By Cait Mizzi, CFNP
A few decades ago, celiac disease (CD) was considered an uncommon condition affecting
children, mainly limited to European descent. However, over the past several decades, the rate of
CD has increased about 7.5% per year. In Canada, 1 in 114 Canadians receives a diagnosis. Yet,
in 2018, Health Canada stated that 90% of CD cases go undiagnosed. In the United States and
Canada, rates have increased 5-fold. 4-fold in the UK, 3-fold in the Netherlands, 2-fold in
Finland. At the same time, Scotland has seen a staggering 6-fold increase. Thus, making celiac
disease a significant public health issue around the globe.
CD is an autoimmune disease characterized by an inflammatory immune response to two
particular components of gluten – gliadin and glutenin. These proteins are found in grains such as
wheat, barley, Kamut, spelt and rye. Antigen-presenting cells get a hold of these specific proteins
and present them to T-cells, which are critical for their role in immunity to foreign substances.
Then, the body creates antibodies against gliadin. Gliadin is often bound to an enzyme called
TG2, implicated in the regulation of cell growth, cell differentiation and cell destruction. The
body then creates antibodies against it, resulting in the “attack of self” at the gut level. Hence, the
classification of celiac disease as an autoimmune condition.
This chain of events triggers a response that results in severe damage to normal gut tissue,
including atrophy of villi in the small intestine, inhibiting the absorption of nutrients. If
undiagnosed or untreated, CD will lead to malabsorption of nutrients, osteoporosis, other
autoimmune conditions and failure to thrive.
A genetic component will predispose an individual to celiac disease, and actually, those genes
are relatively common in the population (about 30%). However, only a tiny percentage of those
who carry the HLA-DQA1 and HLA-DQB1 genes will develop the disease. Since CD is genetic,
it runs in families. Those who have parents, siblings or children with the same genotype as the
family member with CD have a 40% greater risk of developing the disease. Alternately, a
negative gene test will exclude the possibility of developing CD.
Individuals who suspect CD will require appropriate genetic and antibody testing. Blood
screening for tTG-IgA is the first step. Additional antibody tests are used to check for potential
false negatives or false positives, especially in those with other pre-existing autoimmune
conditions. The only way to confirm a celiac disease diagnosis is to biopsy the small intestine.
For those who test positive for CD, lifelong avoidance of all gluten-containing foods is the only
viable treatment. Careful cleaning of shared food prep areas at home and in restaurants is
essential. Continued exposure (with or without symptoms) will further damage the intestinal
lining and increases the risk for more severe complications.
With proper support and guidance, leading a life without gluten can be simple, easy and
delicious! All of our products here at Unbun are 100% grain and gluten-free.