Some may call gluten-free diet a new fad, but intolerance to gluten is real. It affects about one in every hundred people—and almost 3 million people in US alone.
An Italian study of school children found 1 in 184 were positive for celiac, and among these positive cases, 6 out of 7 were previously undiagnosed.
The highest known prevalence of celiac is in Saharawi tribes of Algeria's Sahara desert. At 5.7 percent, it's more than one in twenty people.
This group also has an unusually high occurrence of DQ2 genes, which correlate strongly with celiac. A war in the region recently changed their traditional diet to gluten-rich diet, causing widespread symptoms.
A review of non-western countries suggests celiac is present across Africa, India, East Asia, Latin America, Middle East, South America, and Australia. Many regions have cultural anecdotes supporting gluten intolerance, e.g., the chapati effect in India, during wheat harvesting season, is part of the cultural vernacular.
Only Japan is a rare case, with only two identified cases as of 2006.
Despite widespread social awareness very few people are diagnosed with celiac (or coeliac) disease—suggesting only the tip of ‘celiac iceberg’ is ever noticed.
That’s mainly because symptoms of gluten sensitivity vary significantly, from no signs at all to extreme cases of reactions appearing as rashes, vomiting, diarrhea, and abdominal pain.
Celiac disease was first described in Greece during second century AD by Aretaeus of Cappadocia, who suggested that children who couldn’t retain food, and were letting it pass through without digestion, were coeliacs.
In 1786 William Buchanan of Edinburgh and, in 1888, Samuel Gee of St. Bartholomew's Hospital in London described the modern-day celiac symptoms. Gee pointed out that the only way to cure celiac was through diet, and children fed on Dutch mussels, and very little starch, showed no symptoms until the season was over.
In 1924, Sydney Haas, successfully demonstrated treatment of children with a banana-rich diet that excluded carbohydrates such as bread and sugar. His famous experiment of treating eight anorexic children specifically excluded cereals, bread, potato, and crackers—which is essentially today’s gluten-free diet.
During World War II, Dutch pediatrician WK Dicke and his colleagues successfully connected wheat to celiac. The health of children improved dramatically when wheat, barley, and rye were in short supply during World War II. When the Allied Forces dropped bread from their planes on Netherlands, the first casualty was return of celiac symptoms in those children.
In 1964, Berger's report on detection of anti-gliadin antibodies paved the way to a blood test, that could identify response to eating gluten. Soon reports of celiac’s association with auto-immune diseases, e.g., diabetes and lupus first appeared.
Breakthroughs in the development of biopsy tools showed celiac damages the intestine lining. This knowledge, combined with gluten as the culprit, has been helpful in developing clinical diagnosis.
In 1972, Falchuk was the first person to identify a connection between celiac and a specific gene. Subsequently, many groups in 1980s were conclusively able to connect DQ2 genes (or DQ8 in few cases) to all celiac cases. In 1989, Sollid specifically pointed out the association of celiac with DQ haplotypes, paving way to the identification of up to 39 genes today.
Anyone suspected of gluten intolerance can easily receive a . diagnosis today. Though there is no cure, life-long adherence to gluten-free diet can keep people disease free.
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