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Time Traveler’s Guide to Celiac Disease

Day: September 20th, 2008

Time: 9:00am

Place: Ripon Medical Center

Our very first topic was The History of Celiac Disease. Knowing the backstory on this condition gives us a better understanding. Over the years, I’d add bits and pieces to this article, but it has remained on the back burner for a couple of years…until now. I felt Celiac Awareness Month was a perfect time to finally let this work-in-progress see the light of day. I hope you enjoy reading this as much as I did researching it.

Al Klapperich
Branch Manager
Gluten Intolerance Group of East Central WI

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  • Preface
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    Time Traveler’s Guide to Celiac Disease - By Alan Klapperich

    Many people have never heard of celiac disease, until a friend, family member, loved one, or even themselves were diagnosed with this condition. Despite it being one of the most common auto-immune conditions in the world, 83% of those who have it are undiagnosed.

    While it may be new to many, it's been plaguing mankind for thousands of years.

    Fasten your seat belts, because we are going to be hopping around time to give you a bit of history on this new-ancient disease.

    If we scootch together, we can all fit in the classic H.G. Wells Time Machine. All aboard!

    We're off to a time when men were men and women probably didn't look like Rachel Welch. Surprisingly, the 21st-century male isn’t much different than the Paleolithic male. Go figure… Why mess with perfection, right?

    Paleolithic Era here we come!
  • Paleolithic Man
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    It's dusk and just ahead is a flickering camp fire. The men have returned from a hunt. By their boastful behavior, we can assume it was successful. They will have fresh meat for their meal tonight. The women and children are preparing what they have gathered earlier in the day.

    Their diet consists of small wild game, eggs, fish, nuts, berries, fruits, vegetables, leaves, roots, seeds. When ever possible, most hunter-gather societies try to consume over half of their calories from animal sources. This lifestyle sustained our ancestors for two and one-half million years – until the last 10,000 years – that's when the trouble started.

    Eventually our ancestors figured out how to grow plants, kicking off the Neolithic Era and the agricultural revolution. The hunter-gatherer way of life was replaced by domesticated crops and animals. While this lifestyle change was much more convenient, it came with some unwanted results. Humans had over 2 million years for their gut to evolve into a very sophisticated organ. It was able to handle food antigens that had become staples of the human diet. Since a large percentage of our immune system is housed in the gut, there will be consequences when things get altered.

    Farmers of the Neolithic period experienced a slew of new food antigens they never had before - proteins from cow, goat, donkey milk and cereal grains just to name a few.

    Hello food intolerances and celiac disease.
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    We must be moving on. The H.G. Wells time machine was a bit too cramped.

    Dr. Who’s T.A.R.D.I.S. is the perfect vehicle. Yes, it’s the size of a phone booth, but don’t worry, it’s bigger on the inside. It’s always slightly larger than it needs to be. Com’on in…don’t worry…plenty of room. Remind me to tell you about the swimming pool

    Additional information

    ”Quantifying the Hunter-Gatherer Food Choices” by Loren Cordain, PH.D

    bit.ly/1crtbX0

    ”Frontiers in Celiac Disease”

    
Historical Perspective of Celiac Disease by Stefano Guandalini, MD

    bit.ly/2pQJaYo

    Our ancestors have been gluten-free for over 99% of their existence.

    If we squash the past 2.5 million years in to a single calendar year, we have only been eating gluten for 1.5 days.

  • Aretaeus of Cappadocia (circa 150 AD)
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    Please keep your hands and feet inside The T.A.R.D.I.S until it comes to a complete stop - thank you.

    We have come to rest in second century Rome; in comfort and style, I might add. No shortage of leg room.

    During this time period, the Roman Empire was enjoying greater prosperity under the rulers known as The Five Good Emperors of Rome.

    The inventions and innovations the Romans created changed the world forever. They left indelible marks on architecture, entertainment, government, lifestyle, science, and medicine. Their influences can still be felt in the 21st century.

    We find an amazing Greek physician named Aretaeus of Cappadocia. Historians suspect he studied medicine in Alexandria, Egypt, but practiced in Rome based upon specific wines he prescribed known only to second century Rome. Many specific details of Aretaeus life are uncertain.

    Aretaeus was said to have written seven or eight works. The lost works covered fevers, surgery, pharmacology and gynecology and prophylaxis (preventative treatment of disease). On the Causes and Symptoms of Acute and Chronic Diseases and Book on the Treatment of Acute and Chronic Diseases are two works known to have survived.

    His writing revealed that he was an accurate observer as he described conditions like diabetes, pneumonia, pleurisy, tuberculosis, tetanus, diphtheria, paralysis, and something he called “Koiliakos” which meant "suffering in the bowels". Koiliakos is derived from the Greek word “koilia” which means abdomen. We know this condition as celiac disease.

    In "The Coeliac Affection”, he describes the disease:

    "If the stomach be irretentive of food and if it pass through undigested and crude, and nothing ascends into the body, we call such person koiliakos”.

    …heavy pain of the stomach now and then, as if from a puncture; the patient emaciated and atrophied, pale, feeble, incapable of performing any of his accustomed works. But if he attempt to walk, the limbs fail; the veins in the temples are prominent, for owing to wasting, the temples are hollow; but also over all the body the veins are enlarged, for not only does the disease not digest properly, but it does not even distribute that portion in which the digestion had commenced for the support of the body; it appears to me, therefore, to be an affection, not only of the digestion, but also of the distribution.”

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    I’m sorry, but Dr. Who needs his T.A.R.D.I.S back to dispatch some rather grumpy Daleks. We’ll need to go through the time tunnel to reach our next destination.

    Single file - no running or pushing…please…

    Additional information

    Aretaeus of Cappadocia Biography - eNotes.com

    bit.ly/2pkVQTZ

    Dictionary of World Biographay Volume 1
    by Frank Northern Magill

    
Aretaeus of Cappadocia - Starting on page 110.

    bit.ly/2pQJaYo

    A History of Celiac Disease.

    García Nieto VM. In Rodrigo L and Peña AS, editors. Celiac Disease and Non-Celiac Gluten Sensitvity. Barcelona, Spain: OmniaScience; 2014. p. 45-59.

    bit.ly/1Ej9N4T

    Language history lesson -

    Koiliakos: In translation from Greek to Latin, the ‘k’ became ‘c’ and ‘oi’ became ‘oe’.

    Dropping the Greek adjectival ending ‘os’ gave us the word coeliac – the British spelling.

    Ancient bones show signs of struggle with coeliac disease
    by Ewen Callaway
    Nature.com - April 30, 2014

    Two-thousand-year-old remains of an 18-20-year-old female were found in a Tuscan tomb

    Researchers found evidence of malnutrition, osteoporosis, and two copies of the celiac genes in this 4’ 7” (short of stature) affluent woman.

    These findings strongly suggest celiac disease.

    Read more: Nature.com

  • Matthew Baillie (1761 - 1823)
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    As we exit the Time Tunnel, we find ourselves in the early 1800s to meet a Scottish teacher, physician, pathologist and famed anatomist by the name of Matthew Baillie.

    Baillie, a keen observer with an uncanny ability explain difficult subject matter in a simplistic and understandable manner. He was admired both professionally and personally.

    In 1795, he published the American version of “Morbid Anatomy of the Human Body”; a first of its kind textbook that described pathology according to the organs involved instead of the symptoms.

    In 1814, Baillie also published his observations on a chronic adult diarrheal disorder. In “Observations on a Particular Species of Purging” he describes patients with malnutrition and a gas-distended abdomen.

    He noted that many adult patients had lived in warm, tropical climates. It is suspected that Baillie may have been describing the condition Tropical Sprue (a cousin to Celiac Sprue).

    He describes his observations:

    “They [stools] are pale in their colour, as if lime were mixed with water, are very frothy, like yeast at the top and often smell very sour. atients labouring under this complaint have generally more or less of a sallow countenance, and are thin, but more very much emaciated.

    Patients afflicted with this kind of purging often live for several years, but the disease continues, subject to the changes lately described; and they hardly ever recover.”

    He was also astute enough to notice and suggest dietetic treatment.

    “Although this disease continues its progress, under every kind of diet, yet some patients appeared to derive considerable advantage from living almost entirely upon rice.”

    Sadly, Baillie's observations went primarily unnoticed.
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    We're not done with the 19th Century yet. Please allow my associates to set the WABAC Machine for London, 1887.

    Additional information

    Half-Yearly Abstract of the Medical Sciences
    January - June 1853


    
 By William Harcourt Ranking, Charles Bland Radcliffe, William Dommett Stone

    bit.ly/1IipLDD
    The Works of Matthew Baillie, M.D. (1825)

    by James Wardrop

    bit.ly/2pQJaYo

    “There are many professions where negligence or inattention may be reckoned a folly; but in medicine it is a crime” ~ Matthew Baillie.

  • Samuel Gee (1839 - 1911)
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    Thank you, Mr. Peabody and Sherman for getting us to London safely.

    Crowds are jamming the streets to catch a royal wave from Queen Victoria as she processes from Buckingham Palace to Westminster Abbey. She’s off to attend her Golden Jubilee celebration.

    Despite the opulent celebration, the country is in the midst of a deep recession with skyrocketing unemployment rates.

    Homeless families are camping in Trafalgar Square. They were hoping the fountains offer some refuge from the oppressive heat.

    Charitable organizations provided free loaves of bread to those in need, however, the police felt the need to clear the square on a nightly basis. The Home Secretary decided to outlaw public meetings in the square. This act ignited violent displays of protest condemning the disparity between rich and poor resulted in at least a hundred deaths. This skirmish became known as Bloody Sunday.

    October 5th, only eight weeks before Bloody Sunday, Dr. Samuel Gee describes celiac disease during a lecture to medical students at the Hospital for Sick Children.

    “...a kind of chronic indigestion which is met with in persons of all ages.”

    He noted symptoms of wasting, weakness, and pallor would take precedence over the bowel issues. He also noted management of food was important, and errors in management might be the cause of the symptoms.

    “...But if the patient can be cured at all, it must be by means of diet”, Gee stated.

    In 1888 Gee writes in St. Bartholomew's Hospital Reports his description called “The Coeliac Affection

    "There is a kind of chronic indigestion which is met with in persons of all ages, yet is especially apt to affect children between one and five years old. Signs of the disease are yielded by the fæces; being loose, not formed, but not watery; more bulky than the food taken would seem to account for; pale in colour, as if devoid of bile; yeasty, frothy, an appearance probably due to fermentation; stinking, stench often very great, the food having undergone putrefaction rather than concoction."

    Does “Coeliac Affection” sound familiar? It's very likely Gee paid homage to Aretaeus by using the same title. Other similarities to Aretaeus' writings were also noted throughout Gee's report. Gee’s ability to read Greek may have attributed to the similarities.

    It should be noted that Gee was the first to observe celiac disease in all ages, particularly in children. Aretaeus recorded this only in adults, more commonly found in the aged and women.

    Noticing the food connection, Gee felt "the allowance of farinaceous (starchy) food must be small.” He reports of a child doing amazingly well when fed a quart of the best Dutch mussels every day. However, once mussel season was over – the child relapsed. Funny thing, the child couldn't be persuaded to eat the mussels the following season.

    Gee documents the improvement and relapse connection to food. Keep in mind, Gee still really hasn't connected all the dots. He banned fruits and vegetables, but yet still allowed thin slices of [wheat] toast. He also notices milk intolerance in his patients. He's so close...lactose intolerance can be a direct result of damaged villi. Much like Baillie, Gee's work went largely unnoticed by his contemporaries.

    Gee reportedly performed over 600 autopsies during his medical career. However, in his report on celiac disease he only included this single comment:

    “Naked-eye examination of dead bodies throws no light up the nature of the coeliac affection: nothing unnatural can be seen in the stomach, intestines, or other digestive organs. Whether atrophy of the glandular crypts of the intestines be ever or always present, I cannot tell.”
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    Hope you brought your swimming suit, because we’re taking a dip in the Hot Tub Time Machine.

    Additional information

    Diagnosis and treatment of coeliac disease - Samuel Gee

    http://1.usa.gov/1H0JwMX
    British Medical Journal - Samuel Gee, Aretaeus, and the Coeliac Affection


    bit.ly/2pQJaYo

    ”…But if the patient can be cured at all, it must be by means of diet.”

    ~ Samuel Gee

    Celiac Awareness Day is September 13th; which is Samuel Gee’s Birthday

  • Christian Archibald Herter (1865-1910)
    Coming soon…
  • Sidney Valentine Haas (1870 - 1964)
    Coming soon…
  • Willem Karel Dicke (1905 - 1962)
    Coming soon…