What Causes Celiac Disease?

By Amy Burkhart MD, RD

What causes celiac disease? How can someone who has eaten gluten their entire life suddenly become ill after ingesting it? Researchers may be close to finding an answer to these questions. This is exciting news, as the discovery of potential triggers may lead to therapies to prevent celiac disease.

To have celiac disease, three factors must be present:

You must be ingesting gluten for the immune reaction to occur. If you never ate gluten, a protein that occurs naturally in wheat, rye, and barley, you would never develop celiac disease. The majority of westernized countries are heavily dependent on wheat. Irrespective of the popularity of the gluten-free diet, the vast majority of Americans consume wheat every day.

Second, you must carry at least one of two genes (HLA alleles) associated with celiac disease for it to occur. Having one (or both) of these genes does not guarantee you will get celiac disease. Thirty to forty percent of the general population carries one of the two genetic markers for celiac disease. Still, the condition is only triggered in five percent of the people who have a gene for it.

Something must activate celiac disease in a person who is consuming gluten and carries the appropriate gene. There is very little data on the environmental factors that may be the trigger(s) for celiac disease, but researchers have identified some possible triggers:

• pregnancy
• illness
• menopause
• antibiotic use
• the anti-acne drug isotretinoin (marketed in the USA under the brand name Accutane until 2009),
• prolonged use of non-steroidal anti-inflammatories such as ibuprofen
• gastrointestinal infections.

Another possible trigger is viral infections. Viruses trigger immune reactions that can lead to celiac disease in susceptible individuals.

• Certain viruses can cause the immune system to “overreact.” If this reaction is prolonged or repeated, it may cause someone to lose the ability to tolerate gluten.

• Different celiac patients had different immune responses to the same infection. This may help explain why symptoms vary so much from one person with celiac disease to another.

• Certain viruses, such as rotavirus, are more likely to trigger these particular immune responses.

If viruses are found to contribute to celiac disease development, the discovery could open up avenues for prevention. We may be able to vaccinate against these viruses and prevent the onset of celiac disease in certain individuals. This is of particular importance to relatives of people with celiac disease. They are at higher risk of developing the disease. Treatments such as this may sound far off, but a vaccination already exists for rotavirus. If this virus is one of the triggers for celiac disease, a simple vaccination may help prevent celiac disease in susceptible individuals.

More recent research discusses the role that infections and gut microbiome may play in the onset of celiac disease. This is promising news for the celiac community, as it focuses attention on the prevention of celiac disease for future generations. While we are lucky to have a gluten-free diet as a treatment, this type of research may be an important step to a cure.