People are always asking me if there are celiac disease treatment options besides the gluten-free diet.
Unfortunately, there are not any known treatment options for celiac disease besides following a strict, gluten-free diet. However, there are a lot of promising clinical trials for medications and supplements that promise to relieve symptoms commonly associated with the autoimmune disorder.
In this article, I’d like to share some of the celiac disease treatment options that are on the horizon. Keep in mind, there is no cure for celiac disease and none of the medications below give celiacs permission to eat gluten again. I think all of the medications and supplements that are currently undergoing testing promise to help celiacs experience lessened gastrointestinal symptoms after small and accidental exposures to gluten (such as during times of cross contamination).
Let’s discuss some of the promising medications and supplements that may one day be the future of celiac disease treatment.
Celiac Disease Treatment Options:
Larazotide acetate is a medication that is currently in Phase III clinical trials. It promises to be one of the first – and most exciting – celiac disease treatment options of its kind.
The larazotide acetate compound is used to help regulate tight junctions in the bowel. The junctions in the bowel are closed (except when the body is shedding dead cells) in normal, healthy individuals. However, the presence of gluten causes the tight junctions to remain open in patients with celiac disease. When the junctions are open, the body responds by launching an attack on the intestinal villi, or the hair-like projections surrounding the small intestine that are essential for nutrient absorption. Researchers found that the protein, zonulin, is overproduced by celiac patients after they eat gluten. Larazotide acetate works by inhibiting zonulin from “increasing the permeability of the intestine, and thus stopping the flow of gluten into the body, which in turn can help reduce inflammation, gastrointestinal and other celiac disease symptoms,” according to this article in Allergic Living.
Dr. Alessio Fasano, the leading researcher in celiac disease, says, “Higher zonulin levels can lead to increased intestinal permeability,” such as leaky gut, and, “When someone eats gluten, certain proteins in gluten activate zonulin release, which opens the tight junctions between the epithelial cells.”
Bottom Line: This promising research indicates that larazotide acetate can help to keep the bowel’s tight junctions closed and inhibit the production of zonulin if a person with celiac disease takes it before a meal.
(Source: Allergic Living, “Celiac Disease Treatment Licensed and Headed to Late-Stage Clinical Trials.” (March 15, 2016)
Nexvax2® is a potential vaccine that is currently being tested by researchers and is said to protect celiac disease patients from gluten exposure. According to Beyond Celiac, Nexvax2 is a form of immunotherapy, which uses one’s immune system to treat or prevent disease. The vaccine will allow a celiac patient to build up resistance to the gluten protein without any negative effects, similar to an allergy shot. You can read more about Nexvax2 in this article.
Latiglutenase (formerly known as ALV003 or ImmunogenX)
ALV003 or latiglutenase is an experimental drug – or enzyme supplementation therapy – that can break down proteins into small particles. It combines two enzymes that can break up gluten before the gluten activates an autoimmune response when taken before or during a potential gluten exposure. The drug is currently in clinical trials.
In one such trial, 47 patients on a gluten-free diet consumed six grams of gluten and then doses of either latiglutenase or a placebo every day for six weeks. A small number withdrew due to intolerable symptoms from the gluten challenge (can you imagine having to eat gluten again everyday!?!). Patients taking a placebo showed increased damage in their gut tissue and those on latiglutenase showed no significant change. (Source: Gluten Free Living, “ALV003 Drug Breaks Down Gluten.” December 19, 2014.)
In Phase II clinical trials, researchers found that subjects on this enzyme therapy experienced a significant drop in symptoms (i.e. 58 percent experienced less abdominal pain) but researchers found no histologic improvements (this means they did not see any improvements internally).
Bottom Line: This promising celiac disease treatment option may be able to help people with celiac disease prevent their bodies from activating an autoimmune response when they eat small amounts of gluten. More testing is needed to know if this drug will be effective and safe for celiac disease patients.
(Source: Healio Gastroenterology, “Latiglutenase improves symptoms in certain patients with celiac disease.” (August 31, 2017)
The verdict is still out, however, AN-PEP is an enzyme that is reported to degrade gluten in the stomach. It other words, if you get glutened, you can take this and prevent an autoimmune reaction. It will not work if you eat a whole pizza, but if you get an incidental gluten exposure, likely from cross contamination, and you take this medication, you can prevent a reaction. AN-PEP works similar to how a Lactaid enzyme can break down lactose.
You can currently purchase AN-PEP in the U.S. in the form of a supplement called GliadinX. GliadinX is not approved by the FDA.
Early research indicates that latiglutenase, which is a combination of two enzymes, may successfully break down small amounts of ingested gluten in the stomach. Latiglutenase should be taken in conjunction with a gluten-free diet, but researchers tell Celiac.com, “The intent of the therapy is to combat low levels of gluten that persist in the food chain, as well as in situations where ingestion of gluten is unavoidable due to cross contamination, such as at restaurants.”
Latiglutenase did not demonstrate “clinically significant intestinal healing” but it did show signs of symptom reduction in celiac patients. Latiglutenase is currently undergoing additional clinical trials.
KumaMax is an enzyme designed to break down gluten in the stomach. The drug is said to not only prevent painful symptoms that come with exposure to gluten, but also prevent small intestinal damage from accidental gluten ingestion. It also shows promise as it can survive stomach acid
KumaMax also is for celiac patients on a gluten-free diet but who may accidentally ingest gluten through cross contamination. It has the potential to degrade the immune-reactive parts of gluten before they exit the stomach, according to Takeda, a pharmaceutical company that has committed $35 million to the research and development of KumaMax.
GlutenAid, GlutenEase, Oh My!
GlutenAid and GlutenEase are both proprietary blends of digestive enzymes that promise to help you break down proteins from food. They are two of many digestive aid supplements on the market today that have the word “gluten” in their names.
While the supplements do not give you permission to eat gluten, they do claim to reduce the associated symptoms of a small, accidental gluten exposure. Protease is an enzyme produced in your stomach that breaks down proteins and amylase is an enzyme found in your saliva. Both products contain these enzymes that are known to help aid in digestion. However, both products are supplements, so their claims are not verified by the FDA.
A blogger at DCGFree.com, a blog that has been abandoned, tried GlutenAid after an accidental gluten exposure and she documents her results here. The verdict is still out if they will work as a celiac disease treatment option, and more testing is needed to know if they are safe and effective, however, digestive enzymes are often recommended for relieving symptoms associated with eating hard-to-digest foods.
Celiac Disease Treatment Options Don’t Go Far Enough
Unfortunately, all the medications undergoing testing are meant for helping those with celiac disease who have small, accidental exposures to gluten. None give celiacs permission to load up on gluten, and none show significant physiological improvements; the only true celiac disease treatment option is the gluten-free diet. Most of the promising celiac disease treatment options only offer symptom relief if taken before or during a gluten exposure (i.e. you take it before you eat a meal at a restaurant where cross contamination is possible… err, probable) but do not offer any cure or full prevention of inflammatory response. This means if you have celiac disease, there is no pill on the horizon that will allow you to eat cake again (unless it’s gluten-free, of course).
My ebook, Eating Out Gluten-Free, can help you eat out as safely as possible without compromising your gluten-free diet.