Gluten Intolerance Doubles in Finland

Introduction

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In the early 1980s, about one percent of adults in Finland had gluten intolerance, but the figure has since gone up to two percent by the 2000s.

"We've already seen a similar trend emerge earlier on where allergies and certain autoimmune disorders are concerned. Screening has shown that gluten intolerance occurs in 1.5 percent of Finnish children and 2.7 percent of the elderly. The higher figure for older people is explained by the fact that the condition becomes more frequent with age," says Professor Markku Maki. Maki has set up an internationally acclaimed research team on gluten intolerance, developing screening tests for gluten intolerance. Maki is head of a research project in the Academy of Finland's Research Program on Nutrition, Food and Health (ELVIRA).

According to Maki, gluten intolerance may often be symptom-free, and people may be unaware that they have the condition if their symptoms are mild or atypical. Three out of four people with gluten intolerance have not been diagnosed, which also means that they are as yet going without treatment.

Better diagnosis methods needed

Maki's research team has concluded that the criteria for diagnosing gluten intolerance must be rewritten, since early stages of the condition do not meet the criteria, yet is important to treat. The current criteria for diagnosis focus on damage to the intestinal villi and the small intestine, established in a tissue sample from the small intestine. However, early stages of gluten intolerance are not identifiable from tissue samples.

People may suffer from gluten intolerance, yet have no intestinal symptoms. They may, however, have symptoms unrelated to the intestinal tract. Serious problems with nutrient absorption have become rare; instead, sufferers generally have anaemia due to iron deficiency or folic acid deficiency as their main symptom. If researchers manage to develop sensitive, accurate antibody tests, it will become possible to identify people with early stages of gluten intolerance, who are in need of further treatment. At present, there is no single test to reliably identify early stages of gluten intolerance.

Sufferers are hoping for a diagnosis method that does not involve endoscopy. Researchers are hard at work, looking for new and better markers for gluten intolerance to allow for easier diagnosis of the condition.

Patients are also hoping for an 'anti-gluten pill'. Maki says that some form of pill with enzymes that break down gluten may prove feasible in the future.

2/ Virus infections may be contributing factor in onset of gluten intolerance

Recent research findings indicate a possible connection between virus infections, the immune system and the onset of gluten intolerance, also known as Celiac disease. A research project in the Academy of Finland's Research Program on Nutrition, Food and Health (ELVIRA) has brought new knowledge on the hereditary nature of gluten intolerance and identified genes that carry a higher risk of developing the condition. Research has shown that the genes in question are closely linked with the human immune system and the occurrence of inflammations, rather than being connected with the actual breakdown of gluten in the digestive tract.

"Some of the genes we have identified are linked with human immune defense against viruses. This may indicate that virus infections may be connected in some way with the onset of gluten intolerance," says Academy Research Fellow Paivi Saavalainen, who has conducted research into the hereditary risk factors for gluten intolerance.

Saavalainen explains that the genes that predispose people to gluten intolerance are very widespread in the population and, as a result, they are only a minor part of the explanation for the way in which gluten intolerance is inherited. However, the knowledge of the genes behind gluten intolerance is valuable in itself, as it helps researchers explore the reasons behind gluten intolerance, which in turn builds potential for developing new treatments and preventive methods. This is essential, because the condition is often relatively symptom-free, yet it can have serious complications unless treated.

Researchers have localized the risk genes by using data on patients and on entire families. The material in the Finnish study is part of a very extensive study of thousands of people with gluten intolerance and control groups in nine different populations. The research will be published in a coming issue of Nature Genetics.

Research into hereditary conditions has made great progress over the past few years. Gene researchers now face their next challenge, as a closer analysis is now needed of the risk factors in the genes that predispose people to gluten intolerance. It is important to discover how they impact on gene function and what part they play in the onset of gluten intolerance.

Gluten intolerance is an autoimmune reaction in the small intestine. Roughly one in a hundred Finns suffer from this condition. The gluten that occurs naturally in grains such as wheat, barley and rye causes damage to the intestinal villi, problems with nutrient absorption and potentially other problems too. Gluten intolerance is an inherited predisposition, and nearly all sufferers carry the genes that play a key part in the onset of the condition. The only known effective treatment is a lifelong gluten-free diet.