By Dante Moroni

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

If you are looking to increase your understanding of Celiac Disease (CD), this book is a great place to start. The main author, Peter Green MD is a gastroenterologist specializing in CD, and is the director of the Celiac Disease Center at Columbia University. He has been published many times in several prominent medical research journals and has been cited thousands of times. His stories from actual patients and his experience in the medical field offer a specialized viewpoint in the subject that is hard to find elsewhere.

Overall Book Rating: 8.5/10

The authors lay out the groundwork in all things CD, with a focus on diagnosis, complications of the disease, and common misunderstandings and myths surrounding CD and a gluten free diet (GFD). The main take home point from the book is that 1% of the population has CD and over 50% are un/mis-diagnosed. The negative implications for long term active celiac disease, like increased cancer and osteoporosis risk, are emphasized. A big focus of the book is also celiac disease’s relation to other autoimmune conditions, particularly T1DM (diabetes), is analyzed and discussed in detail. It’s astounding that around 30% of CD have accompanying autoimmune conditions! Luckily, a gluten free diet often improves their outlook significantly.

The ancillary complications of CD are especially concerning since diagnosis can take between 5 and 10 years and contributing to this is the fact that half of CD cases are the silent/asymptomatic type. Diagnosis is most common between the ages of 40 and 60! The book is full of success stories of both adults and children that have wandered the long road to getting diagnosed. It wraps up with lots of practical advice on living gluten free, future potential treatments (tTG blockers, Larazotide, Latiglutenase etc.), and myths that continue to be perpetuated in the field.

The Good

• Introductory review of digestion and the gastrointestinal system. Not too jargony but thorough when explaining the inflammatory process in CD.
• Thorough overview of CD disease etiology and history, discusses potential triggers being theorized (hygiene hypothesis, introduction of gluten timing, infection or environmental insult).
• Lists and explains other gastrointestinal conditions that can have villous atrophy with malabsorption and/or mimic Celiac Disease (Chron’s, IBD, Colitis).
• Lays out the different presentations of CD: classic, silent, atypical and associated symptoms. Ex: Dermatitis herpetiformis, malnourishment, co-existing autoimmune conditions, neropathies, etc.
• Overview of CD complications: ~10% of T1D cases also have CD. ~30% of CD cases have coexisting auto-immune disease.
• Chapter on infertility and CD has great info on how active CD lowers fertility but it returns after taking up a gluten free diet.
• Devotes own chapter to dermatitis herpetiformis, the skin presentation of CD (epidermal tTG crosslinking IgA antibodies).
• Breaks down cancer risk from CD into the individual types (non-Hodgkin’s lymphoma 8-9x, thyroid cancer 22x).
• Explains the different clinical diagnostic markers relevant to diagnosing CD (Anti-tTG, Anti-EMA, Anti-DGP, Marsh Criteria, Serum IgA)
• The book touches on associated neurological symptoms, like neuropathies, ataxia, epilepsy, and migraines. A whole chapter is also devoted to negative mental health associations like depression and anxiety.
• Has great advice on raising children/young adults on a gluten-free diet. May be quite useful for parents.

The Bad

• Sparse mention of how HLA-DQ2/DQ8 genetic screening can be used to rule out CD. For example, 23 and Me can be used for this purpose.
• No mention of AN-PEP and its potential as a gluten degrading therapeutic. Incorrectly states that there are no enzymes that can degrade gluten. Partly due to how old the book is.
• A few of the later chapters seem like fluff. Not needed in scientific review book. “Living gluten free etc”
• Adheres to antiquated overeating, not enough exercising, low-fat diet dogma.