The gluten-free diet is phenomenally popular, fueling a multibillion dollar food industry. Approximately 1 in 133 people have celiac disease, with many of them still undiagnosed. People with celiac disease must eliminate gluten from their diet or face long-term health consequences. Triggered by the gluten protein found in wheat, rye and barley, their immune system mistakenly attacks the lining of the small intestine. People with gluten sensitivity, which causes gastrointestinal distress but no long-term intestinal damage, also benefit from a gluten-free diet.
Alessio Fasano, MD, chief of MassGeneral Hospital for Children’s Division of Pediatric Gastroenterology and Nutrition and director of the hospital’s Center for Celiac Research and Treatment, is one of the world’s foremost experts on celiac disease and gluten-related disorders. His landmark 2003 study established that celiac disease is much more common in the United States than had been previously thought. Studying gluten sensitivity, Dr. Fasano’s research team uncovered molecular and physiological differences between celiac disease and gluten sensitivity, which is thought to affect even more people than celiac disease.
The author of the just-published book, “Gluten Freedom,” Dr. Fasano talks about gluten-free diets, gluten-related disorders, and what’s on the horizon for prevention and treatment.
In his new book, “Gluten Freedom,” Dr. Fasano offers a road map to a healthy, gluten-free lifestyle. Has the quality of life improved for those with celiac disease?
Fifteen years ago, the quality of life was negatively affected. It was hard to dine out and travel. There were very few gluten-free products available, and the quality was so bad that it was hard to tell whether you were eating the food or the box it came in. Now it’s much better. The gluten-free diet is the most popular diet ever in the United States. One hundred million Americans consume gluten-free products every day. The quality of the food has increased dramatically. Gluten-free products have also gone down in price and can now be found in grocery stores everywhere.
Your 2010 paper established gluten sensitivity as a condition separate from celiac disease. Are you close to finding a biomarker so you can more accurately diagnose it?
There are good diagnostic tests for celiac disease and wheat allergy, but not yet for gluten sensitivity. This is very important because some of the symptoms of celiac disease and gluten sensitivity are similar, including abdominal pain, diarrhea and/or constipation. How big of a problem is gluten sensitivity? How many of the 100 million people who are consuming gluten-free products every day really need to? That question can only be answered when we have biomarkers to accurately diagnose gluten sensitivity. We have identified and are evaluating suspected biomarkers.
Would everyone benefit from a gluten-free diet?
Dr. Fasano recommends plenty of fresh fruits and vegetables for patients pursuing a gluten-free diet. There are two schools of thought. No one can digest gluten, as we’ve shown, so some people believe that we should all go gluten free. Others say it is a fad that will go away. I believe that the truth is in the middle. But the gluten-free diet is not a fad. For people with celiac disease, this diet is like insulin for diabetes. It’s a way to survive. However, there is a negative effect to going gluten free. It’s inconvenient. The gluten-free diet is healthy if you’re cooking from scratch and not buying a lot of prepackaged foods. Also, you must make sure you get enough fiber and adequate vitamins and minerals. Cutting wheat out of your diet can make that more challenging. We have skilled dietitians to help balance the diet of people who follow a gluten-free diet for medical necessity.
Your research illuminated the role of intestinal permeability or “leaky gut” in celiac disease. What is the progress on the “celiac pill” you then developed?
We essentially stumbled upon the recipe the body needs to develop celiac disease. We knew you have to have a genetic predisposition and an environmental instigator (gluten). Then we found a third ingredient, a molecule we call zonulin that appears to be the key to opening doors of the intestinal wall. This allows the gluten through, which triggers the autoimmune reaction in celiac disease. We also found that the excessive production of this molecule occurs in other autoimmune diseases. To stop zonulin’s action, we then engineered a blocker drug called Larazotide acetate. It has progressed successfully through the early stages of clinical trials with the biopharmaceutical company Alba Therapeuticsand will soon enter Phase III trials. This “celiac pill” could supplement the diet and be a safety net to stop intestinal damage. It might also be useful in the treatment of other autoimmune diseases like diabetes, multiple sclerosis or rheumatoid arthritis.
“If we could predict which kids lose tolerance for gluten and develop celiac disease, then we could think of prevention by manipulating the microbiome.”
Will celiac disease one day be preventable?
We’ve reached a level of knowledge where we can begin to think about preventing it. We are starting a mega project called Celiac Disease Genomic Environmental Microbiome and Metabolomic (CDGEMM) study. Our preliminary findings suggest that the microbiome, the patterns of bacteria in the gut, is involved in the interplay of genes and environmental pressure that predisposes someone to celiac disease.
We’ve found that the microbiome for kids with celiac disease has a different metabolic profile. There appears to be a specific signature for those with celiac disease, which could be the crystal ball we are looking for. If we could predict which kids lose tolerance for gluten and develop celiac disease, then we could think of prevention by manipulating the microbiome.
Much of what has been accomplished to date is thanks to the generosity of our donors. Additional philanthropic support will help Dr. Fasano and the Center for Celiac Research and Treatment accelerate their quest for new knowledge and treatments. To learn more about how you can support such research, contact us.
