Coeliac disease affects at least 1% of the population in most countries in the world, except for the Western Sahara where it has a very high frequency of 5 – 6%. Although it is unknown why this is, it is believed to be because of a sudden change in diet following Spanish colonisation. Leaving the traditional fare of camel milk and meat, they began eating in the more European style of heavy gluten consumption.

Currently, the only treatment for coeliac disease is a lifelong gluten-free diet, but this treatment and the knowledge that gluten is the cause of the disease has only been around since 1952.

Initial sporadic interest in the condition

The term coeliac itself was coined in the second century AD and was used to describe patients of the disease. At that time, Aretaeus of Cappadocia named the condition ‘oiliakos’, a word he derived from the Greek word ‘koelia’, which means abdomen because patients suffered from abdominal pain.

Despite this, there was no cure and the disease was a mystery that killed patients invariably at a young age as the continuous vomiting and diarrhoea left them anorexic, with swollen stomachs.

Then in 1888, the English physician and paediatrician Samuel Gee gave the first modern-day description of coeliac disease in a talk at the Great Ormond Street hospital for children in the UK.

Interested in the history of medicine and able to read ancient Greek, Gee knew of Aretaeus’s work. He said, “if the patient can be cured at all, it must be by means of diet.” The condition then became known as Gee’s disease.

Image of Samuel Jones Gee in 1881. Photo credit: Wellcome Images/Wikimedia Commons
Image of Samuel Jones Gee in 1881. Photo credit: Wellcome Images/Wikimedia Commons

The first treatment came about by accident

It was not until 1924, when the first solid diet plan was provided for patients. It was a high-calorie, banana-based diet invented by Dr Sidney Haas in which carbohydrates were banned, milk, cottage cheese, meat and vegetables were encouraged and several bananas daily were a requisite.

"At that time, around 30% of children with coeliac died,” Alessio Fasano, chair of paediatrics at Harvard Medical School, says. Parents could leave their children in the hospital for six months after which time, if they survived on the banana-based diet, they could go home.

It was incredibly effective and 600 children from all over America were cured. Parents would go to the docks to buy entire branches full of bananas for their children. Tricia Thompson, founder of Gluten Free Watchdog says of Haas, “so many people were so very grateful to him. He saved their lives.”

A five-year-old was diagnosed with coeliac disease and was prescribed a diet of 200 bananas weekly. Photo credit: HPPR
A five-year-old was diagnosed with coeliac disease and was prescribed a diet of 200 bananas weekly. Photo credit: HPPR

However, Haas’s discovery of the banana diet came from his experience of Puerto Rico in which in a small town, "dwellers who eat much bread suffer from [coeliac] sprue while the farmers who live largely on bananas never."

He believed that it was bananas that eliminated the diarrhoea. Since wheat as the cause was not identified, as soon as patients recovered on the banana diet, they returned to eating gluten.

“Massively underdiagnosed” in the US for a while

Eventually, Dutch paediatrician, Willem Karel Dicke, realised that gluten was the cure when, during World War II, severe bread shortages in the Netherlands meant there was zero mortality from coeliac disease. His theory was confirmed through his study of faecal matter in 1952.

However, Haas was against the gluten-free diet and continued advocating his banana-based cure, according to Alan Levinovitz, a religion professor at James Madison University in Virginia.

“Haas saw these miraculous reversals and didn't want to give up his status as a trailblazing saviour,” explains Levinovitz.

As a result, coeliac disease continued to be “massively underdiagnosed” in the US as compared to Europe.

Today, there are supermarkets and pharmacists with sections dedicated to gluten-free products and now that scientists have discovered genes associated with the disease, they are looking for alternative solutions that can help with the intestine’s vulnerability to gluten. MIMS

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