CELIAC DISEASE- ALL WHAT WE SHOULD KNOW

Celiac disease- All what we should know

§  It is an autoimmune digestive disease, and as the term suggests, it is the body’s own immune system which responds by damaging the small intestine resulting in varied degrees of malabsorption.

1 out of every 250 people may have CD; only 1 out of 10 people may be actually diagnosed and are aware of their condition, thus suggesting high level of its prevalence.

Signs and symptoms

§  Vague GI complaints-hyperacidity, reflux, cramps, bloating, diarrhea, constipation, abdominal pain.

§  Anemia- iron deficiency anemia and folic acid & vitamin B12 deficiency anemia.

§  Weight loss in adults, growth failure & failure to thrive in infants and children.

§  Fatigue and pallor due to malnutrition or multinutrient deficiencies.

§  Mood changes and irritability.

§  Reduced appetite

§  Dermatitis

Complications

§  Calcium and vitamin D malabsorption (and compensatory secondary hyperparathyroidism) may cause osteopenia (decreased mineral content of the bone) or osteoporosis (bone weakening and risk of fragility fractures).

§  Celiac disease is also associated with bacterial overgrowth of the small intestine, which can worsen malabsorption or cause malabsoption despite adherence to treatment.

§  IgA deficiency is present, which result in increased risk of infection and auto immune diseases.

§  Dermatitis herpetiformis; this itchy cutaneous condition has been linked to a transglutaminase enzyme in the skin.

§  Vitamin K deficiency can lead to risk of abnormal bleeding.

§  Recurrent miscarriages and unexplained infertility.

§  Abnormal liver function test (randomly detected on blood tests).

The Treatment

Dietary management in celiac disease is the backbone of treatment and since it is lifelong it needs a very clear, concise and innovative management involving a straight gluten free environment for a celiac which primarily means totally abstaining from cereals like wheat, barley, rye, and oats.

A gluten free diet ensures speedy healing and at the same time maintains health through the adoption of a well-balanced, interesting lifestyle that avoids gluten and gluten contamination even hidden gluten sources.

Hidden sources of gluten are frequently present in what would otherwise appear to be safe foods.

Dairy foods need to be restricted initially because patient with untreated celiac disease often have untreated lactase deficiency. After 3-6 months of strict gluten free diet, adequate mucosal healing should have occurred to allow for gradual re introduction of dairy products.

Only treatment for celiac disease is a gluten free diet

(GFD).

·      Permanent lifestyle changes

·      Avoid

Wheat

Barley

Rye

Oats

Hidden source of Gluten:

·      Malted drink additives like Horlicks, bournvita, complain, etc.

·      Barley malt (a sweetener commonly used in breakfast cereals, snacks, and convenience foods).

·      Chocolates/ candies.

·      Soups, soup pre mixes.

·      Sauces containing flour / malted vinegar- namely soy sauce and Worcestershire sauce / tomato sauce.

·      Wheat germ oil.

·      Asafetida (Hing) commonly used seasoning in Indian cooking.

·      Fruit beer, alcoholic beverages like beer and vodka.

·       Mustard powder.

·      Baking powder and baking soda.

·      Soya sauce.

·      Malt vinegar.

·      Mono sodium glutamate (MSG).

·      Modified food starch.

·      Using same mill to grind grains where wheat is being ground.

·      Using same bakery to produce gluten free products where wheat products are produced.

·      Using same spatula to pick various cereals and spices (i.e. gluten containing & gluten free) at grocery shop.

·      Battered food.

·      Nonfood sources:

                 Lipstick

                  Stamp and envelope glues

                   Play dough

                   Mouth wash and tooth paste

                   All chewing Gums (sugar free)         

Archna Shah

archnashahconsultant@gmail.com

Cross-Contamination of Gluten

Cross-Contamination

When preparing gluten-free foods, it is important to avoid cross-contamination. Cross-contamination occurs when foods or ingredients come into contact with gluten, generally through shared utensils or a shared cooking/storage environment. In order for food to be safe for someone with celiac disease, it must not come into contact with food containing gluten.

Places where cross-contamination can occur

Toasters used for both gluten-free and regular bread

Flour sifters

deep fried foods cooked in oil shared with breaded products

Shared containers including improperly washed containers

Condiments such as butter, peanut butter, jam, mustard, and mayonnaise may become contaminated when utensils used on gluten-containing food are double-dipped

Wheat flour can stay airborne for many hours in a bakery (or at home) and contaminate exposed preparation surfaces and utensils or uncovered gluten-free products.

Oats Only farm pure oats can be used

Non-certified baked goods e.g. “gluten-free” goods from otherwise gluten-containing bakeries

Bulk bins (most common contamination) at grocery stores 

If In Doubt, Go Without!

If you are unable to verify questionable ingredients, or if an ingredient list is unavailable, don’t eat the product. Regardless of how much you plan on eating, it is not worth triggering your immune system. Remember that for people with celiac disease, damage to the small intestine occurs each and every time gluten is consumed, whether symptoms are present or not. If you accidentally ingest gluten, stop eating immediately, as higher doses can be increasingly damaging.

Be Healthy.. Eat Gluten Free..

Archna Shah

archnashahconsultant@gmail.com