Yet, what stands out about this tall, thin, fairly long-haired Italian consummate researcher who after almost 25 years at John Hopkins University joined the Massachusetts General Hospital’s ever growing research team is a certain sparkle in his eyes, typical of those who know they are on to something big.
Professor Alessio Fasano let us start by defining words: what do the terms celiac and celiac disease actually mean?
Alessio Fasano: Celiac disease is an autoimmune disorder, just like diabetes, multiple sclerosis, rheumatoid arthritis etc…, with some unique peculiarities: In fact, it is the only autoimmune disease for which we know the trigger — the enemy, so to speak.
And what is gluten exactly?
AF: It is the fundamental protein in certain cereals like wheat, rye and barley. It is the only protein that we cannot manage to digest completely, so the “pieces” of this protein that remain undigested for long periods of time could cause damage to the organism of those who are genetically inclined
From an evolutionary point of view, we, the humans, as a species, are not made to eat gluten. In fact for two and a half million years (the time of our evolution on earth) gluten did not exist in nature. It arrived in the last “minute and a half”, about 10,000 years ago, with the advent of agriculture.
Most of us, in fact a great majority of humans, have no consequences from eating gluten, as our immune system manages to eliminate this “enemy.” However, there is a small number of people who are genetically predisposed that do have consequences. It is a small number … about one percent of the entire population.
Lately, however the gluten-free diet and lifestyle is booming, even beyond the medical aspect of it, how come?
AF: Certainly, the gluten-free diet in the United States – as well as in Europe, at least recently – has become by far the most popular one. At least 100 million Americans have deliberately tried at least once a gluten-free product. Half of them think – or they heard – that eating gluten-free is generally healthy. About a third think that not eating gluten helps to lose weight – which is absolutely not true. Let me explain: By cutting out of the diet foods that naturally contain gluten (basically anything made with wheat-derived flour such as pasta, pizza, bread, etc…. ) you will obviously lose some weight; yet if you exaggerate with alternative, gluten-free products, oh well, you will actually end up gaining some.
Then, about 6-7 million people say that as they encounter gluten, gastrointestinal symptoms appear, another 5-6 million complain about other symptoms, from difficulty to concentrate, to fatigue , skin rashes etc.. and finally there is the only group that we know for sure needs a gluten-free diet, namely the diagnosed celiac ones, who are about 300,000.
However, although gluten itself is not a protein we actually need, eliminating foods that contain it also takes a lot of important nutrients contained in those foods off one’s diet. So in any case, a gluten free diet, like all diets really, should always be followed under medical supervision.
It might be a fad for many, yet fads, (like the “sugar-free” one has been for diabetics) come extremely handy to those who suffer, right?
AF: Certainly. Who has a real medical necessity has benefitted greatly from it both in terms of taste and also of price. Nowadays, the most important – and most desirable – foods that would normally be off limits for celiac disease sufferers, can be found everywhere in their gluten-free version. Bread, pasta, cookies, pizza .. even bagels in the United States.
A few years ago a common joke among patients was: “what am I going to eat today, the product or the box it comes in?” In fact they usually tasted the same! And that was ’95 .. not 1895… 1995 … only 15 years ago! Now the situation is very different.
Is one born a celiac or can he/she also become one?
AF: Good question! Until not too long ago the answer would have been you can only be celiac by birth because of your genes. Instead, and that is the most interesting aspect of our current work, we realized you can also become celiac.
Hence, this means research is well underway …
AF: Absolutely! We are in the midst of a true Copernican revolution. In fact, Celiac disease can be used to understand the mechanisms of a variety of other apparently unrelated conditions from Parkinson’s disease to breast cancer.
What we are discovering [at the Center for Celiac Research and Treatment], as well as elsewhere in the medical research world, is that having the Parkinson’s gene or, say, the prostate cancer gene does not mean that sooner or later you will get these diseases. Whether you get them or not depends solely on environmental factors that interact with your genetic material. This is the great lesson we are learning from celiac disease.
Professor Fasano, where were you born, and most importantly, where did you become who you are today?
AF: I was born in Salerno, then at 18 I moved to Naples to study medicine at the Federico II University. There I also specialized in Pediatrics; hence my formation is totally Italian. After that, I became a faculty member at the University of Catanzaro in Calabria. Then in 1988, a period of research here in the United States (which went from an initial duration of three months to two years), then back to Italy in 1991 and again back to the States — this time for good — in 1993.
I don’t think my personal story is unique or, for that matter, very different from that of many Italians in science and research. All “brain drain” stereotypes aside, there are situations here in the United States that are difficult to replicate overseas – although it is not necessarily impossible.
In fact, four years ago we embarked upon a project that tries to do – even though on a smaller scale – exactly that. We founded a large research institute in Salerno that opened three months ago: EBRIS (European Biomedical Research Institute of Salerno) a joint venture between MGH (the main financial supporter and ‘know-how’ provider) and the Municipality of Salerno, which among other things donated a beautiful historic building that was probably the original seat of the oldest medical school in Europe.
Basically the idea is to create an environment to prevent Italian ‘young guns’ in research from going through the same process I – and so many others like me – went through.
Video interview (in Italian) by Stefano Salimbeni, for RAI Italia: