Are people with type 2 diabetes at higher risk for developing celiac disease?
There is no correlation between type 2 diabetes and celiac disease. The prevalence of celiac disease among those with type 2 diabetes is just the same as the general population, about 1 percent.
What vitamin or mineral supplements do you typically recommend for a person with disease?
I typically recommend a comprehensive multivitamin, but do not recommend high-dose vitamins. Even those people with severe intestinal damage from celiac disease begin to heal with a gluten-free diet fairly quickly and this rapidly restores normal absorption of vitamins and minerals. It has been found that when gluten is removed from the diet, intestinal health can be restored in a matter of weeks to months. It is a common error for people to think that high doses of vitamins are recommended; high doses can lead to vitamin intoxification. I do recommend people make sure their medications and vitamins are gluten-free, as many drugs contain gluten. There is a website that lists current gluten-free medications – it includes over-the-counter medications as well as prescriptions and is updated regularly: www.glutenfreedrugs.com.
What is your hope for the future of celiac disease?
First, I would like to increase medical education and awareness and convince physicians to screen patients for celiac disease more often. Although this has improved over the past few years, we still have a long way to go. Currently, we estimate that approximately 97 percent of people with celiac disease have not been diagnosed. I would like to see this decrease to at most 40 to 50 percent. Second, I hope in the future we have treatment options in addition to the gluten-free diet. This area is currently being researched very actively. Several lines of investigations are being pursued. One option involves taking a pill containing enzymes ("glutenase"), which can destroy gluten in the stomach, so that any food that enters the small intestines would be largely gluten-free. It should be noted that, to date, none of the products currently available for celiac disease have proven effective.
The second option being researched is a pill that improves the intestinal barrier, stopping gluten from crossing the barrier and entering the body. Such an approach could be useful in preventing the effects of consuming minute amounts of gluten, which often happens when people, for instance, eat cross-contaminated foods. In practice, when someone with celiac disease is going out to eat at some event and can't guarantee that their meal is 100 percent gluten-free, taking such a pill would help prevent negative effects. The third longer-term option being studied is a vaccine that can interfere with the intestinal immune system so that it can "trick" it into thinking that gluten is not an antigen, but rather something that is tolerable, and something not to react to. The University of Chicago Celiac Disease Center lab is currently pursuing this exciting avenue, something that has the promise of offer eventually a real cure for this disorder. The road is long and requires major financial support, but the prospect of such an achievement is absolutely thrilling.
Personal Interview, February 2009.
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