Celiac is a life-long condition and the elimination of gluten is the only available treatment strategy.
Dr Tehsin A Petiwala, consultant gastroenterologist, hepatologist and endoscopist at Masina Hospital, Mumbai, explains how to identify the condition and lead a normal life.
Miss Universe 2021 Harnaaz Sandhu was recently in the spotlight for highlighting a unique health condition that likely only a few Indians are aware of.
Harnaaz, who returned to India and walked the ramp for designers Shivan and Narresh at the FDCI x Lakme in Delhi, was being trolled for her weight gain.
Speaking to reporters in her hometown in Chandigarh, Harnaaz explained the challenges of living with Celiac, a permanent disorder that discourages her from consuming gluten and other foods.
"I'm one of those individuals who was first bullied that 'she's too skinny' and now they bully me saying 'she's fat'. Nobody knows about my Celiac disease. That I can't eat wheat flour and many other things," the 22 year old told PTI.
What is Celiac?
Celiac disease, also known as Gluten-sensitive Enteropathy, is an auto immune disorder which is triggered due to consumption of gluten.
Gluten is a protein that is found in wheat, rye, barley, and foodstuffs which contain any one of these.
The immune system in patients with celiac disease abnormally reacts to the ingested gluten in foods and causes damage to the lining of the small intestine.
This causes difficulty in the absorption of nutrients and their deficiency leading to illness.
This disease can affect persons of any age or sex and can remain silent for many years before it gets diagnosed.
While there is no permanent cure for celiac, one can control it by eliminating gluten from the diet.
Celiac in India
Celiac affects 1% to 2% of the world population, but until a few decades ago, celiac was thought to be uncommon in India and Asia.
However several screening studies, particularly from North India have shown that it affects 1 in 100 (or less) individuals which means it is a fairly more common but under-recognised condition.
In the past, it was perceived more as a childhood disease, but nowadays it has been increasingly recognised in adults even after the age of 60 years.
The symptoms
The classic symptoms of celiac disease are diarrhea, greasy stools, and weight loss or inability to put on weight. But these occur in less than half of the patients.
Gastrointestinal symptoms like vague abdominal discomfort and bloating are extremely common and can also lead to misdiagnosis of Irritable Bowel Syndrome (IBS).
Fatigue, anemia, mouth ulcers, bone pains, swelling in feet, infertility, or recurrent miscarriages are related to malabsorption of nutrients.
Thyroid, liver, and skin and psychiatric diseases can also be associated with celiac disease. Early diagnosis of this disease is essential for preventing complications such as gastrointestinal cancer.
How to detect Celiac
In most cases celiac disease is not suspected as it presents with vague symptoms, many of which are caused by other common conditions e.g., abdominal bloating which is associated with IBS.
It can be diagnosed by blood testing and a small intestinal biopsy taken during an Upper GI Endoscopy.
Blood testing is done to find out specific antibodies that are increased in celiac disease. These are 95% sensitive and specific. But these can come falsely negative in persons who have already stopped gluten.
For confirmation of celiac disease, an Upper GI endoscopy with a small intestinal biopsy is required.
Other tests like iron, vitamin B12, vitamin D, calcium, etc are done to see if there is an associated deficiency of nutrients. Importantly, diagnosis is easier if the disease is suspected.
Dietary modifications for Celiac
Celiac is a lifelong condition and the elimination of gluten is the only available treatment strategy.
Grains like wheat, rye, and barley are best avoided but it’s more difficult to eliminate them.
Since wheat is used in a variety of daily foodstuffs such as bread, biscuits, cereals, pasta, noodles, and even in sauces or gravies, it's a challenge to completely eliminate it.
To complicate things further, 'hidden gluten' is present in non-food sources such as lipsticks, toothpaste, play dough, topical cosmetics, etc.
Malt beverages including beer are not gluten-free either.
Gluten-free foods are almost two to three times more expensive than regular gluten-containing foods.
Foods such as oats, rice, corn, fruits, vegetables, meat, etc. can be added to the diet safely. However, dietary advice from a dietician is most essential and recommended.
Patient education and awareness along with family counselling about the disease and dietary modifications is helpful to deal with the condition.
Treatment
Compliance with a gluten-free diet is the cornerstone of treatment.
As gluten-free diet contains a lesser amount of iron, calcium, and certain vitamins, appropriate supplementation of nutrients is required.
Most patients usually recover within two weeks of a gluten-free diet with near resolution of symptoms.
However, there may be instances of weight gain initially as the absorption of nutrients including fat is increased.
Patients who are put on a gluten-free diet need to be checked twice yearly for ensuring compliance with a gluten-free diet.
Blood tests help in the identification of adequate compliance to a gluten-free diet.
Upper GI endoscopy with small intestinal biopsy is repeated after two years to see if there is disease resolution at the microscopic level or not.
Overall, Celiac disease is a lifelong disorder which can gradually lead to damage to the small intestinal lining subsequently causing various clinical manifestations.
Adhering to a strict gluten-free diet may lead to quicker resolution of symptoms so the individual can lead a normal healthy life.
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