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So here’s my rule of thumb: I generally tell underweight patients that they may gain a bit on the gluten-free diet and, if they are normal weight, they may stay the same or gain a bit, too. And the morbidly obese – yes, there are morbidly obese celiac patients – will probably lose a bit.
SC: It is not uncommon for people with celiac disease to gain weight on a gluten-free diet. Because once you remove gluten from your diet, the villi [in the small intestine] heal and absorb the nutrients more effectively. Also many gluten-free products are lower in fiber and higher in calories, due to higher carbohydrate and fat content. That’s why it’s important to work with a dietitian to design a plan that is nutritious but not excessive in calories.
Is it safe to buy a product with a label that says ‘May contain traces of wheat’ or ‘Made in a facility that processes wheat?’
SC: That’s a tricky one. Unfortunately in the U.S. and in Canada, precautionary advisory statements are voluntary and unregulated. The Food and Drug Administration says these statements may be used, but must be truthful and not misleading. The challenge for gluten-free consumers is to find out the real risk of eating products that have these type of statements on the label.
For example, some manufacturers use these statements yet the risk is minimal to none. Others don’t include any statements on the label, but the risk could be greater. There is no clear-cut formula to know based on the presence or absence of precautionary statements. The bottom line is that people need to call the company to learn more about how they prevent cross-contamination.
What happens if I kiss someone who has just had a meal filled with gluten?
JM: The likelihood of celiac symptoms is extremely low. It’s not like peanut anaphylaxis, where the merest trace amount can cause a drastic allergic reaction. If, after eating a dish of pasta, your partner gives you a peck on the cheek, I wouldn’t worry at all. If it escalates into something more intimate, I’d suggest that teeth get brushed first. Better to be safe than sorry!
Does semen contain gluten?
JM: I have been asked this question – and the answer is “no.”
Will I one day be able to eat whatever I want and not have to worry about cross-contact when I eat outside my home?
AF: Right now, the gluten-free diet is the only solution, but there will be more answers and solutions down the road. The progression of our knowledge about celiac disease is like the development of any other body of scientific knowledge.
We started with the black hole and dark matter of many years ago when we didn’t know anything. Now, we’re at a point where we have mapped out many of the steps that lead to its development and can start to play with it and tweak destiny.
Think of it: until 2005, there were no clinical trials for celiac disease treatments, but in the past 10 years, there have been over 100. At Massachusetts General, we have just been entrusted by the National Institutes of Health to create a “crystal ball” to see if we can tell early on which infants will develop celiac disease and which will not.
So what does the future look like?
AF: You will come to my clinic and hand me a microchip that contains your genome information so that, genetically speaking, I know who you are, as well as a sample of stool. My computer will not only give me a detailed description of the macrobiotic environment in your gut, but it will also be able predict what the odds are that you will develop celiac disease – and I will be able to manipulate your microbiome so that you stay healthy.
These two concepts are already here in terms of health care, with personalized medicine and preventive medicine and, although I can’t give a timeline, I believe we now have all the tools we need to achieve this goal. We just have to make them work together.
Gluten Freedom, by Alessio Fasano; Mayo Clinic Going Gluten Free, by Joseph A. Murray; and Gluten-Free Diet: A Comprehensive Resource Guide, by Shelley Case.