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around for thousands of years. The Greek physician
Aretaeus of Cappadocia wrote the first account of the
disease around the first century A.D. He described
patients whose food passed through them without
being digested, calling the disease the
coeliac diathesis, stemming from the Greek
word koalia, meaning abdomen. For cen-
turies afterward, the diagnosis served as a
death sentence, as no one knew the cause
or any treatment.
Physicians did recognize that some
patients improved, and could even gain
weight, when consuming highly modified
diets. Experimental nutritional regimens
based on eating mainly rice, mussels or
bananas achieved varying degrees of suc-
cess. Still, these diets were unappetizing at
best, and most people couldn’t maintain
them over time.
It would take the wartime famine to provide the
final clue for how doctors could help patients with
celiac disease.
STARVATION SCIENCE
Dutch pediatrician Willem-Karel Dicke had a long-
standing interest in celiac disease, and in the 1930s he
encountered patients who told him their symptoms
worsened after eating bread or biscuits. He suspected
something related to bread was the cause of the disease.
Then, when the Hunger Winter came in 1944,
Dicke saw its effects firsthand. People in the western
Netherlands had to subsist on just 500 to 1,000 calo-
ries each day, and sometimes even less. The famine
was severe; more than 4 million people went hungry,
and between 20,000 and 30,000 died.
“No bread was to be had in the cities, with the
rare exception of black marketeers offering a barely
edible product at extortionate prices,” says van
Arragon. “It wasn’t a wheat shortage so much as an
absence of wheat.”
But at the same time, Dicke realized, children with
celiac disease were seeing improvement in their symp-
toms; some even gained weight. It made him curious.
After the famine ended along with the war in
May 1945, food supplies from the Allies, including
wheat and bread, flooded back into the Netherlands.
That’s when Dicke made a critical observation: Celiac
patients had a clear and rapid relapse.
The connection was enough to get Dicke to rigor-
ously investigate the relationship between diet and
celiac symptoms. Over the next roughly five years,
and through experiments with wheat-free diets,
Dicke determined that avoiding foods with wheat
and related grains reduced diarrhea and allowed for
weight gain in people with celiac disease. They usually
felt better, too.
Scientists working together “determined that
gliadin, a protein fraction of wheat, rye and
barley gluten, was the trigger of bowel inflam-
mation in celiac disease,” says Carol Semrad,
a physician and celiac disease expert at the
University of Chicago School of Medicine.
“These findings led to the modern treatment
of celiac disease, a gluten-free diet.... On a
strict gluten-free diet, most individuals with
celiac disease have complete bowel recovery.”A GLUTEN-FREE WORLD
Over 70 years later, Dicke’s discovery remains
the cornerstone of celiac disease treatment.
But questions about the treatment linger.
“Although the gluten-free diet is highly
effective,” says Semrad, “gluten is present in most
foods in a Western diet — breads, pasta, pizza, des-
serts, processed foods — making it difficult to follow.”
It’s also hard for food manufacturers to maintain
completely gluten-free conditions, as even residual
amounts of gluten used in the production of normal
foods can contaminate gluten-free foods.
That’s why research into novel treatments for
celiac disease is underway. “New therapies under
study include oral enzymes to fully digest gluten in
the diet... and a vaccine to promote tolerance to
gluten,” says Semrad. If successful, people with celiac
disease finally may be able to eat what everyone else
gets to enjoy.
On the other hand, many of those without the
disease choose to eat gluten-free foods, or even try to
adhere to a gluten-free diet. It’s unclear how helpful
this is to people without celiac disease. As long as a
balanced diet is maintained, though, going gluten
free won’t cause any harm, and some people do feel
better. These folks may have “non-celiac gluten sen-
sitivity,” and researchers are working to learn more
about this condition, including whether gluten is
the true cause.
Celiac disease has gone from being a lethal enigma
to a bona fide medical success story. Since WWII, we
have learned a tremendous amount about it, based on
decades of research by thousands of individuals. But
we owe a special debt to a curious Dutch pediatrician
who kept his eyes open and made good clinical obser-
vations, even under the worst of circumstances.^ DDouglas G. Adler is a professor of medicine at the
University of Utah School of Medicine in Salt Lake City.HISTORY LESSONS
Willem-Karel Dicke
(above) treated
patients throughout
the Dutch Hunger
Winter, which left
millions starving
(below). This was
when he first
realized a gluten-free
diet might help
people with celiac
disease improve.TO
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