it impossible to correlate the benefits of a gluten-free diet with a reduction in symptoms.

The gluten-free diet has been widely reported on in the media and picked up on by the food industry for several years now, but it is still the subject of debate amongst the general population. It is the most popular diet in the United States, ahead of the fat-free and sugar-free diets.

The book "Wheat Belly" by Dr. William Davis, for example, has played a major role in spreading this nutritional trend. The cardiologist retraces his investigation to identify the toxin responsible for the disorders he and many of his patients experience. He denounces the harmful effects of wheat (not just gluten) on the body, in particular by advocating a "grain-free" diet that would allow his patients suffering from obesity or diabetes to lose tens of kilos. Faced with the explosion of cases of obesity, particularly in the United States, the effectiveness of this diet has become popularized.

This is why, in spite of this, it is necessary to remain vigilant because this diet is not recommended for everyone and gluten has proven to be toxic in the majority of genetically predisposed people. It is a restrictive diet that will permanently change the lifestyle of those who are ill.

To help patients suffering from celiac disease, the Celiac Disease Foundation provides invaluable advice, tips, recipes and more to offset the social and psychological impact that this type of diet can have.

Before being a trend, the gluten-free diet is a real therapeutic solution that considerably improves the quality of life of patients.

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