Review by Dante Moroni

Note: The statements below are only my opinion and are not to be taken in any way as medical advice.

Dr. Alessio Fasano is one of the world’s top celiac/gluten experts. He is the director at the Center for Celiac Research, part of Mass General Hospital for Children. He was a driving force behind establishing the seroprevalence of Celiac Disease (CD) in the USA at about 1%, matching that of Europe. Before this, it wasn’t even thought to be common in North America. His book, Gluten Freedom, lays out a detailed foundation in all things related to gluten. Fasano writes about how his own research has helped move forward the understanding of CD and non-gluten sensitivity. For anyone wanting to learn more about CD, NCGS, or the gluten-free diet, this book is sure to teach you a thing or two.

Overall Book Rating: 8.5/10

Celiac disease has been around for at least the past 2,000 years. Its only known treatment is a life-long gluten free diet. Fasano explains how the disease’s clinical presentation has trended from an obvious pediatric wasting disease into more commonly an atypical silent form of adult CD.

Fasano discovered the protein Zonulin in 2000 as a physiologic modulator of gut permeability. The discovery wouldn’t have happened it not for previous research he had done on Cholera infections. Fasano observed that the toxin produced from Vibrio cholerae was able to induce intestinal permeability.² His team was then able to identify that Cholerae toxin was interacting with the receptor for the human protein, Zonulin, which was responsible for the loosening of enterocyte tight junctions.³ Their research team then had the idea to test whether gliadin (gluten) could have an effect on intestinal tight junctions. It was shown that gliadin had the ability to upregulate Zonulin release and increase permeability in celiac disease and to a lesser extent in non-celiac individuals^1,4. Other substances have also have been shown to increase intestinal permeability such as ethanol consumption and certain non-steroidal anti-inflammatory drugs.

The Good

• Clarifies the differences between celiac disease, NCGS, and wheat allergy.
• Explains the history of celiac disease, current understanding of the condition, and its spectrum of symptoms.
• Deciphers varying combinations of genetic and antibody markers in individuals with silent, potential, and overt celiac disease.
• Provides good overview of how far endoscopic technology / intestinal biopsy has come.
• Gets into details about varying theories behind the pathogenesis of celiac disease and NCGS.
• Calls attention to potential relationships between autism, schizophrenia, and gluten.
• Chapter devoted to pregnancy, breast feeding / microbiome, gluten introduction timing, etc.
• Concludes with taking a look at the different therapies and treatments in development for CD (Larazotide, tTG inhibitors, Enzymes, Vaccines, etc.).

The Bad

• The Fasano Diet, Recipes, Grocery Lists could be left out.
• Bias from investments in Larazotide and Alba Therapeutics.
• Anecdotal stories here and there. Gluten Free college advice.
• Seems to be a bit over zealous about gluten intolerance.
• Doesn’t give enzyme supplements potential as cross contamination preventives and/or refractory CD therapies enough credit partly due to limited research at the time.

References

1. Fasano, A. Intestinal Permeability and Its Regulation by Zonulin: Diagnostic and Therapeutic Implications. Advances in Translational Science. 2012;10:1096-1100.
2. Fasano A, Baudry B, Pumplin DW, Wasserman SS, Tall BD, Ketley JM, Kaper JB. Vibrio Cholerae Produces a Second Enterotoxin, Which Affects Intestinal Tight Junctions. PNAS 1991;88:5242-5246.
3. Fasano A, Not T, Wang W, Uzzau S, Berti I, Tommasini A, Goldblum SE. Zonulin, A Newly Discovered Modulator of Intestinal Permeability, and Its Expression In Coeliac Disease. The Lancet. 2000;355:1518-1519.
4. Drago S, Asmar RE, Pierro MS, Clemente MG, Sapone ATA, Thakar M, Lacono G, Carroccio A, D’Agate C, Not T, Zampini L, Catassi C, Fasano A. Gladin, Zonulin, and Gut Permeability: Effects on Celiac and Non-Celiac Intestinal Mucosa and Intestinal Cell Lines. Scandinavian Journal of Gastroenterology. 2005;41:408-419