Ask a Doctor: Probiotics and the Genetics of Celiac Disease

World-renowned pediatric gastroenterologist, research scientist and entrepreneur Dr. Alessio Fasano is chief of Pediatric Gastroenterology and Nutrition at MassGeneral Hospital for Children. Dr. Fasano directs the Center for Celiac Research and Treatment, specializing in the treatment of patients of all ages with gluten-related disorders, including celiac disease, wheat allergy and gluten sensitivity. He is also a member of the Gluten-Free Living Medical Advisory Board.

This month, Dr. Fasano discusses the potential benefits of probiotics for someone with celiac disease and the genetic component of the disease. Send your questions for Dr. Fasano to [email protected] 

Alessio Fasano headshotWhat are the benefits of probiotics for someone with celiac disease, and how can I make sure I’m getting enough of them in my diet?

Probiotics can surely be a powerful and potentially effective tool to help rebalance the gut ecosystem, and our so-called microbiome, for those who experience a variety of chronic inflammatory diseases. And in celiac disease, some studies show that the microbiome is off balance.

However, we are far from establishing whether this unbalanced microbiome is the cause or a consequence of celiac disease. This means that if someone wants to take probiotics to control celiac disease, this is just a wishful target that is not yet on our horizon.

We hope it will be an achievable goal when studies like our Celiac Disease, Genomic, Environmental, Microbiome and Metabolomic Study (www.cdgemm.org) begin to provide detailed results about the development of celiac disease in at-risk infants and how the “landscape” of the microbiome changes as the disease progresses.

If, on the other hand, the goal is to remain healthy, it is my suggestion to use natural sources of probiotics, such as yogurt and fermented foods, etc. A registered dietitian with experience in celiac disease or other chronic inflammatory diseases can be your best ally in maintaining a healthy diet and a balanced microbiome.

I’ve heard that celiac disease can be genetic. Is this true? If I have celiac disease, are my children more likely to have the disease as well?

Because celiac disease is an autoimmune condition, there is a genetic component. However, the number of genes and which specific genes are involved is still a work in progress. Nevertheless, if someone in the family is affected by celiac disease, we recommend that the entire household be screened because of the higher risk of having celiac disease when compared to the general population.

The risk for the general population is 1 percent; in first-degree relatives of people with celiac disease, this increases from 10 to 40 percent, perhaps depending on genetic makeup. Genetic predisposition is necessary but not sufficient, since there are other elements at play, including the environmental trigger of gluten, increased gut permeability, a hyperbelligerent immune system and an off-balance microbiome.

Therefore, while we don’t currently have strategies to prevent celiac disease, we are aiming at that goal through our CDGEMM project. We are studying these five elements in depth to see if we can predict who will be at risk of celiac disease and take the “wrong turn” toward disease.

Our eventual goal is to stop the progression toward the disease by manipulating the gut microbiome, reducing the immune system activity and/or correcting the increased gut permeability. The results of studies like CDGEMM most likely will provide us with guidance on the conceptualization of preventive strategies in subjects at risk of the disease.

Ask a Doctor: Over-the-counter medications that claim to alleviate celiac symptoms, alternative or complimentary treatments for celiac disease, and the neurological consequences of celiac disease.

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