Medicine Q&A with Dr. Benjamin Lebwohl
How long have you been with us, and what is your role here in the Department of Medicine?
I arrived as a first-year medical student in August 1999, but by then Columbia had already long occupied a special place in my imagination. My father, Oscar Lebwohl, has been on faculty here since the late 1970s and has been a role model for how one can have a varied and fulfilling life in academic medicine.
After completing four years of medical school (graduating class of 2003), I stayed on as a resident in internal medicine, then spent an extra year as chief medical resident; my co-chiefs Betsy Verna and Shep Weiner are Department of Medicine colleagues. I completed my GI fellowship in 2010, during which I also received a master's degree in Patient Oriented Research from the Mailman School of Public Health. I joined the faculty in 2010.
I'm an adult gastroenterologist specializing in celiac disease and gluten-related disorders, and I also provide general GI care including colon cancer screening and management of gastrointestinal symptoms. I'm the principal investigator of a large multi-center NIH-sponsored trial testing management strategies for people with recently-diagnosed celiac disease. I mentor medical students, residents, and fellows in research projects, and serve as Director of Clinical Research at the Celiac Disease Center.
Since 2021, I've been Chair of an Institutional Review Board (IRB) ( that evaluates and approves research involving human subjects. I'm also the director of the Evidence-Based Medicine unit at VP&S, which focuses on teaching first-year medical students how to critically read papers and understand study design. I am co-director, with Dr. Marcella Walker, of the Clinical Research Track in the VP&S Scholarly Project Program. I serve as associate director of Quality Improvement in our GI division under the direction of Dr. Anna Krigel. As of January 1st, I'm the incoming Clinical Chief of GI, a role that includes outpatient operations, access, partnering with NYP to advance our clinical mission, and faculty recruitment and development, all in close partnership with Dr. Braden Kuo, the Chief of Digestive and Liver Diseases. I’m also a co-author, with dietitian Anne Lee, of the updated edition of “Celiac Disease for Dummies,” published on December 17th.
What can you tell us about the Celiac Disease Center?
We are a major center in the US for research in celiac disease and a top referral destination for people with known or suspected celiac disease or difficult-to-manage cases. The center was founded and is directed by Peter Green, MD, my mentor. We are very engaged in conversations with key stakeholders, including pharmaceutical companies, and the wider public. We're accredited as a Celiac Disease Unit Recognition Program participant by the Society for the Study of Celiac Disease.
Should everyone be on a gluten free diet?
No. For the great majority of people, gluten is perfectly harmless and is ordinarily part of a standard diet. Only 1 to 2% of us have celiac disease and must avoid gluten at all times. A somewhat larger proportion of people note that when they eat diets high in gluten they tend to experience bloating and other symptoms—some of those people might have irritable bowel syndrome or a related condition. In some people it's gluten itself, and we use the term “non-celiac gluten sensitivity” when we suspect that gluten is the trigger. In others it turns out to be some other dietary trigger that correlates with gluten consumption.
If someone suspects that gluten is causing symptoms, a key step is to get a blood test done: the TTG-IgA blood test can be ordered by any health care provider. Once you start a gluten-free diet, these tests become less reliable, so it's important to get tested before making dietary changes.
What are the most common misconceptions patients have about celiac disease when they first come to you?
The most common myth is that celiac disease is a solved problem—that once you're diagnosed, you just follow the gluten-free diet and you'll be fine. In fact, a substantial proportion of people with celiac disease have recurrent or ongoing symptoms despite adhering to the gluten-free diet. One of the tasks we take on is understanding the cause of these symptoms. Inadvertent gluten exposure is a common cause, and we work with our dietitians to identify or rule out exposure as a contributor. Another cause is that we may diagnose additional conditions beyond celiac disease. The diagnosis is really just the beginning. The gluten-free diet can be very challenging, particularly for people who live in a food environment where they might not be able to vouch for the gluten-free content of everything they eat.
For that reason, we're actively collaborating with pharmaceutical sponsors to develop and test non-dietary therapies for celiac disease. Here at the Celiac Disease Center at Columbia, we're the site of multicenter clinical trials of a number of non-dietary agents.
With over 350 publications, what research finding has surprised you most in your career?
The research finding that I found most striking was the extent to which cutting out gluten and becoming knowledgeable in the gluten-free diet can sometimes paradoxically make people worse off. My collaborator Randi Wolf, a professor of nutrition at Teachers College, has spearheaded a series of studies investigating the concept of hypervigilance. We identified that a subset of people living with celiac disease who have very thorough knowledge of the gluten-free diet and are taking great measures to avoid gluten are reporting inferior quality of life and significant limitations despite scoring very highly on knowledge assessments. We started out thinking that celiac disease was a matter of education—the more you knew, the better off you'd be. It turns out that the more you know about the gluten-free diet and hidden sources of gluten, the harder it can be to navigate this lifestyle because of the trust required when traveling, eating out, and potentially encountering hidden sources of gluten.
These are people who may be the most educated and most careful, and they might actually be suffering more because of their degree of vigilance. In some cases, this vigilance is necessary because there are degrees of sensitivity, but in other cases people might be taking precautions that are actually unnecessary. They could even afford to become more lax in certain contexts. The wonderful thing about our dietitians at the Celiac Disease Center is they are particularly expert in helping each individual navigate the line between taking appropriate precautions while also having a good quality of life.
As an IRB chair, what advice do you have for researchers in the Department of Medicine?
I would say the most important thing to do is to collaborate. The days of the sole investigator doing brilliant work all by themselves are over. Get yourself out there by sharing with a colleague, co-principal investigator, a mentor, or a mentee. This is important at the very earliest stages so you can get a reality check, and it's also important as you're looking at preliminary data and trying to understand and interpret your findings.
The best research tends to come from team science. You'll learn from each other's orientations and from each other's strengths. It's also particularly important in this era of increased scrutiny on scientific integrity: sunlight is the best disinfectant. When you're doing work together with other people and you can see each other’s process and work, you're much more likely to end up with results that are truthful and sound.
