Celiac disease (CD) is a genetically-linked autoimmune condition, which means that although “CD genes” are present in nearly everyone who has the disease, the genes alone do not tell the whole story.1 For example, some babies show signs of CD from the first introduction of gluten, but most people with Celiac develop it much later in their lives when an event or “trigger” (such as an illness, a physical or emotional trauma, a poor diet, exposure to environmental toxins. etc.) overburdens their immune system. Having CD also increases a person’s risk of developing other autoimmune conditions. Unlike other autoimmune disorders, however, such as Multiple Sclerosis (MS), Lupus, Rheumatoid Arthritis (RA), there is a key to turning off the Celiac disease process – adopting a gluten-free diet.
In autoimmune conditions, a normally harmless trigger causes the immune system to overreact, leading to inflammation and a range of physical problems, such as damage to the pancreas in Type-1 diabetes, damage to the small intestine in CD, and damage to the joints in RA. Celiac is the only autoimmune condition where this process can be completely and safely stopped and further damage prevented.
Researchers are examining the mechanism of CD to determine how we can apply this knowledge to other autoimmune conditions to find similar ways of disrupting those disease processes. Dr. Alessio Fasano, one of the leading experts on Celiac disease, published an excellent article on this topic called “Celiac Disease Insights: Clues to Solving Autoimmunity” in the August 2009 issue of Scientific American.2 Although it’s a lengthy article, it’s a must-read for anyone with Celiac or any other autoimmune condition.
Dr. Fasano and others have discovered that many people with autoimmune conditions, such as CD, RA, MS, and Type-1 diabetes, have intestinal permeability, otherwise known as “leaky gut syndrome.” It is a problem that has been associated with high levels of a molecule called zonulin, and in people with CD, the presence of gluten stimulates the production of zonulin.3 Research is underway to see if using a medication called Larazotide is effective in blocking the production of zonulin, and thus interrupting or halting the inflammatory process.4 So far, the studies have been so promising that drug manufacturers have begun to study whether patients with Type-1 Diabetes or Crohn’s Disease who take Larazotide experience similar anti-inflammatory benefits.
So bring on the lasagna, right? Actually, no. The drug is still in research phases, and the approval of any medication is years away. In addition, it is designed to protect only against small amounts of gluten, or accidental cross-contamination. Thus, at least for the foreseeable future, anyone diagnosed as having CD will still need to eliminate gluten from his or her diet to live symptom-free. The eventual availability of a drug like Larazotide, however, could someday provide a safety net for people with Celiac and offer huge health benefits for people who suffer with other autoimmune conditions. It is as yet unclear how this medication or line of research might impact people with non-autoimmune gluten sensitivity (those who do not have CD or other autoimmune issues, but who report feeling better when they observe a gluten-free diet).
The University of Maryland Center for Celiac Research (UMCCR) has been conducting a study on infant feeding for the last few years. Although earlier research indicated that introducing gluten to babies at between four and seven months of age was ideal in terms of helping the children avoid developing Celiac Disease,5 recent UMCCR studies have shown that a 12- month delay in introducing gluten into the diets of infants who are at high risk for developing CD6 may lead to a four-fold reduction in their risk of developing Celiac! It will be many years more years of research, however, before we know if this protection is temporary or lifelong. It is also worth mentioning that studies have shown that breastfeeding offers some protection against CD, especially if the child is still breastfeeding when gluten in introduced.
- It is estimated that 1 in 30 or 3% of the people who have the genes for CD actually have the disease. See Liu E, Rewers M, Eisenbarth GS. Genetic testing: who should do the testing and what is the role of genetic testing in the setting of celiac disease? Gastroenterology. 2005;128(4 Suppl 1):S33-S37.
- There is evidence that gluten also causes tissue inflammation in people who do not have Celiac, too, but to a lesser extent. See Drago S, et. al. Gliadin, zonulin and gut permeability: Effects on celiac and non-celiac intestinal mucosa and intestinal cell lines. Scand J Gastroenterology. 2006 Apr;41(4):408-19.
- Dr. Fasano has been involved in the development of Larazotide.
- Agostoni, Carlo, et al. Complementary feeding: a commentary by the ESPGHAN Committee on Nutrition. Journal of Pediatric Gastroenterology and Nutrition: January 2008 – Volume 46 – Issue 1 – p 99-110.
- Infants considered “high risk” for developing CD one day are those who possess with the genes for CD and have an immediate family member who has been diagnosed with the disease.