When humans first evolved, we were separated into one of two categories: hunters or gatherers. Our diets consisted of lots of fruits, nuts and, on occasion, meat, when the hunters came back full-handed. Over time, we ditched these old ways and learned how to cultivate plants, sparking the agricultural revolution. But while these advancements were important milestones in our history, they weren’t without their drawbacks. The human gut had functioned the same way for more than 2 million years prior to the agricultural revolution. This meant that it was used to tolerating the same food antigens over the same period of time. But how would it react to these antigens that were previously unknown to man? For the most part, early man was able to adapt and continue living their lives normally. However, for those that could not adapt, they developed food intolerances and allergies to new food antigens.
This was how celiac disease began.
Early History Of Celiac Disease
8,000 years after its inception, celiac disease was identified by Aretaeus of Cappadocia, a Greek physician living in the first century AD. He originally named the disease as ‘koiliakos’ after the word ‘koelia’, meaning abdomen. In his own words, “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.” 17 centuries later, Dr Mathew Baillie published his own observations relating to diarrhea in adults, causing malnutrition due to a gas-distended abdomen. Baillie suggested his own stance on treatment through diet, writing, “some patients have appeared to derive considerable advantage from living almost entirely upon rice.”
Unfortunately, Baillie and his work went unnoticed. It wasn’t until Samual Gee, a leading English doctor in pediatric diseases, that the modern description of celiac diseases was credited. Like Baillie, Gee suggested that diet was an important factor for overcoming this disease. He documented the health of patients getting better after after starting a gluten-free diet.
But even though the first symptoms and possible treatments were discovered, it remained to be seen what actually caused people to contract celiac disease. Yet, what we consider recent advances were actually known many centuries ago, such as the presence of celiac disease without diarrhea.
20th Century Discoveries
Today, celiac disease is thought to affect one in 100 children in the US. In the 20th-century, strides were being made to tackle the problem head on. A new dietetic treatment burst onto the scene in the 1920s: the banana diet. In fact, the banana diet was considered the cornerstone therapy for decades for celiac sufferers. In 1914, Sidney Haas described how he successfully treated 8 children whom he had himself diagnosed with celiac disease and anorexia, with the use of bananas, being inspired by previous success with patients suffering from anorexia. Out of the 10 cases he treated, 8 of them were classified as ‘clinically cured’, while the other 2 died.
This led to his paper, and therefore Haas himself, experiencing great success, with the banana diet used at scale, saving lives.
It’s worth noting that alongside eating bananas, patients were required to avoid eating gluten-based foods like bread, potatoes and cereal. With this in mind, it can be easy to see how the success of the banana diet wasn’t in fact due to the banana itself, but by eliminating gluten from the diet.
It wasn’t until 40 years later that more progress was made. Dicke, a Dutch pediatrician, found a pattern between the bread shortage in the Netherlands caused by World War II and the health of children living with celiac disease. During times when bread was scarce, the health of these children improved, but when Allied planes brought bread for them to eat, their conditions got worse. Dicke documented a host of seminal papers a few years later, highlighting the role gluten derived from wheat and rye plays in celiac disease.
In the 1950s, Margot Shiner made a major breakthrough. She biopsied the distal duodenum, allowing doctors to connect celiac disease with the first ever recognizable pattern of damage to the proximal small intestinal mucosa. Therefore, by the 1960s, 3 important elements to celiac disease were known:
- Gluten triggers celiac disease;
- There was recognizable damage to the mucosa;
- An instrument was known to obtain biopsies.
Modern Knowledge Of Celiac Disease
In 1969, the ‘Interlaken criteria’ was formalized by a panel of experts in the European Society for Pediatric Gastroenterology (today ESPGHAN). For more than 20 years, these would serve as the globally accepted diagnostic standards of celiac disease. However, the Interlaken criteria failed to account for celiac children with antibodies in their blood caused by the ingestion of gluten. So, in 1964, Berger discovered anti-gliadin antibodies and 7 years later, Seah et al. identified anti-reticulans, autoantibodies in the serum of celiac children. However, it took several years before their diagnostics were taken seriously. In the 1980s, it was becoming more and more accepted that celiac disease could also be associated with other health conditions. One of the major classifications were autoimmune disorders like Type 1 diabetes but it was also connected with Down syndrome among others. Furthermore, it became more apparent that celiac disease was less of an intestinal disorder, but more of several symptoms and signs.
After 1990, it became widely accepted that celiac disease is an autoimmune disease. When the tissue transglutaminase enzyme helped to finally identify the missing autoantigen, it was acknowledged that celiac disease was triggered by gluten, with the autoantigen also known.
We don’t know what the future holds in terms of further discoveries or advancements in the area of celiac disease. What we do know, however, is that it will not take us as long as it did previously to make a groundbreaking discovery, should there be one. With technology and science evolving all the time, researchers are well-equipped to handle it. More than 3 million Americans have celiac disease.