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Melanie Cole (Host): Celiac disease is one of the more common diseases that results from both environmental and genetic factors and here to tell us about celiac disease today is Professor Michael Wilschanski on this episode of Hadassah On Call.

Welcome. My guest today is Professor Michael Wilschanski. He’s the director of Pediatric Gastroenterology at the Hadassah Medical Organization in Jerusalem. Professor tell us a little bit about yourself and how you came to the Hadassah Medical Organization.

Michael Wilschanski, MD (Guest): Well I was born and trained in England and we came on Aliyah in 1985. I worked at a different hospital but then it’s very clear that Hadassah is the major hospital in Jerusalem, so I moved over there about 18 years ago and I’m head of the pediatric gastroenterology in both Ein Kerem and Mount Scopus and I’m very happy to be working at Hadassah.

Melanie: So, let’s get into celiac disease a little bit. Is it really considered a disease Professor? Tell us what it is.

Dr. Wilschanski: That’s a very good point to start off with. I actually am one of those people who think that it is not a disease; because actually people who have celiac and as long as they conform with the diet, are entirely healthy. So, there’s not really a disease per se. So, it is a condition. It is very, very common. It is one in one hundred people around the world. So, it’s very difficult to say that it is a disease so common. It is a condition. It is an intolerance to gluten which is part of wheat and barley and it is – if the person is – has a genetic background which causes this problem and it is not looked after; then the gluten does cause damage to the intestines and this causes major problems, both in children and in adults. But as I say, once again, if it is sorted out and it can be sorted out very, very easily just with dietary changes, no medications, no IVs, no drugs and the person will live a normal life. So, I agree that it is in choice of medicine whether it is disease or not.

Melanie: Can a child grow out of it? Is it something that if they follow the diet and we are going to speak about treatments just a little bit and the diet; but can they grow out of it? Is it something that will change as they grow?

Dr. Wilschanski: Yeah, everyone asks me that question whether you can grow out of it. And the reason for that question is because in the layman’s understanding, it’s a bit like milk allergy or peanut allergy, let’s try and put the kids back on peanuts or back on milk later on and see what happens. Celiac is not like that at all. Celiac is an intolerance which unfortunately is lifelong and therefore, normally one does not grow out of it per se. I cannot say that. The reason why – another aspect of this is that if the child is so compliant with the diet or the adult is compliant with the diet; he feels no symptoms for years on end, so therefore he feels like he or she feels like he has grown out of it. But actually, he is still on the diet. So, that’s another way of looking at it. But actually, per se, it is not something which one just grows out of.

Melanie: Professor, do we then really need a cure for celiac if gluten free diet, a strict gluten free diet takes care of all of these symptoms that we are going to discuss, and do you see that compliance with a gluten free diet is very, very difficult especially among adolescents.

Dr. Wilschanski: Yes, it is difficult, but much easier than it was ten or fifteen years ago. It’s very interesting, as a pediatric gastroenterologist, all the families who walk into my office who are getting medications for other diseases say when can we just have a diet to cure this problem. I just want to be on a diet then I don’t need the medication. And then the celiac families walk in and they say I just want a medication. I don’t want to be on this diet. So, it’s just a question of how you look at it. Many, many of our celiac families get on extremely well with the diet and of course it is a pain in the neck. I agree with you. Sometimes going to a party, going to a wedding, sitting on the airplane, getting gluten free food is not the easiest. But still, I would think that it is better than getting certainly injections. I can talk about – there are a lot of research going on to actually give some medication which will prevent the gluten from entering the lining of the intestine and that could be – so it could be that in the not too distant future a celiac person could eat gluten and have a like a capsule likely, the adults and children who are lactose intolerant can drink milk with a tablet; they could possibly be something like that and that will be happening soon I hope. So, there is on the horizon various ways to stop gluten causing the damage but actually, as I said once again; being on the diet is an absolute cure as well.

Melanie: So, then tell us about your latest research in celiac at Hadassah Medical Organization. What’s exciting? What are you doing?

Dr. Wilschanski: Well as I said, we are seeing many, many more celiacs than we were a few years ago and everyone is seeing that. All of these kinds of problems are much more common, both in pediatrics and in adults. And we are doing some nice research at the Hadassah Medical Organization. We have had two studies published recently and one of them was we noticed that the gluten free diet actually does contain a lot of calories because if you do avoid – it seems to be that avoiding the gluten, one tends to eat a lot of carbohydrates and a lot of calorie containing food and a wonderful dietician has done some work on our patients and we have actually proven that. That the gluten free diet is what we call obesogenic, in other words it can cause you to gain weight. Many, many of our families have that because – and this is something which we are educating the medical community from Hadassah that one has to be careful to certainly increase fruits and vegetables with the celiac diet and not – to watch out for the obesogenic part of it. That’s one study we have just published now.

And the other study which we published is that we noticed that because if celiacs do not keep the diet and they do not absorb calcium well; then there is a problem with their teeth. And we have noticed that many of our children mainly, with celiac, certainly the ones who before the diagnosis have bad teeth and we have done some research on that as well and have published about that certainly in the beginning of the diet therapy one has to be more careful about dental hygiene and that there may be an enamel issue that the enamel is not well made in celiacs. So, that’s another study which we have done recently.

And another one which we are doing, is a lot of our families complain – there are some neurological issues with celiac because if you think about this; the gluten is actually not good for this particular individual, it goes around the body and affects various organs no necessarily just the intestines and we have had some – there are well known neurological issues with celiac and one thing which we have noticed is that there is a sleep disturbance. All of our certainly younger children as soon as they go on the gluten free diet; suddenly their sleep pattern improves. They don’t wake up in the night. So, actually we are doing another – some more research so I can’t tell you the results of that yet, but we are doing it right now at Hadassah looking at various aspects – working together with the sleep clinic in Hadassah to try and sort this out. So, there are lots of things going on in Hadassah with celiac and we are very proud that this is all happening.

Melanie: Wow, that is so interesting Professor, so the obesogenic; that is fascinating as well as you have noticed that gluten free diet is high in calories and so let’s just start there and we don’t have a lot of time, but I would like to delve into these just a tiny bit and the dental hygiene; I was researching that as well and that’s fascinating. What would you like listeners to take from this as far as the high calories that are found in a gluten free diet, or the dental hygiene issues that you have noticed in your research? What would you like your patients and listeners to know and do about this?

Dr. Wilschanski: I think both at the moment. Why not? I think it’s something which because we did the study with the dental department in Hadassah. Of course, not everybody has access to these wonderful doctors there as well. And I think generally, one should look into the dental health of our new celiacs. Certainly, if you have a child who – obviously with the families generally are very concerned about growth of course and getting the blood tests back and anemia and everything else getting back to normal; but I think if the people who are listening would take that into account also. I think one should be a little bit more careful about dental health with dental hygiene with our celiacs.

One interesting just sort of a case report which we had, and we actually had one child who was referred from the dental clinic. He actually did not have much GI issues. He was growing well and didn’t have much stomachache or diarrhea or the usual symptoms, but he had terrible teeth and he had – and one of these very bright Hadassah dentists took celiac antibodies and they were sky high. So, actually, we were referred this young boy from the dental clinic and the celiac was diagnosed because he had bad teeth. So, I think that’s another issue which our listeners can understand, that is something which we need to look into and why not to make sure that our celiacs have excellent teeth.

The thing about the obesogenicity is interesting. It’s true that years ago we thought that celiac – you look at the old pictures and they had all these thin little children with protuberant abdomens and they looked very, very sad themselves, malnourished. Now that isn’t the case at all. Now we’re diagnosing celiac much earlier; the blood tests are very, very good nowadays. We are getting the- they are being diagnosed earlier so the children are generally not malnourished and I think that putting a child on a gluten free diet with all the different substitutes there are, and the dieticians are excellent getting substitutes for gluten. But one has to just be careful with calories and to make sure that the calories are not too great because we have been seeing and sometimes as you know, the families also – sometimes the whole kitchen changes to being gluten free because they have a child with celiac and everybody seems to be gaining weight. And that is because of the gluten free diet. I would like people to know that one should be a little bit more careful.

Melanie: So interesting and how does what you are doing at Hadassah Hospital in Israel affect global treatment of celiac? Wrap this up for us with your best information, your take home message what you would like listeners to know about celiac and what you are doing there at Hadassah.

Dr. Wilschanski: I think the take home message is that we are still missing too much of our celiacs. We are diagnosing; they come to Hadassah too late and I think the message is if – let’s say I’m talking to the parents here – you see that the children are not gaining weight or they are not doing well even just as I said before, neurological or psychoneurological issues, they are not doing well in school or there are other feeding problems that the child doesn’t want to eat certain things; then one should just ask the primary care physician to do the celiac test. It’s a really simple test and we are diagnosing it – the good doctors are diagnosing it very, very early. That’s point number one.

Point number two, I think that Hadassah is at the forefront of pediatric gastroenterology and certainly we have a very large clientele of celiac and we are – as I said, we are doing research as I have mentioned. Not every celiac needs to come to Hadassah of course, one can certainly manage that very well in anyplace in the world, but sometimes if the listeners want to send their children for a gap year or something whatever it is then certainly at Hadassah, we are very able to look after them.

Melanie: Thank you so much Professor Wilschanski for being with us today, for explaining celiac and your exciting research and your common-sense advice, really about dental hygiene for people with celiac especially children and for the weight gain that could come along with that strict gluten free diet and it’s such interesting information. Thank you so much again for being on with us today. This is Hadassah On-Call: New Frontiers in Medicine brought to you by Hadassah, the women’s Zionist organization of America. The largest Jewish women’s organization in America, Hadassah enhances the health of people worldwide through medical education, care and research innovations at the Hadassah Medical Organization. For more information on the latest advances in medicine please visit www.hadassah.org and to hear more episodes in this podcast series please visit www.hadassah.org/podcasts, that’s www.hadassah.org/podcasts. This is Melanie Cole. Thanks so much for listening.