Q & A with Dr. Peter Green of the Celiac Disease Center at Columbia University

Ask-the-Doc: Q & A with Dr. Peter Green of the Celiac Disease Center at Columbia University
By Tiffany Janes, Delight Contributor 

For over ten years, the Celiac Disease Center at Columbia University has been on the forefront of celiac disease research in the U.S. The director of the Center and Professor of Clinical Medicine, Peter H. R. Green, MD, has devoted equal amounts of time to research and patient treatment. In fact, people from around the world travel to New York to seek help from the wonderful gastroenterologists at Columbia University’s Celiac Disease Center. Recently, Dr. Green took the time to answer some of our questions about celiac disease as it affects Americans as well as people in other nations around the world.

DGF: Why is it still difficult to get doctors in the U.S. to consider that celiac disease could be the culprit making patients sick—especially the ones with IBS symptoms that don’t resolve with IBS treatments?

Dr. Green: There are a couple of reasons, actually. Most doctors here are not prominently taught about celiac disease in medical school or in post-graduate education. The latter is often funded by big pharmaceutical companies, and none of them presently offer a medication to treat celiac disease. We really can’t blame the doctors totally because most of them are not going to look for something in their patients that they were taught is extremely rare. Of course, celiac disease is not rare at all, but many doctors still think that it is.

DGF: Researchers now know that there is such a condition as non-celiac gluten sensitivity. Is there a way to diagnose that condition?

Dr. Green: Like patients with celiac disease, patients with gluten sensitivity can have gluten antibodies which indicate they have issues with the protein. Some of them go on to have normal biopsies, so they are not given a celiac diagnosis. There is a concern that some of those patients don’t have proper biopsies performed; many doctors take only two samples from the intestine when looking for villi damage (which celiac causes), whereas four or more samples are needed for an accurate diagnosis. It’s been shown that taking four samples will double the rate of diagnosis in celiac patients. Another problem is that not all pathologists know how to properly read the biopsy slides submitted for evaluation. Thus, some patients with celiac are labeled as gluten-sensitive.

With gluten sensitivity patients, there is a spectrum of symptoms and manifestations. We’ve seen some people with Dermatitis Herpeteformis who have no intestinal damage. There is currently no test specifically for gluten sensitivity. If a patient’s symptoms indicate issues with gluten and tests for celiac are negative, the patient can be diagnosed as gluten-sensitive. As with celiac disease, a strict gluten-free diet is the only treatment for gluten sensitivity.

DGF: You’ve spoken before about the fact that the gluten-free diet can be devoid of some nutrients that one would get by eating a diet containing gluten. Gluten-free oats can help with that issue, but some patients with celiac can’t tolerate even certified gluten-free oats; why is that?

Dr. Green: Oats themselves are gluten-free, but commercial oats are often contaminated with gluten due to the way they are grown, stored, or transported. There have been a couple of cases in which celiac patients have had true gluten reactions from certified gluten-free oats, but most people with celiac disease can safely tolerate certified gluten-free oats. Some patients who think they’re reacting to safe oats are actually reacting to the extra fiber (from the oats), which they are not used to. Oats should be added to the gluten-free diet slowly in order to avoid symptoms that mimic those of a gluten reaction. Safe gluten-free oats can be an important part of the gluten-free diet, adding needed fiber and other nutrients not present in many of the popular gluten-free grains.

DGF: What do you see in the future regarding the treatment for celiac disease? Could the dream of a prescription medication that would allow patients to eat gluten one day be a reality?

Dr. Green: I don’t think there will be a medication that will allow people who can’t tolerate gluten to eat a normal diet. More than likely what will happen is that a drug will be developed that will help protect against cross-contamination. Such a therapy could allow people to more safely eat outside their homes, avoiding getting sick when dining out and traveling. The treatment might even prove to protect from quite a bit of gluten exposure. For instance, some naturally gluten-free foods have been found to be packed in gluten flour, and taking a medication could prove beneficial in those cases as well.

However, it is a matter of concern that some patients might start taking pills on an ongoing basis and resume eating a normal diet. That is the worrisome side to the introduction of a new drug therapy for celiac disease. In such cases, patients could cause themselves intestinal damage while the drug masked outward symptoms. Nevertheless, a new treatment for celiac disease would improve the quality of the lives of the people who have the condition. In a recent study, only 30 percent of people polled said they were not interested in taking a pill for celiac disease. That leaves 70 percent of patients waiting for such a treatment to hit the market. When any new treatment for celiac disease is available, celiac awareness in the medical community will increase, since there will be, for the pharmaceutical company that produces the drug, a benefit in educating doctors about the conditions it’s meant to treat.

DGF: The U.S. has come a long way in the last five years regarding gluten-free products and dining options for people on the gluten-free diet. Even so, many European companies are still ahead of those in this country in terms of those things and celiac awareness in general. What can the average person do to help drive change in our communities so we can catch up with countries that got a head start on us?

Dr. Green: It’s true that people with celiac in some countries have benefits offered to them through their healthcare programs. For example, in the U.K., celiac patients can have gluten-free food delivered to their homes for free, since food is the drug prescribed for their condition. In Italy, people get a couple of extra (paid) days off each year in order to shop for gluten-free food. That food is also partly subsidized by the government. These benefits are not available in the U.S. because healthcare is provided through privately owned insurance companies.

There are many things that patients can do to help increase awareness and improve the gluten-free market themselves. People should talk about the condition with friends, family members, teachers, and social workers. Also, patients need to demand appropriate medical care for their disease. They should ask their doctors what other tests they need due to their celiac condition. They can even educate their doctors about gluten-free foods, letting them know that there is much more available for patients these days than ever before. It’s a good idea for people to invite doctors and teachers to local support group meetings as well.

One of the ways people can be most helpful is to help fund celiac research in this country. Just as people run races for conditions like breast cancer, multiple sclerosis, and Crohn’s disease, so people with celiac disease can participate in such fundraising activities. This is done to a degree here, but not on a large scale. It has not been the norm for the celiac community to rally behind fundraising events. Research money is needed, and, in fact, it would make a great difference in the progress we’re making to improve the lives of people with celiac disease.

Peter H.R. Green, MD is the author of Celiac Disease: A Hidden Epidemic, now in its second printing. Visit www.celiacdiseasecenter.org for more information.

 





14 comments (Add your own)

1. Gluten Intolerance Group of Southwest Florida wrote:
Thank you for posting this interview with Dr. Peter Green- I always appreciate the attention given to not only Celiac Disease, but also to non-Celiac Gluten Sensitivy.

Mon, January 2, 2012 @ 4:46 PM

2. arnold zimmerman wrote:
Spreading the word regarding celiac awareness is very important in today's world. Unfortunately, the allopathic community is devoid of the tools and insights needed, to truly heal their afflicted patients. The intestinal biopsy is not the gold standard that we have been told, the genetic tests are improperly interpreted and the prescribed diets are nutritional mine fields. They may be wheat, rye and barley free but they are not gluten free. They are gliadin free. Most still contain saponins, zeins, etc. These are milder molecular forms of gluten/gliadin but can produce very similar pro inflammatory states. However, the most egregious omission is the denial of the existence of a hyper permeable intestine. This is the key to wellness. Only about 1/3 of all celiacs/gluten intolerant patients ever fully heal. This is the reason for all the accompanying autoimmune gut mediated problems, that they suffer from. They deny it as a result of medical indoctrination and they never read their own journals. The arrogance is stunning. Heal and seal the gut, the patient gets well.

Tue, May 15, 2012 @ 6:04 PM

3. Liliana wrote:
is truly surprising how many dieferfnt symptoms people have who are diagnosed with celiac disease. Most of the people in the video were diagnosed by lab test and biopsy. One of the reasons it makes it so difficult to get diagnosed and tested. Please keep spreading the word.

Thu, June 21, 2012 @ 7:41 PM

4. TM62 wrote:
Hi I have Dr Green's book on my Ipod and found it very informative when I was first diagnosed.

I just wanted to make a small point that people in the UK do not get gluten free food delivered to them for free.

In England we still have to pay for our NHS prescriptions and we generally have to visit the pharmacist/ doctors surgery or supermarket to pick up our prescription foods.

We can purchase a prepayment card from the NHS for just over £100 per year which allows us to get prescriptions free. In both Scotland and Wales prescriptions are free.

Fri, September 7, 2012 @ 6:05 AM

5. Tobie wrote:
I have Celiac Disease and I have found it extremely difficult not to ingest wheat on occasion. I travel for work and let's face it, if you're in a restaurant the potential for cross contamination is huge. As a result, I have not been absorbing vitamins properly and I have not been able to loss the 10 pounds I have gained since I was diagnosed and went off gluten two years ago. I basically felt as if I was at deaths door. I collapsed and found myself inside an ambulance, the CBC blood work showed nothing. I had constant urges to eat, I had hot flashes, a vertigo sensation and fatigue. It was horrible.

That was until I randomly got a vitamin B shot to loss weight and felt fantastic. It made me wonder what else was happening here? I began taking probiotics, stopped eating corn, dairy, eggs, soy, sugar, drinking diet soda and all caffeine. Basically I have eliminated popular food intolerances that cause a leaky gut and taking in beverages that were hurting my kidneys and replaced some of the vitamins I wasn't absorbing through my small intestine. My energy level is now through the roof, I have lost the craving and the pounds I put on. I have gone from being depressed, with brain fog, on the couch to running two miles a day. It wasn't even hard to do. This was all over a months time. I have another doctor's appointment because I want my vitamin D levels and an anemia panel run.

Why this isn't testing these levels and eliminating food intolerance aren't standard protocol for Celiac patients I have no idea? Other than it's free and nobody profits. It's terrible I had to stumble upon this through experience. I have a young daughter too who has this and I am changing her diet as well.

Doctor's are not doing enough, they don't know enough and you really have to take your own health into your own hands and try things that have worked for others. If they find a cure...great but I feel too good to go back even if they do.

Fri, March 15, 2013 @ 9:25 AM

6. Tobie wrote:
We need a universal protocol for physicians that treat Celiac patients. We need regular diagnostic testing for vitamin deficiencies, anemia and determine what other food sensitivities patients have that are causing inflammation and we need this now! There are children and adults that will never get well because of the current short sited approach and lacking education. It's not just gluten! It's a disease of malabsorption. We need vitamin replacement therapy, probiotics, enzymes and elimination of an individual's food intolerances. This preventative approach is much easier to manage, compared to the high costs of treating the other autoimmune diseases that cascade alongside Celiac Disease.

Fri, March 15, 2013 @ 9:51 AM

7. Susan wrote:
I was diagnosed with Celiac 2 weeks ago. I have had diarrhea for 2 years, no stools and Osteoporosis for 4 years. My bone density has dropped very low and the Dr. recommends Bone Infusions for a short time. Is this a good solution? I have lost weight, muscle, bone, hair thinning. I have been off gluten for weeks and have had some energy return but nothing like my old self. Bowels are still watery after 3 weeks of no gluten, at aleast as far as i can tell.
I eat mostly fresh foods, have Dr. Green's book along with lots of other research materials. Visited a dietitian, etc.
I need to know about these infusions and if I should be getting a vitamin shots too?

Tue, June 4, 2013 @ 8:56 AM

8. sherry jamison wrote:
hello my 7 year old was diagnosed 2 years ago, her levels were low and I put her on the diet and now they are compeletletely normal, but my thing is she was exposed to gluten several times a month befor she had her yearly blood taken,so why where her levels normal when she had gluten several time just a month prior to her getting her blood drawn?

Thu, July 18, 2013 @ 12:07 AM

9. Eva Summers wrote:
After research discovered I had gluten intolerance at least, not knowing to get the biopsy first as the blood tests or biopsy wont show up after being off glutens maybe 3 mo.? (given so many GI docs are not up with all of this its very hard to even trust their protocol. I improved almost immediately when elim. glutens. Yet now, 5 yrs later find Im also allergic to many foods and other grains gluten free. As Tobie and Arnold stated...arrogance is rampant and confusion also. Keeping the gut in good order w/a good integrative dr who actually understands probiotics and repairing a "leaky gut"is essential along w/knowing all foods causing inflammation. BTW, anyone know how accurate the 2013 genetic tests for Celiac are? I have several autoimmune disorders but thought they only came w/celiac?? Any thoughts?

Sat, September 14, 2013 @ 9:06 PM

10. Patty IA wrote:
At age 44 I just learned I have 2 Celiac genes and hashimotos thyroiditis. Like numerous posts from other Celiacs, I have been frustrated my entire life w/myriad of seemingly unrelated health issues...as a young child I knew I could not tolerate milk & would avoid it at all costs, ear-aches & ear infections to the point of scarring &mild hearing loss along with almost constant use of Advil or some other antibiotic prescribed by a well-meaning GP Dr, unexplainable stomach/intestinal pains, I would get the Celiac itchy, blistery "rash/lesions/hives" in the most unfortunate bodily locations, was always underweight & could eat & eat & eat w/ no weight gain until in my 20's & the birth of 2nd child when I could not lose weight (part of the hashimotos thyroiditis in which I swing between hyper & hyper thyroid), flatulence that could peel paint off the walls, painful monthly cycles, headaches/migraine style, uncontrollable moodswings, constant low back pain, breast lumps which doctors labeled 'clogged milk ducts' or essentially blocked lymphatic fluid, severe hormonal fluctuations, perimenopause started @ age 37, anxiety!, @ age 39 loss of menses for 10 months w/a raging return of it in now monthly blood-clotting tissue type menses...sorry I know graphic-I just think people need to know about all the unbelievable co-occuring health conditions and unbeknownst to most doctors can ALL be attributed to gluten! Now finally on the path of becoming gluten free and hope to repair my damaged villi & leaky gut...its humbling to realize 35+ years of my 44 years have been less than wonderful...I am grateful to have a chance at reestablishing better health.

Sun, December 22, 2013 @ 10:41 PM

11. L.P. wrote:
Non-celiac gluten sensitivity can be lab tested accurately, through the grace of trailblazing Enterolab.com (Dr. Kenneth Fine). They saved my life.
I'm really sad that so many people cannot get diagnosed because their doctors only do blood tests, which will not show markers except in the late stages of Celiac disease. Non-celiacs won't have positive blood results or positive biopsies, and these can also give false negatives for Celiacs. Supposedly, over 60% of Americans are genetically predisposed to gluten sensitivity in all its forms.

Tue, February 4, 2014 @ 10:23 PM

12. Jeanne Urso wrote:
My daughter was diagnosed 4 years ago with celiac disease in your clinic. We became gluten free immediatly. She did not get too much better and after a year we went to Mayo clinic and she was diagnosed with chronic vomiting symdrome. On Pentasa and topomax, she is back to work part time and still suffers with a lot of joint pain. She is able to get out and enjoy some low key activities, but becomes exhausted and has the bad joint pain, which has not allowed her to resume her normally active life. Where can we go from here?

Mon, March 3, 2014 @ 1:05 PM

13. Tina kalvelage wrote:
For Dr. Peter Green, director of the Celiac Disease Center at Columbia University Medical Center in New York City,I have been diagnosed with Crohn's disease and have been on the SCD (specific carbohydrate diet) for 2 years with amazing results. I wish someone would research the the amazing results of this diet which has been around since the early 1900's with proven results. Not only is the brainfog lifted but people are healing their digestive tracts with it.

I keep reading studies such as yours and wonder why no one is researching this diet when it's already proven that it heals.

It's worthy of more research.

Wed, July 9, 2014 @ 10:05 PM

14. Kat Van Schyndel wrote:
Thanks for this excellent article, unfortunatly there has been too much sudo science published regarding Celiac disease that are using unfounded conclusions as opposed to actual reasearch. So glad to read something that is well researched and articulated.

Wed, October 15, 2014 @ 10:18 AM

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