Celiac disease is not a disease
Monday, September 12, 2011 at 09:21AM By Dr. John
“HLA antibodies complexed to alpha-/beta-gliadin.” Image: Wikimedia CommonsThe New Oxford American Dictionary defines a disease as:
a disorder of structure or function in a human, animal, or plant, esp. one that produces specific signs or symptoms or that affects a specific location and is not simply a direct result of physical injury
For this discussion, the key point is “a disorder of structure or function.” With celiac disease (CD) however, there is a problem: the person does not have “a disorder of structure or function.” Their structure or function would have been just fine before the agricultural revolution. There is nothing wrong with the person; the problem is the invented diet of the agricultural revolution. (Consider it this way: if someone is suffering from chronic mercury exposure, you do not say they have mercury disease, you say they have mercury poisoning.)
Dr. Stefano Guandalini of the University of Chicago Celiac Disease Center, in A Brief History of Celiac Disease, writes:
The agricultural revolution of the Neolithic period generated a whole battery of food antigens previously unknown to man, including protein from cow, goat, and donkey milk, as well as birds’ eggs and cereals. Most individuals were able to adapt. Among those who could not, food intolerances appeared and celiac disease was born. (emphasis added)
According to Guandalini, Aretaeus of Cappadocia, a Greek physician, described celiac “disease” in the first century AD; the name was created from “koelia”, the Greek word for abdomen. Aretaeus' observation:
“If the stomach be irretentive of the food and if it pass through undigested and crude, and nothing ascends into the body, we call such persons coeliacs.”
In 19th century, avoidance of “farinaceous food” (starchy foods) was recommended. However, according to Guandalini, “there was still no clue as to what could be causing celiac disease and no hint (in spite of autopsies frequently performed given the high mortality rate) of the damage to the intestinal mucosa.” (emphasis added).
In the mid-20th century, Dutch pediatrician Dicke
“… noticed that during bread shortages in the Netherlands caused by World War II, children with celiac disease improved. He also saw that when Allied planes dropped bread into the Netherlands, they quickly deteriorated.”
In the 1960’s, antibodies to the gluten protein gliadin were discovered and CD began to be viewed as an autoimmune condition. The gut, sensing the foreign protein invader (gluten), mounted a strong immune reaction that if sustained, can eventually destroy the gut. Avoidance of gluten allows many to return to normal, although long term effects on development, such as short stature, are not reversible in adulthood. Celiac disease represents a strong argument for returning to a modern equivalent of the diet of the Paleolithic eara.
The current "treatment" advice is outlined by the National Digestive Diseases 
Information Clearinghouse (NDDIC). (Please refer to the NDDIC link if you have, or believe you may have, CD. If affected, your goal is learning how to avoid a toxin, one that was never a significant part of the original human diet.) Part of the NDDIC advice includes:
“Plain” meat, fish, rice, fruits, and vegetables do not contain gluten, so people with celiac disease can freely eat these foods. In the past, people with celiac disease were advised not to eat oats. New evidence suggests that most people can safely eat small amounts of oats, as long as the oats are not contaminated with wheat gluten during processing. People with celiac disease should work closely with their health care team when deciding whether to include oats in their diet.
In the celiac as a "disease" model, persons with CD are said to be "genetically predisposed" to the disorder. However, this depends on the point of view. For those supporting the disease model, "genetic predisposition" will be the frame of reference. The opposite point of view is more accurate: those that tolerate gluten have a "genetic protection"; one that, for many, was an evolved trait in view of the loss of persons not adapted to gluten.
In summary, reaction to gluten was mostly a non-issue for human kind during the Paleolithic. The exception may have been occasional exposure to wild grains, most likely during times of relative starvation. Celiac disease is a modern disease with it origins at the beginning of the modern era 10,000 years ago. A return to the original human diet, commonly known at the Paleolithic diet, avoids this, for some, toxic stimulus.
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Reader Comments (5)
Dr. John
Excellent article. I would just at the celiac "disease" is an autoimmune disorder and in fact is the trigger for the development of various other autoimmune disorders. Lupus, rheumatoid arthritis, psoriasis and Hashimoto's thyroiditis to name a few. Many, if not the majority of patients with other autoimmune disorders will resolve their symptoms with gluten avoidance.
I would add that up to 20-30% of the population likely reactive to gluten in some fashion and only a small percentage actually have celiac. Celiac, representing the most severe form of reaction. The other larger group of patients we refer to as "non-celiac gluten sensitive" patients.
Keep up the good work.
As someone who is grain and gluten intolerant and seemingly not a full-blown Celiac, I too improved by simply avoiding grains entirely. When I first figured out grains were giving me problems, I tried going GF--it helped for awhile, but man, that was an expensive ride! After about a couple years of using "their" flours and stuff, I noticed I was till getting reactions---extremity redness and nasal problems. I tried using the WAPF methods of grain prep, thinking that was the answer--again, it helped for awhile, but the symptoms returned. Where do you go when you're soaking GF flours and beans/legumes overnight (or longer) in an acid medium, and still having trouble? Dairy also causes me nasal problems--not your typical food allergy symptoms, I know, and this is why I confused my food allergies with pet dander, pollen, and mold issues.
"Typical" was killing me. Even my doctor missed the signs. Thank god the web didn't.
The next step was to avoid the offending foods completely, which I did. I'm fine now, as long as I stick to the Paleo diet.
If we observe nature, we see that fruits and grains are for birds, nuts are for squirrels, and milk is for baby herd animals. Why must we insist on upsetting the natural order of things when it's obviously hurting us?
Sometimes it's what you're NOT eating that helps the most!
Thanks for this article! This is a really positive and seemingly sensible way of looking at celiac disease. I have celiac disease and have always wondered what happened to me. I was a really healthy kid and then suddenly everything started to fall apart. I didn't find out I have celiac until I was in my late 20s. So maybe I just one of those who did not adapt. I cannot tolerate any kind of grains. The reaction to them is not the same as the reaction to wheat but it is notable anyway.
"The agricultural revolution of the Neolithic period generated a whole battery of food antigens previously unknown to man... Most individuals were able to adapt. Among those who could not, food intolerances appeared and celiac disease was born."
This quote from Dr Steffano was great. People tell me that I shouldn't be so sensitive to foods since I've been eating healthy for so long. I've wondered if this is not true, if it is instead my inability to tolerate foods of agriculture. I am quite fine as long as I avoid them, not so fine if I don't.
Thanks to Dr. Guillory for providing a wider framework and pointing out that celiac disease triggers other autoimmune disorders and that 20-30% of us are reactive to gluten. Learn more about celiac disease and gluten sensitivity from Dr. Guillory through the first and sixth links listed the Related Entries above.
Whenchypoo clearly describes how going gluten free is not that simple. It makes so much sense to just take it all the way and go Paleo. For some, it just seems better to replace all grains with nutrient-dense modern equivalents of the Paleolithic diet. Thanks Whenchypoo.
Peggy - As you know, healthy eating is your best defense. I think your system should still be on guard for those insults (foreign proteins) that your body does not want to see. Just tell your friends that being healthy does not mean we now get sloppy on what we defend against.
Dr. John
It's always great to see others providing important information about the lupus disease. Living with lupus symptoms is difficult, but not impossible. Thanks!