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Being Poor and Dirty May Help Protect Against Celiac Disease 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.

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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. welcomes your comments below (registration is NOT required).

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16 Responses:

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said this on
08 Apr 2008 4:49:55 AM PST
If being 'poor and dirty' protected against celiac I certainly would have never developed it. Perhaps the poor in Russia have had to live without the bread and the other artificially glutened food ingredients that are rampant here in the US. But being poor in the US means you live off bread and cheap foods many of which should be gluten free but have had the substance added to it.
This research study leaves a lot of unanswered questions. The idea that here in the US you are less likely to have celiac if you are 'poor and dirty' is so ridiculous it isn't even funny.

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said this on
09 Apr 2008 4:00:25 AM PST
This is not surprising. In nature, defective genetics are quickly removed from a population. Affluence allows defective genes like celiac to be compensated for, allowing the carriers to pass their defective genes on in the affluent population.

said this on
09 Apr 2008 7:54:39 PM PST
There was a study that showed that the exposure to sunlight of the child early on was the Problem. Lack of Sunlight may be bad. If the poorer children got out more
then investigate the Sun's rays too. Oregon and Washington states large populations are having very low sun because of cloud cover. And I believe they
are high on the Celiac occurrences too. Also, the Coastal cities of Ireland probably have cloud cover. I also heard that the Jews that went into hiding had little sunlight and were under stress... check it out. Thanks.

S Barwick
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said this on
10 Apr 2008 1:16:32 AM PST
Krista is right. This is very interesting research but the 'poor and dirty' idea is a guess. The researchers need to look hard at the typical diets of the two groups before they leap into their sanitation - so to speak. When my ancestors were poor and dirty - farm laborers in the north of England in the early 19th C and before - they would have eaten mainly oat cakes, vegetables and a bit of meat. The celiac gene would barely have been tickled awake.

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said this on
10 Apr 2008 1:38:56 AM PST
Obviously, being poor cannot directly affect the chance of getting celiac, but it is almost equally obvious that being dirty could directly affect the chance of getting celiac. It all has to do with developing immunities. Of course, it could also be that some dirty poor people die from immune problems and the ones who are left (natural selection) to be surveyed are the ones who were born with certain immunities.

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said this on
10 Apr 2008 7:10:27 AM PST
I am really curious to know what foods comprise the main parts of the diet for each group. I agree with Krista; typically some of the cheapest foods contain wheat, like bread and pasta. In many places rice or potatoes would come first, but I would be curious to know the result of that same test in the US. Here our cheapest foods are basically all wheat-based, or at least, that's what people think to buy first; a loaf of bread, a box of macaroni and cheese, a dollar-menu big Mac, the list continues. My hypothesis for that same study done here in the US would be for it come out opposite from the Russian study.

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said this on
10 Apr 2008 8:43:52 AM PST
The assumption that poverty and dirt is the 'causal' factor seems a little premature. Perhaps the poor people in Russia spend more time outdoors? Given the slew of recent medical research connecting cholecalciferol (vitamin D) deficiency and higher rates of autoimmune diseases (among other things), MAYBE time in the sunshine is the real difference behind the rates of celiac in these two populations. In any case, 'poverty' implies a lot of lifestyle differences besides 'dirt.'

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said this on
10 Apr 2008 9:40:07 AM PST
If Celiac comes from being too clean then what's genetic predisposition got to do with it? My whole family (Mother, her siblings) are equally clean, and they don't seem have Celiac, but I do. How could one of us be too clean?

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said this on
11 Apr 2008 7:59:42 AM PST
I agree with the others that more investigation into the diet and lifestyle differences between the countries is warranted. But I find it a fascinating study and hypothesis. There is a similar 'hygiene hypothesis' in the development of allergies that has been studied a lot more and is really gaining steam.


said this on
11 Apr 2008 8:12:42 AM PST
I have a hard time buying the thought of being in poverty will help protect you from developing celiac disease. Kristia is right, here in the U.S. the food that gets donated to food banks and issued by the government is high in gluten. Since this is a gene-related disease, has any one ever thought about inter family marriages as a possible factor, for the richer people to have a higher level of celiac? Back over hundreds of years, there were a lot of rich families marring each other. Just a thought.

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said this on
11 Apr 2008 3:46:05 PM PST
I agree with Krista, too. I'm 1/2 Finnish and can tell you that I grew up with a fine Finnish baker for a grandmother - and she was 'allergic' to wheat (and had alopecia and arthritis). I also grew up poor and dirty. Wish I could say I grew up in an Asian community ...

Dawn Kunath

said this on
13 Apr 2008 12:11:22 PM PST
The results could also be interpreted that those having celiac disease are less likely to thrive &amp; reproduce when born into squalor, compared to celiacs born into better conditions who have more resources and become able to reproduce.


said this on
16 Apr 2008 12:33:47 AM PST
The poor have a high infant mortality rate. What about the spontaneous abortions? The doctors here are not even giving blood tests when women miscarry. It helps prove the antibody and biopsy testing is limited. There is a test I found on the net that is non- invasive. Does anyone have the chance to see if it can help? Also, how about all of those who are 'asymptomatic.' Many docs try to evade with this fact. I am surprised.

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said this on
23 Apr 2008 8:03:54 AM PST
Do the Russian Karelians eat more buckwheat, millet and rice than their richer Finnish cousins? Development of coeliac disease depends on exposure to gluten, so a diet low in gluten is less likely to stimulate the response. The Saharawi population in Africa had little historical exposure to gluten. When it was introduced to their diet, they developed incredible rates of coeliac disease. Here's a quote:

--- It has been hypothesized that the abrupt change of feeding habits in this population played a primary role in increasing the risk of CD (18). In the traditional diet, the main foods consisted of camel milk and meat, moderate amounts of cereals (wheat, barley and millet), legumes (lentils) and dates. Young children were exclusively fed with breast milk during the first years of life. After the european colonization, bread made of wheat became the staple food of this population. Moreover, duration of the breast feeding felt dramatically down, and it is not uncommon nowadays to see Saharawi children that are weaned during the first three months of life.

The strong genetic predisposition and the 'sudden load' of dietary gluten, in a population that was not used to high intakes of this protein, seem therefore to be the factors responsible for the CD 'endemy' in the Saharawis.---

That's from the Italian Coeliac Society's website.

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said this on
18 Sep 2008 8:06:14 AM PST
Perhaps, along with the poor conditions in Russia also reflects on more bacteria (probiotic link) to be included in the intestines of this group of people. Isn't the probiotic link and some relief from the symptoms of Celiac Disease already being tested at this time? I do agree that the probiotic I am on does relieve some of my symptoms. I would like to try the actual one that was described in one of the other articles.

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said this on
06 Mar 2017 5:12:31 PM PST
I think something is missing in this study.

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