It’s curious to think there was a time when the words “gluten” and “celiac disease” weren’t part of the common vernacular. Over the last few decades, rates of celiac disease have grown to the point where it is now considered a major public health problem worldwide.1 In fact, a 2018 meta-analysis shows that pooled global prevalence of celiac disease is 1.4%, based on serologic tests. The prevalence values for celiac disease are 0.4% in South America, 0.5% in Africa and North America, 0.6% in Asia, and 0.8% in Europe and Oceania; the prevalence is higher in females versus males and is also significantly greater in children than adults.1,2
Until a few decades ago, celiac was considered to be an uncommon disease affecting mainly children and limited to individuals of European ancestry.1 As such, initial prevalence studies in the general population came from European countries. It was estimated to affect approximately 1% of that population; celiac disease was later reported in other parts of the world with predominant Caucasian populations. However, in the past few decades, population-based data has been reported on celiac disease from areas like the Middle East, India, and Latin America.1
Furthermore, the prevalence of undiagnosed celiac disease seems to have increased dramatically in the US in the last 50 years.3 In the following video, renowned celiac researcher Alessio Fasano, MD, speaks with IFM educator Patrick Hanaway, MD, on how research has impacted estimated prevalence rates of celiac disease in the US.
Celiac is not the only autoimmune condition increasing in prevalence—so, too, is type 1 diabetes.4 Interestingly, between 10% and 30% of patients with celiac disease are thyroid and/or type 1 diabetes antibody positive, while around 5% to 7% of patients with autoimmune thyroid disease and/or type 1 diabetes are IgA anti-tissue transglutaminase antibody positive.4 And while the close relationship between celiac disease and endocrine autoimmunity is largely explained by sharing a common genetic background,5 researchers speculate that the cause of the rise of the disease is likely environmental and linked to gluten intolerance.6
In celiac disease, gluten has been established as the instigator of autoimmunity; the classical presentation consists of gastrointestinal symptoms associated with malabsorption, including diarrhea, steatorrhea, weight loss, or failure to thrive.6 Other symptoms include iron deficiency, recurrent abdominal pain, aphthous stomatitis, chronic fatigue, short stature, and reduced bone density. The autoimmune process is halted by removing gluten from the diet, which allows for resolution of celiac autoimmune enteropathy and subsequent normalization of serological markers of the disease.6
The cause of the disease is an interaction among a triad of factors: genetic susceptibility due in part to HLA haplotype, environmental factors, and intestinal permeability.7,8 More recently, researchers have found that HLA haplotype may impact the make-up of the intestinal microbiome, creating an environment in which dysbiosis can lead to loss of immune tolerance to gluten.9 There is speculation that environmental factors such as breastfeeding may be protective, perhaps by influencing the gut microbiome.9
The main treatment for celiac disease is a strict, lifelong adherence to a gluten-free diet.10 Yet alarmingly, 2018 research suggests that some “gluten-free” foods sold in the US actually contain trace levels of the substance that contribute to symptoms and persistent intestinal histologic damage.11 Research is ongoing into alternative treatments for celiac disease that may not require a zero-gluten diet.2
If left undiagnosed, celiac disease can be life-threatening. A 2009 study of 9,133 healthy young adults at Warren Air Force Base found, during 45 years of follow-up, that undiagnosed celiac disease was associated with a nearly four-fold increased risk of death.3
At IFM’s Immune Advanced Practice Module, expert Functional Medicine clinicians will present the latest research on celiac disease and non-celiac gluten sensitivity and provide you with the tools for identifying these conditions and effectively treating them.
Learn more about autoimmunity from researcher Alessio Fasano, MD, who in 2000 proposed a third element—intestinal permeability —as part of the trajectory of autoimmunity.
How do Functional Medicine clinicians approach celiac and other autoimmune diseases? Learn more here.
Read more about the impact of gluten on the gut and its role in the development of issues unrelated to celiac.
- Singh P, Arora A, Strand TA, et al. Global prevalence of celiac disease: systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2018;16(6):823-836.e2. doi:10.1016/j.cgh.2017.06.037
- Caio G, Volta U, Sapone A, et al. Celiac disease: a comprehensive current review. BMC Med. 2019;17(1):142. doi:1186/s12916-019-1380-z
- Rubio-Tapia A, Kyle RA, Kaplan EL, et al. Increased prevalence and mortality in undiagnosed celiac disease. 2009;137(1):88-93. doi:10.1053/j.gastro.2009.03.059
- Wood M. Dr. FAQ: Stefano Guandalini on the rise of celiac disease. Science Life. Published February 5, 2014. Accessed October 2, 2019. https://sciencelife.uchospitals.edu/2014/02/05/dr-faq-stefano-guandalini-on-the-rise-of-celiac-disease/
- Kahaly GJ, Frommer L, Schuppan D. Celiac disease and endocrine autoimmunity – the genetic link. Autoimmun Rev. 2018;17(12):1169-1175. doi:10.1016/j.autrev.2018.05.013
- Serena G, Camhi S, Sturgeon C, Yan S, Fasano A. The role of gluten in celiac disease and type 1 diabetes. Nutrients. 2015;7(9):7143-7162. doi:10.3390/nu7095329
- Fasano A. Zonulin and its regulation of intestinal barrier function: the biological door to inflammation, autoimmunity, and cancer. Physiol Rev. 2011;91(1):151-175. doi:10.1152/physrev.00003.2008
- Fasano A. Zonulin, regulation of tight junctions, and autoimmune diseases. Ann N Y Acad Sci. 2012;1258:25-33. doi:10.1111/j.1749-6632.2012.06538.x
- Serena G, Lima R, Fasano A. Genetic and environmental contributors for celiac disease. Curr Allergy Asthma Rep. 2019;19(9):40. doi:1007/s11882-019-0871-5
- Morreale F, Agnoli C, Roncoroni L, et al. Are the dietary habits of treated individuals with celiac disease adherent to a Mediterranean diet? Nutr Metab Cardiovasc Dis. 2018;28(11):1148-1154. doi:10.1016/j.numecd.2018.06.021
- Syage JA, Kelly CP, Dickason MA, et al. Determination of gluten consumption in celiac disease patients on a gluten-free diet. Am J Clin Nutr. 2018;107(2):201-207. doi:10.1093/ajcn/nqx049