Gluten Freedom: my thoughts on the book

I just finished reading Dr. Alessio Fasano's book, Gluten Freedom, and it is amazing!  Definitely a must-read for any clinician who works with patients suffering from digestive, dermatological, neurological conditions or for anyone who is a patient and thinks they might have a gluten-related condition.  It is especially helpful for anyone whose doctor has ever said "it's all in your head"!

The leading expert in gluten-related disorders, Dr. Fasano tells the history of celiac disease, explains the improvements in diagnostic methods throughout the years, and also covers the spectrum of non-celiac, gluten-related disorders, including wheat allergy (think hives and difficulty breathing) and the more recently accepted non-celiac gluten sensitivity (NCGS) - which is a real condition!  He uses friendly analogies to explain scientific concepts and includes multiple real-patient stories to help illustrate key points, both of which make the book fun and easy to read.

I read the book Wheat Belly last fall and, although I enjoyed the facts Dr. William Davis provided, I didn't agree with his point of view that everyone should avoid high-yield, semidwarf wheat.  Indeed, there are scientist who believe that gluten is toxic for humankind and everyone should follow a gluten-free diet. While there is some evidence to support this -- for example, it is true that no one is able to completely digest the protein gluten and that that fragments of undigested gluten peptides can make the intestines leak, attract immune cells into the intestines causing inflammation, or kill cells -- it doesn't make sense that a food that humans have been eating for thousands of years is the root of all disease.

Zonulin and Its Regulation of Intestinal Barrier Function:
The Biological Door to Inflammation, Autoimmunity, and Cancer
Read the study here

Although Dr. Fasano has contributed to the above discoveries about gluten, he does not share the same position.  Instead, he writes that "we engage daily in a ware with many dangerous bacteria but rarely do we lose this battle, which is an event that leads to infection.  We are also engaged in daily confrontation with gluten, but only a minority of us will lose this battle.  These are the genetically susceptible individuals who will develop gluten-related disorders."

My own beliefs align more closely with those of Dr. Fasano, that only genetically susceptible individuals need to follow a gluten-free diet.  Instead of silver bullets and one-size-fits-all approaches, it is my opinion that practicing personalized medicine is the best way to help clients achieve health.  How do you know if you need to follow a gluten-free diet?  Learn more here!

Perhaps my favorite part of the book is near the end when Dr. Fasano gives an overview of the human genome project ("genomics") - how many scientists thought that cracking the code would help us better understand and eradicate human disease...until we realized that humans actually have way fewer genes than originally expected...so we focused on "proteomics," which also failed to answer our complex questions about health.... so we eventually turned to "microbiomics."

Ultimately, he hypothesizes that humankind is made up of two genomes - the human genome and our individual microbiome, which is expressed by the trillion of bacteria that live on and in us.  He advocates for vaginal birth (the best way to inoculate baby with a healthy dose of probiotics) and concludes by saying "In my opinion, the result of this interplay between the human genome and the human microbiome ultimately holds the key to the answer of how to maintain the yin and yang between health and disease."

Check out this NPR story - Finally, a map of all the microbes on your body

It is obvious that Dr. Fasano has spent his life dedicated to "increasing the awareness of celiac disease in order to provide better care, better quality of life, and more adequate support for the celiac disease community," -- the paramount goal of the Center for Celiac Research, which he founded in 1996.  When treating his first patients, Dr. Fasano asked them to write down their top three wishes in regard to celiac disease.  Here are the "Aladdin's lamp" wishes:

1. A treatment alternative to the gluten-free diet
2. Improving their quality of life by educating physicians about celiac disease and by providing more palatable gluten-free food
3. A way to avoid the cumbersome intestinal biopsy as a necessary step to diagnose celiac disease, especial for children.

Nearly 20 years later, almost all three wishes have been granted.

This book inspires me to finally choose ONE thing to focus on and become an expert at something, just as Dr. Fasano has become an expert on celiac disease and gluten-related disorders.  It also reminds me how much I love the mystery of the gut - this black box where food goes in one end, waste comes out the other, and exactly what happens in between is largely unknown.  If I had to bet, I would bet that the next big discovery in health and medicine has to do with the microbiome.  I just hope that I can be a part of it!