With a rise in the number of celiac disease in north India due to consumption of wheat, rye and barley, the need of the hour is early detection and follow a gluten-free lifestyle, says Sangeeta Yadav
What is Celiac DiseaseIJ
It is a digestive disease that damages small intestine, interferes with absorption of nutrients. The disease can develop at any point in life, from infancy as young as two-year-old to late adulthood of any age. Once thought to be a rare disease restricted to western Europe, it is now a global disease affecting approx. 37 million to 69 million individuals. Celiac has affected almost 0.7 per cent of the world’s population. In India, about six to eight million are estimated to have this disease, and its prevalence in north India is 1 in 100.
Occurrence
It can occur due to genetic and environmental factors as well as diet. It is an auto-immune disease that occurs because of ingestion of a protein, called gluten, which is present in wheat, rye and barley. In these patients, the gluten protein is not digested completely and that leads to damage to the small intestine. With the damage of small intestine, the food is not absorbed and patients fail to grow in height and weight, develop chronic diarrhoea, anemia, and weakness of bones.
Chris J Mulder, Hepato-gastroenterologist and Head of Department, VU Medical Centre, Amsterdam, The Netherlands, says: “The reason why there is a rise in the incidents of Celiac Disease in India is because of wheat consumption in Northern India. People consume about 30-40 gm of wheat daily. About 50 gm of this can induce villous atrophy. Gluten can gradually erode the villi in the small intestine and prohibit the body from absorbing nutrients from food.”
Challenges
A gluten-free diet (GFD) is most effective, but since gluten is ubiquitous, especially in processed food products, it is often found in daily consumption products like beer and ale, salad dressing, communion wafers, canned soups, sauces and gravies, that makes very difficult for the patients to completely avoid it. Readymade GFD food products are not easily available in the market. This limits the patients to strictly follow a particular diet.
“Since the maintenance of GFD is very expensive and demanding, the family and friends should motivate the patient and also look for different ways to make GF home-cooked food. To have a wide variety of GF food, industries need to come up with large-scale production of such products. There is also a need to have a legislation for labeling,” Dr Makharia, tells you.
Treatment
life-long and complete avoidance of gluten in the diet is the key to the treatment and prevention of Celiac Disease. After a diagnosis is made, all the patients should be referred to a dietician for nutritional assessment, to be followed up every three months. During the follow-up check-ups and consultancy, one should get symptomatic review, diet review, adherence to GFD, diet quiz to confirm gluten exposure and serology to examine the blood serum.
Some other approaches include meal planning and assistance with the social and emotional adaptation to the gluten-free lifestyle.
Diagnosis
Due to the lack of awareness about celiac disease, which remains largely undiagnosed, one-third of Indians have genetic susceptibility to develop celiac disease. There are two major tests.
Serologic blood test: The test is done to detect and measure the levels of antibodies. It checks the anti-endomysial antibody and anti-tissue transglutaminase antibody.
Duodenal biopsy
“The biggest impediment in the prevention and treatment of celiac disease is limited awareness about it and its causes. The 17th International Celiac Disease Symposium was organised for the first time in Asia by AIIMS in association with the Indian Society of Gastroenterology, International Society for the Study of Celiac Disease, and the Asia-Pacific Association of Gastroenterology to spread awareness. To prevent the emerging epidemic, the need of the hour is to research and create awareness,” Dr Govind Makharia, organising chairman & professor, Department of Gastroenterology and Human Nutrition, AllMS, New Delhi, says.
what to eat
Grains: Rice, Cassava, Corn (maize), Soy, Potato, Tapioca, Beans, Sorghum, Quinoa, Millet, Buckwheat groats, Arrowroot, Amaranth, Teff, Flax, Chia, Yucca, Gluten-free oat and, Nut flours
Beverages: Most beverages are gluten-free, including juices, sodas, and sports drinks. Alcoholic beverages, including wines and hard liquor/distilled liquors/hard ciders are also gluten-free. However, beers, ales, lagers, malt beverages and malt vinegars that are made from gluten-containing grains are not distilled and therefore are not gluten-free.
Medicines, Vitamins and Supplements: Not all medicines and vitamins are gluten-free, so make sure to read the label before you buy.
Foods to avoid
Sauces: Many have wheat as a thickener
Symptoms