For millions of people living in western areas of the Netherlands during World War II, the winter of 1944-1945 was a time of extreme suffering and deprivation. It was widely known as the “Hunger Winter” due to severe shortages caused by a German embargo on food and fuel and plummeting temperatures that caused the canals to freeze. Around 20,000 people are thought to have perished during the famine.
Amidst all of this suffering, there was one group whose health actually improved—children who had been hospitalized due to celiac disease. It is now understood that celiac disease is a genetic autoimmune disorder marked by gluten intolerance that mainly affects the small intestine, resulting in symptoms such as chronic diarrhea, a distended abdomen, loss of appetite, anemia, and an inability to absorb nutrients from food. Serious untreated cases in children can result in a failure to thrive and may be fatal.
Thankfully, celiac disease is now highly treatable with a correct diagnosis. The prognosis is excellent for individuals who follow a strict gluten-free diet. Yet before the 1940s, the cause of celiac disease was not yet understood. Tragically, many children suffering from celiac disease were given foods made with wheat, rye, and barley in the hopes of encouraging growth. Yet rather than nourishing them, these gluten-containing foods caused severe gastrointestinal symptoms and prevented normal physical and mental development due to malabsorption of nutrients.
In the late 19th and early 20th centuries, British pediatrician Samuel Gee and American physician Christian Herter described celiac disease and proposed various diets to treat the symptoms, though neither suggested eliminating gluten. One of the most popular early treatments for Gee-Herter disease, as celiac disease was sometimes known at the time, was a specific carbohydrate diet known as the banana diet (as ripe bananas are virtually free from starch), proposed by pediatrician Sidney V. Haas in the 1920s. As no grains were permitted, the children treated with this diet improved. At the time, Haas and others believed that starches, rather than the wheat protein gluten, caused celiac disease.
Yet it was during the Netherlands’ Hunger Winter that the most significant strides in understanding the cause of celiac disease were made. Faced with severe food shortages (which included traditional staples like wheat flour), pediatrician Willem Karel Dicke, the medical director of the Juliana Children’s Hospital in the Hague, made the difficult decision to allow his starving patients to be fed tulip bulbs, which can be toxic. Yet without bread in their diet, the patients in the celiac ward began to improve. Dicke's theory that wheat intake aggravated the symptoms of celiac disease was corroborated when the food shortages eased and the children were once again given food containing wheat flour.
After the war ended, Dicke continued to focus on uncovering the causes behind celiac disease. By observing the growth charts of young children, he noted that they seemed to recover during stints in the hospital when they were fed a gluten-free diet. Yet their symptoms returned and their growth slowed when they went home and were given bread (against medical advice) by their parents. In the 1950s, further research from Dicke and others confirmed that it was the gluten component of wheat that was responsible for the symptoms of celiac disease.
Solving the mystery of celiac disease:
- Celiac disease was first described in the second century A.D. by the ancient Greek physician Aretaeus of Cappadocia. Its name comes from the Greek word koiliakos, referring to a disease of the abdomen.
- It is estimated that up to 80% of people with celiac disease are undiagnosed due to non-classic symptoms or minimal gastrointestinal issues. In modern medicine, a diagnosis may involve blood antibody tests, an intestinal biopsy, and/or genetic testing.
- Rates of celiac disease vary among different regions of the world. The disorder is slightly more common in women than men.