Celiac Disease

Celiac disease is not as common as other diseases, but the burdens it holds may be just as bad, if not worse, as some more prominent diseases. Not only do people with celiac disease accumulate a lot of medical costs, they also have to participate in a complete lifestyle change: eating gluten-free. Eating gluten-free is challenging, but also very expensive. There is also a bad stigma around eating gluten-free because of people who have transformed this necessary lifestyle change for those with the disease into a fad diet that many people who participate in don’t even truly understand.

            Celiac disease is an autoimmune disorder in which the ingestion of gluten causes the body to attack its own cells and damage the lining of the small intestine. It is a common lifelong disorder and it affects about 1 in every 100 individuals, or 1% of the population (Lionetti and Catassi 2015). The only treatment for this disease is a strict lifelong adherence to a gluten-free diet. The exact cause of celiac disease is unknown. It is believed to be caused from a mix between genes, eating food with gluten, and other environmental factors. Gastrointestinal infections and gut bacteria may also be a factor in the disease. In some cases, celiac disease may develop after surgery, pregnancy, childbirth, viral infection or extreme stress. It is found that there are genes that increase your risk of celiac disease. People who have family members with the disease, have type I diabetes, Down syndrome, autoimmune thyroid disease, and Rheumatoid arthritis are more likely to develop celiac disease (Symptoms and causes 2016). Just because a person has these genes, though, doesn’t mean they will get the disease.

The number of people who have celiac disease has increased in developed countries, which leads to the conclusion that there are environmental factors that have a role in this disease (Lionetti and Catassi 2015). Lionetti and Catassi say in their paper that it is possible that intestinal infections and microbiota, nutrition, and the amount and quality of gluten ingested can cause a change from being tolerant to having an immune response to gluten (2015). Lionetti and Catassi hypothesized that the age at which gluten is first introduced has an effect on the risk of celiac disease (2015). After testing this, they found that this does not change the risk of celiac disease. Their results also found that the risk of celiac disease is not related in any way to breastfeeding practices. While these results are very important findings, more research needs to be done to see if other factors such as intrauterine and perinatal exposures, drug exposure, microbial infections, and the microbiome have a role in the development of celiac disease (Creach 2015). Someone can develop celiac disease at any age, so findings of this research would be important to help figure out when the loss of tolerance happens and to be able to intervene before the disease develops (Creach 2015). With continued research, I’m sure these unknown questions about what causes celiac disease can be answered.

The medical costs for someone with celiac disease may not be as high as other diseases, but they are still a great deal more than the average person’s medical costs. A study done by Guandalini et al. found that people with celiac disease have medical costs 2.5 to 3.8 times higher than people without celiac disease (2016). Medical costs don’t stop after the initial diagnosis of the disease. Numerous tests and follow ups are needed as well. People who are diagnosed with celiac disease are recommended to follow up 3-6 months after the diagnosis and then annually after that to address any symptoms or nutritional deficiencies the person has and to make sure they are following the gluten-free diet (Celiac Disease Treatment 2016). Some people with celiac disease will also be prescribed medications like dapsone or sulfapyridine for dermatitis herpetiformis, a rash, for a short period of time (Celiac Disease Treatment 2016). Along with their normal doctor they see, people with celiac disease may also see a dietitian. They are recommended to see a dietitian at the time of diagnosis, after 2 months, after 12 months, and sometimes after 24 months (Celiac Disease Treatment 2016). These medical costs can add up and really become a burden for people with this disease, but these aren’t the only costs they have to deal with.

A person with celiac disease must follow a gluten-free diet. Not only is it a nuisance to have to buy foods that are gluten-free, it also is quite expensive to buy them. A study done by Stevens and Rashid compared the prices of gluten-free food with regular gluten-containing food to see if eating gluten-free actually is more expensive (2008). They found that the mean unit price for gluten-free products was $1.71 and the mean unit price for regular products was $0.61. This shows that gluten-free products are 242% more expensive than regular products. This is definitely a financial burden to those with celiac disease. It also makes me wonder why people who don’t have celiac disease would choose to eat gluten-free, seeing that it is so much more expensive.

There seems to be a lot of people who have started to eat gluten-free who don’t have celiac disease. New diets come and go and this one seems just as ridiculous as most. It would make sense to eat gluten-free if it actually had a health benefit, but according to Nelson, there isn’t much evidence supporting that eating gluten-free has any health benefits (2016).  It is possible to still eat healthy when on a gluten-free diet by eating foods that naturally don’t have gluten, like lean meats, low-fat dairy, vegetables, whole grains (that are gluten-free), and healthy fats. The problem with eating gluten-free comes in when gluten-containing products are replaced with red meat, full-fat dairy, starchy vegetables, sweets, fats and commercially prepared gluten-free products. This can lead to a higher intake of cholesterol, saturated fat, sodium and too many calories (Nelson 2016). While it is possible to eat healthy on a gluten-free diet, it still stands that you don’t gain any health benefits from it. Since a lot of people are trying this gluten-free diet, the idea of eating gluten-free has become much more recognized.

Celiac disease has been around for about 10,000 years (Guandalini, 2007), but eating gluten-free has just recently become acknowledged because of the new fad diet. I hadn’t even heard of people eating gluten-free until I started hearing about people doing it because they wanted to try a new diet. I didn’t realize that there are people who need to eat gluten-free for medical reasons. Most restaurants now offer gluten-free options, but I believe they only started doing that because many people want to eat gluten-free, rather than for the people who need to eat gluten-free. There are many people who are involved in this fad diet who don’t even know what gluten is or what the effects of eating it or not eating it will do to your body. It’s these people who are giving a bad stigma to eating gluten-free.

The overall costs of celiac disease end up being pretty high after all the medical bills plus the lifetime of eating gluten-free products, which are a lot more expensive than regular products. It is easier now than before to find gluten-free products, since it has become a popular diet, but the costs of eating gluten-free still make it a burden on those with the disease. In addition to people with the disease dealing with the costs of it, they must also deal with the social aspect of eating gluten-free. People who choose to go on a gluten-free diet have given it a bad stigma, which is unfortunate for those who have celiac disease and must eat gluten-free for medical reasons. While I’m glad eating gluten-free has become more acknowledged, I hope people will learn and understand the medical reasons behind it.

References

Creach, N. 2015. Environmental Factors and Development of Celiac Disease. Retrieved October 28, 2016, from https://www.gluten.org/environmental-factors-and-development-of-celiac-disease/.

Celiac Disease Treatment and Follow Up. 2016. Retrieved October 11, 2016, from https://celiac.org/celiac-disease/understanding-celiac-disease-2/treating-celiac-disease/

Guandalini, S. 2007. A brief history of celiac disease. Impact 7: 1-2.

Guandalini, S., N. Tundia, R. Thakkar, D. Macaulay, K. Essenmacher and M. Fuldeore. 2016. Direct costs in patients with celiac disease in the USA: A retrospective claims analysis. Digestive Diseases & Sciences 61: 2823-2830.

Lionetti, E. and C. Catassi. 2015. The role of environmental factors in the development of celiac disease: What is new? Diseases 3: 282-293.

Nelson, J.K. 2016. Is gluten-free a healthy way to eat? Retrieved October 13, 2016, from http://www.mayoclinic.org/is-gluten-free-a-healthy-way-to-eat/expert-blog/bgp-20243635.

Stevens, L. and M. Rashid. 2008. Gluten-free and regular foods: a cost comparison. Canadian Journal of Dietetic Practice and Research: 69: 147-150.

Symptoms and causes. 2016. Retrieved October 13, 2016, from http://www.mayoclinic.org/diseases-conditions/celiac-disease/symptoms-causes/dxc-20214627.