Toward the end of World War II, the Netherlands suffered a “Winter of Starvation.” With shipments of staple foods, such as bread and cereal, disrupted, the Dutch ate tulip bulbs and whatever they could scavenge from the great outdoors. But while most people grew thinner under this harsh regimen, a pediatrician named Willem-Karel Dicke watched with interest as one group of his patients actually gained weight.
Eventually, Allied planes dropped bread to the hungry Dutch people. Most of the population began to regain the weight they had lost, but Dicke noticed that the children who had started thriving during the famine were sickly once again. These kids previously had been diagnosed with celiac disease, a condition marked by chronic intestinal troubles and malnutrition. Although celiac disease was named by a Greek physician in the first century B.C. (its name is derived from the Greek word for abdomen), the condition was still something of a medical mystery. Dicke and other experts had suspected that celiac symptoms stemmed from some sort of intolerance to wheat; the children’s dramatic health improvements during the time when grains were unavailable provided the proof. A few years later, Dicke and two colleagues published papers showing that it is specifically the gluten in wheat (and barley and rye) that causes people with celiac disease such distress. Today, experts concur that people with celiac disease carry at least two genes that predispose their small intestines to greet incoming gluten as an alien invader, not a nutrient.
“For celiacs, there’s a battle in your gut between your immune system and the gluten, which it considers an enemy,” says Joseph Murray, M.D., a gastroenterologist and professor of medicine at the Mayo Clinic in Minnesota. This immunological warfare winds up damaging the small, fingerlike projections called villi that line the gut. Under normal circumstances, the villi expand the surface area of the small intestine and allow it to absorb nutrients. But when doctors biopsy the small intestine of someone with celiac disease, they find that many of the villi have atrophied and flattened. The damage prevents proper absorption of nutrients, causes a variety of problems throughout the body and, left untreated, can even lead to cancers in the intestine.
When Dicke and his colleagues wrote their landmark paper, most people thought celiac disease affected only children—patients were often counseled that they would “grow out of it.” Now, it is widely recognized as an autoimmune disease that persists for a lifetime and can develop at any age. It sometimes becomes active after surgery, pregnancy, a viral infection or emotional stress, for reasons that remain unclear.