Being Poor and Dirty May Help Protect Against Celiac Disease
Celiac.com 04/07/2008 - No, this is not some kind of April Fool’s joke.
When I read this report, I just about fell off my chair. New research indicates that
being poor and living in squalor might actually provide some benefit
against the development of celiac disease.
A team of medical
researchers recently set out to examine gene-environmental interactions
in the pathogenesis of celiac disease. The research team was made up of
A. Kondrashova, K. Mustalahti, K. Kaukinen, H. Viskari, V. Volodicheva,
A. M. Haapala, J. Ilonen, M. Knip, M. Mäki, H. Hyöty, T. E. Group.
Finland and nearby Russian Karelia have populations that eat about the
same amounts of the same grains and grain products. The two populations
also have a high degree of shared genetic ancestry. The only major
difference between the populations of the two areas lies in their
socioeconomic conditions.
The region of Russian Karelia is
much poorer than the neighboring areas in nearby Finland. The
sanitation levels in Russian Karelia are also distinctly inferior than
they are in Finland. The researchers compared the prevalence of celiac
disease and predisposing human leukocyte antigen (HLA) alleles in
populations from Russian Karelia and Finland. The team performed
screening for tissue transglutaminase antibodies (tTG) and HLA-DQ
alleles on 1988 school-age children from Karelia and 3654 children from
Finland. Children with transglutaminase antibodies were encouraged to
have a duodenal biopsy.
Interestingly, the patients from
Russian Karelia showed tTG antibodies far less often than their Finnish
counterparts (0.6% compared to 1.4%, P = 0.005). The patients from
Russian Karelia also showed Immunoglobulin class G (IgG) antigliadin
antibodies far less frequently than their Finnish patients (10.2%
compared to 28.3%, P<0.0001).
The researchers confirmed a
diagnosis of celiac disease by duodenal biopsy in four of the eight
transglutaminase antibody-positive Karelian children, for an occurrence
rate of 1 in 496 versus 1 in 107 Finnish children.
In both
groups, the same HLA-DQ alleles were associated with celiac disease and
the presence of transglutaminase antibodies. The patients from Russian
Karelia showed a much lower prevalence of transglutaminase antibodies
and celiac disease than the Finnish children.
The poor
conditions and inferior hygienic conditions in Russian Karelia might
provide some kind of protection against the development of celiac
disease. The value of studies like this aren’t to make us wax nostalgic
for poverty, or to encourage people to fend off celiac disease by
becoming poor and living in squalid conditions. The value of a study
like this lies in the idea that there may be more to the development of
celiac disease than simple biological factors. That environmental
conditions might play a key role in both the frequency of
celiac-related antibodies, and in the development of the disease itself
is quite intriguing and clearly warrants further and more comprehensive
study.
Ann Med. 2008;40(3):223-31.