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    Ep 146 Celiac Disease: Rootin tootin gluten

    enJuly 23, 2024
    How does celiac disease affect mental health?
    What challenges does a gluten-free diet present?
    Why is diagnosing celiac disease often delayed?
    What extra-intestinal symptoms are associated with celiac disease?
    What alternative therapies are being researched for celiac disease?

    Podcast Summary

    • Mental health impact of celiac diseaseCeliac disease can exacerbate mental health issues like eating disorders due to fear, stress, and negative associations with food during diet navigation

      While celiac disease may be primarily understood as a physical condition that affects digestion, it can also have a profound impact on mental health. Becca's story illustrates this, as she shares how her diagnosis during puberty exacerbated her existing body image issues and turned food into an enemy. The fear and stress of navigating a gluten-free diet, combined with the weight loss and negative associations with food, led to an eating disorder. It's important to recognize and address the mental health aspects of celiac disease, in addition to the physical symptoms, to ensure proper treatment and support for those diagnosed.

    • Celiac Disease and HLA MarkersCeliac disease is an autoimmune condition triggered by gluten consumption, damaging small intestine cells. HLA DQ2 and DQ8 markers are linked to its development, and a gluten-free diet is necessary for management.

      Celiac disease is an autoimmune disorder where the body attacks itself in response to consuming gluten, a protein found in wheat, rye, and barley. The body creates autoantibodies against the gliadin proteins in gluten, leading to damage of the small intestine cells. Over 99% of people with celiac have one of two HLA markers, HLA DQ2 and HLA DQ8, which play a crucial role in the development of the disease. Gluten-free diets are essential for managing celiac disease. The discussion also included a quarantini recipe, a rhubarb mojito without grains, and a promotion for Cremo Men's Body Wash.

    • Celiac Disease and Immune ResponseCeliac disease is an autoimmune disorder caused by a combination of genetics, gluten exposure, and an unknown third factor. The immune response involves T cells and B cells, and HLA proteins play a crucial role in presenting gluten to these cells, leading to damage in the small intestine.

      Celiac disease is an autoimmune disorder caused by a combination of genetic susceptibility, exposure to gluten, and an unknown third factor. Our immune system, specifically our T cells and B cells, play a crucial role in identifying gluten and initiating an inflammatory response. The HLA proteins, particularly DQ2 and DQ8, have an affinity for gluten and present it to T cells in our guts, leading to an immune response and potential damage to the small intestine. Pyers patches, similar to tonsils, are where immune cells, including T cells and B cells, congregate in our guts to respond to potential threats. The small intestine, responsible for digestion and nutrient absorption, is primarily affected in celiac disease due to the damage caused by the immune response to gluten. The development of celiac disease is not solely determined by genetics and gluten exposure, but also by an unknown third factor that triggers the production of autoantibodies against tissue transglutaminase and other enzymes, leading to further immune activation and damage to the small intestine.

    • Extra-intestinal manifestations of celiac diseaseExtra-intestinal symptoms of celiac disease include skin conditions and neurological issues, and their causes are not fully understood, but they're related to the disease. Symptoms can have a variable onset and untreated celiac disease can lead to complications. Diagnosis is challenging due to symptom variability and there's no known prevention method.

      Celiac disease is not just characterized by intestinal symptoms like diarrhea, but also extra-intestinal manifestations such as skin conditions like dermatitis herpetiformis and neurological issues like gluten ataxia. While the exact causes of these extra-intestinal symptoms are not fully understood, they are related to celiac disease. The symptoms of celiac disease can have a variable onset, ranging from no symptoms to years of symptoms before diagnosis, and untreated celiac disease can lead to long-term complications. Currently, we don't have a definitive answer on how to prevent celiac disease, and the diagnosis process can be challenging due to the variability of symptoms.

    • Triggers and complications of celiac diseaseDespite progress in understanding celiac disease, there are still unknowns such as what triggers it and the lack of a definitive test for those already on a gluten-free diet. Not everyone achieves complete healing, leading to potential health complications.

      While we have made strides in understanding celiac disease, including its symptoms and the importance of a gluten-free diet for treatment, there are still many unknowns. For instance, we don't know what triggers celiac disease in some individuals, and we don't have a definitive test for the disease if someone is already on a gluten-free diet. Additionally, not everyone with celiac disease achieves complete healing of their small intestine, which can lead to complications such as an increased risk of certain cancers and other health issues. It's also important to note that celiac disease is distinct from other conditions, such as wheat allergies and non-celiac gluten sensitivity, which have different causes and require different approaches to treatment.

    • Celiac disease and ancient dietsDespite the long history of grain consumption, celiac disease has posed a significant challenge due to severe symptoms experienced in ancient times, with the link to a gluten-free diet not discovered until the mid-20th century

      Celiac disease, a condition that makes it difficult for the body to process gluten, has been a challenge for humans for thousands of years, despite the fact that grains, the primary source of gluten, have been a staple in many diets for just as long. The severity of the disease, which can lead to malnutrition, wasting, and even death, is a paradox given its prevalence in populations with long histories of grain farming. While some theories suggest that modern gluten-containing grains may be more harmful or that people with celiac disease historically suffered less, there is evidence that people with the condition in ancient times experienced severe symptoms. Another hypothesis is that having celiac disease provides a health trade-off, such as increased resistance to certain infectious diseases. However, the evidence for this is not conclusive. Regardless, the link between celiac disease and a gluten-free diet was not made until the 1950s, making this relatively recent discovery a significant advancement for those with the condition.

    • Celiac Disease EvolutionThe cause and evolution of celiac disease is complex and not fully understood, with theories suggesting some parts may have been beneficial or neutral, and the connection to gluten was not discovered until the late 19th century

      The evolution of celiac disease is complex and not fully understood. While we know that celiac disease is caused by a network of genetic risk factors, it's unclear if the disease as a whole was selected for or against in evolution. Some theories suggest that individual parts of the disease may have been beneficial or neutral, leading to their persistence. The connection between celiac disease and gluten was not made until the late 19th century, despite earlier descriptions of the condition. Doctors like Samuel Jones-Ghee suspected a dietary cause, but the specifics were not yet known. The disease was not fully understood until the mid-20th century, with the discovery of the link between gluten and celiac disease. Overall, the evolution of celiac disease highlights the complex and often messy nature of biological evolution.

    • Discovery of Gluten-Celiac Disease ConnectionThe discovery of the connection between gluten and celiac disease came from observing the effects of a famine in the Netherlands in the late 1940s and earlier experiments with alternative diets like the banana diet.

      The connection between gluten and celiac disease was discovered through tragic circumstances during a famine in the Netherlands in the late 1940s. Prior to this, there were hints and experiments with alternative diets, such as the banana diet introduced by Sidney Haas in 1924. The banana diet, which excluded bread, was claimed to have cured some individuals with celiac disease, but it also raised concerns about potential toxicity from excessive vitamins and fiber. As the 20th century progressed, research continued to uncover the mechanisms, diagnostic criteria, and heritability of celiac disease. However, the gluten-free trend that emerged around 2010 was a mix of fact, fiction, and commercialization, leading to both benefits and challenges for those with gluten sensitivities or celiac disease. Today, celiac disease is recognized as a global issue with an estimated prevalence of around 1.4%.

    • Celiac Disease ComplexitiesDespite a low global prevalence of celiac disease, many cases go undiagnosed leading to significant health consequences. Research is ongoing for alternative therapies to the strict gluten-free diet, including tolerance induction, gluten degradation, inhibiting TTG, and monoclonal antibodies, but none are available yet.

      While the global prevalence of celiac disease is estimated to be around 1.4%, this number might be an overestimate due to the large number of undiagnosed cases. The incidence of celiac disease is increasing, leading to more people being diagnosed and living with the condition. The delay in diagnosis can range from three years or more, which can have significant health consequences, especially for children. Research is ongoing to develop alternative therapies to the strict gluten-free diet, which can be difficult to follow due to the widespread presence of gluten and the potential for unintentional exposure. These therapies include tolerance induction strategies, gluten degradation, inhibiting TTG, and monoclonal antibodies. None of these therapies are available yet, but they are in various stages of development. Overall, celiac disease is more complex than it appears on the surface, and ongoing research holds promise for improved diagnosis and treatment options. For more in-depth information, check out the sources mentioned in the podcast, including "Celiac Disease as a Model for the Evolution of Multifactorial Disease in Humans," "A History of Celiac Disease: Arateus to Crosby," and "Going Gluten-Free: The History and Nutritional Implications of Today's Most Popular Diet."

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