Celiac Disease (CD) is caused by an immune reaction (hypersensitivity) to gluten, a protein found in wheat, barley, oats, and rye. In people with CD, gluten triggers an autoimmune reaction in which the body produces antibodies that attack its own tissue. This reaction causes inflammation and damage to the lining of the small intestines.
Celiac Disease is also known as Celiac Sprue, Gluten Enteropathy, Gluten Sensitivity. The current treatment is a strictly gluten-free diet for life. In a gluten-free diet, wheat, barley, and rye are avoided. Oats are not toxic in over 95 per cent of patients with CD or dermatitis herpetiformis, but there is a small subgroup (less than five per cent) for whom oats are not safe. Rice and corn can be part of a gluten-free diet. Most patients have a rapid clinical response to a gluten-free diet (within two weeks), although the rate of response varies. Patients should be encouraged to eat natural high-iron and high-folate foods, as these deficiencies are common. Though the cornerstone of treatment remains a gluten-free diet, compliance due to palatability, inadequacies in food labelling and possible cross contamination are major challenges.
Symptoms
Symptoms vary from person to person. Digestive symptoms are more common in infants and young children and may include abdominal bloating and pain, chronic diarrhoea, vomiting, constipation, pale, foul-smelling, or fatty stool and weight loss. Irritability is another common symptom in children. Malabsorption of nutrients when nutrition is critical to a child's normal growth and development can result in other problems such as delayed growth, short stature, delayed puberty and enamel defects of the permanent teeth.
Adults are less likely to have digestive symptoms and may instead have one or more symptoms like unexplained iron-deficiency anaemia, fatigue, bone or joint pain, arthritis, bone loss, depression or anxiety, seizures, infertility ... People with celiac disease may have no symptoms but can develop complications over time including malnutrition, liver diseases, and cancer of the intestine.
Since malabsorption is a major problem, daily vitamin and mineral supplements is essential. Important supplements include iron, B vitamins, magnesium, calcium and vitamin D. Include foods rich in omega-3 essential fatty acids to your diet like ground flax meal, walnuts, fish oil, and sprouted walnuts. Add nutrient-dense and unprocessed foods such as sprouted nuts and seeds to your diet.
Myths
Celiac disease is a disease of children: No doubt celiac disease is commonly diagnosed in children but more cases are being diagnosed in adults too.
Diarrhoea is a constant: Diarrhoea is the commonest presentation but it may not be the presenting feature. It may be totally absent and other presentations like anaemia, osteoporosis, infertility may be the only presenting feature.
Blood tests are enough for diagnosis: Not true. A duodenal biopsy should always be done before starting a gluten-free diet.
It can be outgrown: Celiac disease requires lifelong adherence to a gluten-free diet to avoid complications. A patient may become asymptomatic after some time but it does not mean one has outgrown it.
A little bit of gluten now and then will not hurt: There is evidence that ingesting as little as 30 mg of gluten damages the intestine. Hence, intermittent ingestion can be harmful. At times celiac crisis can occur.
Celiac disease needs time, patience, persistence and support in making changes. Living with celiac disease can be a huge challenge that requires both emotional and physical adjustments. Eating out can be a challenge, as patients have to be extremely careful about what they eat. With experience and knowledge, one can figure out dishes at restaurant, parties or friend's home that are gluten-free. The golden rule: “If in doubt leave it out”. Lots of individuals, organisations and resources are available to help you thrive. Over a period, managing the disease will become second nature.
Super Six
The six elements essential to treatment:
C: Consultation with a skilled nutritionist
E: Education about the disease
L: Lifelong adherence to a gluten-free diet
I: Identification and treatment of nutritional deficiencies
A: Access to an advocacy group
C: Continuous long-term follow-up.
What to avoid
All supplements that contain gluten since wheat starch is used as a binding agent in tablets and capsules.
Cosmetics since Gluten can be found in products such as lipstick.
All grain alcohols such as beer and malted liquors.
Atta, Maida, sooji, rye barley, dalia and their products.
Noodles, pasta, bread, bread rolls, pizzas, wheat flakes, soup sticks, seviyan, rusk, cake.
Burger, kulcha, naan, upma, crackers, biscuits, cutlets and other wheat products.
Barley water, hot chocolate, Complan, Horlicks, Boost, Bournvita, soups made of soup cubes or soup powder.
Tinned and canned foods, sauces, instant curry mixes, baked beans.
Sausages, hams, seekh kebab, tikka.
Safe foods
Cereals: rice, makki atta, topiaca, sago, bajra, jowar, singhara atta, kuttu atta, arrowroot
Pulses: all dals
Processed cereals: chirwa, murmura, rice flakes, cornflakes, puffed rice, popcorn, rice noodles, rice papad, sago papad
Snacks: idli, dosa, vada, potato cutlet, roasted corn
Desserts: Freshly prepared rice kheer, sago kheer, fresh Paneer, caramel custard, carrot halwa
Beverages: Fresh juices, milk and its products, fresh soups with without cornstarch
Fresh foods: Freshly cooked vegetables, fresh fruits, and fats and oils, whole/ground spices and condiments, freshly cooked meat, fish, chicken, egg.
The writer is the Chief dietician, Asian Institute of Medical Sciences (AIMS).
