Celiac Disease Facts and Causes: The History Behind the Diagnosis

In the winter of 1944, the Netherlands ran out of bread. 

Nazi forces had blockaded food shipments into the western provinces, and what became known as the Dutch Hunger Winter left cities like The Hague surviving on tulip bulbs and sugar beets. It was one of the worst famines in modern European history. And in the middle of it, a Dutch pediatrician named Willem Dicke noticed something that shouldn't have made sense: his sickest patients - children who had been wasting away from a chronic digestive illness doctors had puzzled over for decades - were getting better. 

Bread was the ingredient missing from their diet. And bread was the answer. 

That single wartime observation cracked open a mystery that had confused physicians for nearly two thousand years, and it's the reason we now have a clear picture of celiac disease facts and causes rather than a vague, mysterious illness. This is the story of how we got there; the researchers, the false starts, the strange treatments, and what all of it means for the roughly 1% of the world's population living with celiac disease today, many of whom don't even know it yet. It's also why we take gluten-free certification seriously here at Saffron Road; not as a checkbox, but as a response to a disease that took two millennia to actually understand.

Quick Facts 

If you're looking for what to actually eat right now, head over to our guide to celiac-friendly frozen meals. For more background on how we got here, read on.

What Is Celiac Disease, Really?

Celiac disease is an autoimmune condition, not a food allergy or a simple intolerance. The Celiac Disease Foundation explains it this way: when someone with celiac disease eats gluten - a protein found in wheat, barley, and rye - their immune system doesn't just react to the gluten itself. It mistakenly attacks the lining of the small intestine, specifically the villi, which are the tiny finger-like projections responsible for absorbing nutrients from food. Over time, that damage impairs the body's ability to absorb nutrients at all, regardless of how well someone otherwise eats. 

That distinction matters more than it might seem. A food allergy triggers an immediate immune response - sometimes a dangerous one - but it doesn't damage the digestive tract itself. A sensitivity or intolerance can cause real discomfort but doesn't involve the immune system attacking the body's own tissue. Celiac disease does both: it's immune-mediated, and it's structurally damaging. 

Celiac Disease vs. Gluten Sensitivity vs. Wheat Allergy 

These three conditions get lumped together constantly, but the NIDDK and Mayo Clinic both draw clear lines between them: 

All three call for avoiding certain grains. Only one of them quietly damages the body even when there are no symptoms at all, which is part of why the history of figuring this out took so long.

The Long, Strange History of Celiac Disease 

Ancient Beginnings 

The earliest known description of what was likely celiac disease comes from Aretaeus of Cappadocia, a Greek physician writing in the 1st or 2nd century AD. A historical review in PubMed credits him with describing adult patients suffering from chronic digestive disturbance and malnutrition, whose condition improved with fasting; an early, accidental clue that food itself was the problem, centuries before anyone could explain why. For nearly 1,700 years after that, the condition surfaces only occasionally in medical literature, usually described as a mysterious wasting illness with no clear cause and no reliable treatment. 

1887–1888: Samuel Gee's First Modern Description 

The modern understanding of celiac disease begins with Samuel Gee, an English physician at London's Hospital for Sick Children. In a lecture later published in 1888, Gee gave what Beyond Celiac calls the first modern medical description of the disease, characterizing it as a chronic condition affecting people of all ages, marked by digestive symptoms and malnutrition. Gee also made a prescient leap: he believed the disease could ultimately be managed through diet, going so far as to describe a child who improved dramatically on a diet of Dutch mussels and relapsed the moment mussel season ended. He couldn't identify what it was about diet that mattered, but he was right that diet was the lever. 

The Banana Diet Era 

In the 1920s, American pediatrician Sidney Haas developed a treatment that became widely used for children with celiac disease: a diet built heavily around bananas, along with other fruits, vegetables, and dairy, while cutting out starches almost entirely. It worked dramatically for many patients, and at a time when more than 30% of children with celiac disease were dying from it, as Beyond Celiac's history of the disease notes, Haas's banana diet saved lives. But it worked for the wrong reason nobody yet understood: the diet happened to be very low in gluten, almost by accident, since it eliminated wheat-based starches along with everything else. Doctors at the time credited the bananas. The real answer was what the diet left out. 

The Discovery That Changed Everything: Willem Dicke and the Dutch Famine 

Dicke had actually suspected a connection between wheat and celiac disease as early as the 1930s, based on clinical observations of his young patients—a detail documented in a historical profile of his work. But it was the Dutch Hunger Winter of 1944–45 that gave him something closer to proof. With bread and flour virtually unavailable, he watched celiac patients in his ward improve and then relapse when Allied food drops brought bread back into circulation before the war's end. It was, in effect, an accidental clinical trial forced by wartime scarcity.

Dicke formalized the theory in his 1950 doctoral thesis, demonstrating that removing wheat, rye, and oats from the diet led to marked improvement in celiac patients — a milestone traced in detail in a peer-reviewed history of the disease. Working with colleagues Jan van de Kamer and Henriette Weijers, he helped develop objective ways to measure the effect, including fat levels in stool as an indicator of digestive recovery, turning a clinical hunch into something researchers could actually test and confirm. 

Confirming the Trigger: The 1950s and the Rise of Modern Diagnosis 

By the early 1950s, researchers had isolated the specific culprit within wheat: not the starch, but gluten, the protein responsible for wheat's elastic, doughy texture. English researchers published findings in 1952 confirming that removing wheat and rye flour from patients' diets produced significant clinical improvement, corroborating Dicke's work. 

The following decades filled in the rest of the picture: 

In less than a century, celiac disease went from an unexplained wasting illness treated with mussels and bananas to a genetically understood autoimmune condition with a reliable diagnostic pathway. That's a remarkably fast turnaround for a disease that had confused physicians since antiquity, and clinical research summarized by NCBI makes clear it's still evolving. 

What Actually Causes Celiac Disease? 

A clinical review from NCBI's StatPearls frames celiac disease as the result of three things converging: genetic predisposition, an environmental trigger, and an immune system response that doesn't shut off the way it should. 

The Genetic Component

Nearly everyone with celiac disease carries one of two specific gene variants, HLA-DQ2 or HLA-DQ8. The Celiac Disease Foundation puts the numbers plainly: if a parent, child, or sibling has celiac disease, your own risk of developing it is about 1 in 10. But genetics alone doesn't explain it: a large share of the general population carries these same gene variants and never develops the disease, which means something else has to tip the balance. 

The Environmental Trigger

The obvious one is gluten itself: without it, the disease has nothing to react to, regardless of genetic risk. Researchers are also studying other contributing factors. The same StatPearls review notes that certain viral infections in early life, including rotavirus and adenovirus, have been studied as potential triggers, while other exposures, like H. pylori infection, may actually be protective. The timing of when gluten is introduced to infants and the broader composition of the gut microbiome are also active areas of study. None of this fully explains why celiac disease develops when it does, which is exactly why it remains an area of ongoing research rather than settled science. 

The Immune Mechanism 

In someone with celiac disease, gluten gets broken down during digestion into smaller fragments, including one called gliadin. In a person without celiac disease, this passes through without incident. In someone with celiac disease, the immune system identifies these fragments as a threat and mounts a response—one that, instead of staying contained, ends up damaging the intestinal lining itself. That's the core mechanism: not a reaction to gluten as an irritant, but an autoimmune attack that happens to be triggered by it. 

Celiac disease can develop at any point after someone starts eating gluten, whether in early childhood, in the middle of adulthood, or later in life. WebMD's clinical overview notes it often follows a stressful physiological event, like an infection, surgery, or pregnancy. There's no single age where the risk disappears. 

Why Celiac Disease Matters More Today Than Ever 

Celiac disease affects roughly 1% of the population worldwide, though prevalence varies significantly by country, from under 1% in some regions to nearly 2% in Finland, according to NIDDK. What's changed is not just detection but the disease itself. A 2025 epidemiological review describes celiac disease incidence as genuinely increasing over recent decades, not merely a byproduct of better testing, though improved diagnostics play a role too. Beyond Celiac cites estimates putting the rate of increase at roughly 7.5% per year over several decades. 

The more striking number is the diagnosis gap. Beyond Celiac's published figures suggest that as many as 83% of people with celiac disease in the U.S. remain undiagnosed or are misdiagnosed with something else: irritable bowel syndrome, chronic fatigue, or anemia, among others. That means for every person who knows they have celiac disease, there may be three or four who don't, quietly living with a disease that's actively damaging their digestive system. 

The Real Stakes of Undiagnosed or Poorly Managed Celiac Disease 

Celiac disease left untreated isn't simply an uncomfortable digestive condition. Ongoing intestinal damage impairs the body's ability to absorb iron, calcium, and other nutrients, which is why anemia and low bone density are common in people with undiagnosed celiac disease. In children, Mayo Clinic notes that untreated celiac disease can affect growth. In adults, a 2025 narrative review of the condition links long-term, unmanaged celiac disease to increased risk of osteoporosis, fertility issues, several neurological conditions, and, in rare cases, certain cancers of the digestive tract, including intestinal lymphoma. 

The encouraging part of this picture: a strict gluten-free diet, once diagnosis happens, generally allows the small intestine to heal and resolves most of these downstream risks, which is exactly why early, accurate diagnosis matters as much as it does. 

Common Misconceptions About Celiac Disease 

A few myths persist even as the science has become clearer: 

What History Teaches Us About Living With Celiac Disease Today 

Here's what's striking when you line up the history against where things stand now: the treatment for celiac disease hasn't fundamentally changed since Dicke's thesis in 1950. A strict, lifelong gluten-free diet is still the only treatment. Eighty years of genetic research, biopsy refinement, and blood-test development haven't produced a pill or a cure—they've produced a much better understanding of who has the disease and why, but the solution has always come back to what's on the plate. 

What has changed is what's available to put on that plate. For most of the 20th century, "gluten-free" meant bananas, rice, and whatever a household could piece together from scratch, often at the cost of flavor, convenience, or both. The actual, daily problem people with celiac disease face today isn't a mystery about causes anymore—it's the much more practical challenge of finding food that's reliably safe, doesn't take an hour of label-reading and cross-contamination research, and doesn't taste like a compromise. 

That's the modern chapter of this story, and it's a solvable one. If you want to see what that looks like in practice, Saffron Road's collection of certified gluten-free frozen dinners is one place to start. We've also written in more detail about how to navigate the category as a whole - from what "gluten-free" labeling actually guarantees, which frozen meals are genuinely safe versus just marketed that way, and how to build a freezer you can rely on - in Celiac-Friendly Frozen Meals: What's Actually Safe, What's Just Labeled.

How Saffron Road Fits Into the Modern Celiac Story 

The entire premise of a "gluten-free" processed food industry has historically been a substitution-based engineering of wheat-free versions of foods that were built around wheat in the first place, like bread and pasta, with mixed results on both texture and flavor. Saffron Road's frozen dinners take a different starting point. The core of our meals and snacks - rice, chickpeas, rice noodles - was never built to rely on gluten to begin with. These are global cuisines where bold flavor has always come from spice blends, aromatics, and slow-cooked sauces rather than from wheat-based bases. That's not a workaround engineered around a limitation; it's just what the cuisine already looked like before anyone was thinking about celiac disease at all. 

On top of that, Saffron Road's frozen entrees carry GFCO certification, tested to under 10 parts per million. This is meaningfully more rigorous than a self-declared "gluten-free" label, and the kind of third-party verification that matters most to people managing a diagnosed autoimmune condition rather than a general preference. You can see the full lineup of what's certified across the brand on our gluten-free product page. 

In a sense, the food has finally caught up to what the science figured out decades ago. Dicke proved that removing gluten resolves the disease. The remaining question was always going to be whether the food available to people managing that reality could taste like something you'd actually choose to eat, not just tolerate. That's the gap Saffron Road's globally-inspired, certified gluten-free frozen dinners are built to close. 

FAQ 

What is the main cause of celiac disease? 

Celiac disease is caused by an autoimmune reaction to gluten in genetically predisposed people. Nearly all cases involve the HLA-DQ2 or HLA-DQ8 gene variants, but genetics alone isn't enough: environmental factors, including gluten exposure itself, are required to trigger the disease.