A fight against celiac disease

Health alert

Celiac disease, an allergy to gluten, a protein contained in wheat and barley, is being increasingly reported from India. Recent studies from North India suggests that the incidence is high and considered almost endemic for this disease.

Despite such high incidence facilities for early diagnosis and management of this lifelong disease remains woefully inadequate largely because of lack of awareness regarding the disease and also because of any legislative action to ensure food labelling and availability of gluten-free foods in the market.

Till late eighties, celiac disease was considered rare in our country. However, many studies, including the most recent multi centric study carried by ICMR, have shown that the disease affects a significant number of individuals. In India incidence of celiac disease is rising and more prevalent in the Northern part of the country due to the high consumption of wheat and barley by the people. Gluten-free packaged foods frequently contain a greater density of fat and sugar than their gluten-containing counterparts which may lead to deficiencies in vitamin B, folate and iron, given a lack of nutrient fortification of many gluten-free products.

Recognising the need to create awareness on celiac disease, an increasingly recognized condition among Indians, Indraprastha Apollo Hospitals in association with the Celiac Support Organization conducted a session on ‘Lesser known facts on celiac disease’.

Taking the awareness drive a step forward, Indraprastha Apollo Hospitals joined hands with Hope and Helping Hand Society and Celiac Support Organization to organise a marathon for celiac awareness recently at Jawaharlal Nehru Stadium in the city. Dr Anupam Sibal, group medical director, Apollo Hospitals Group, senior consultant pediatric gastroenterologist and hepatologist, Indraprastha Apollo Hospitals shares some extensive measures and tips to combat the disease which may effect any age group. 

Symptoms: Infants and children with celiac disease tend to have digestive problems. Common symptoms for infants and children include:
Growth problems
Decreased appetite and failure to gain weight
Chronic diarrhoea, which can be bloody
Chronic constipation
Vomiting
Abdominal bloating and pain
 Fatigue
 Irritability

The only known treatment for this disease is life-long adherence to a totally gluten-free diet. The diagnosis requires a simple blood test and an endoscopy and is easy to make. An early diagnosis can help prevent significant stunting and severe malnutrition. There is a lot of research effort going on to find a specific cure for this disease.

Here are some healthy tips to follow:

Avoid all foods made from wheat, rye, and barley. Examples are breads, cereals, pasta, crackers, cakes, pies, cookies, and gravies.

Ask your doctor about oats. Some patients with celiac disease can tolerate oats in the diet. But long-term safety of oats in celiac disease patients is unknown, and some oat preparations can be contaminated with wheat. Thus, it is probably best to avoid oats at least during the initial treatment with a gluten-free diet. Once the disease is in remission with a strict gluten-free diet, it may be possible to reintroduce small quantities of oats into the diet under medical supervision.

Beware of tablets, capsules, and vitamin preparations that contain gluten. Wheat starch is commonly employed as a binding agent in tablets and capsules. Gluten also can be found in many vitamin products, and cosmetic products such as lipstick.

Avoid beer but wine, brandy, whiskey, and other alcohols without barley are fine in moderation.

Avoid milk and other dairy products that contain lactose. Untreated patients with celiac disease often are lactose intolerant. With successful treatment, dairy products can often be reintroduced slowly into the diet later.

Consult dietitians and national celiac disease societies for lists of gluten-free foods. Read the food and product labels before buying or consuming any product. This is necessary, because a manufacturer may change a product's ingredients at any time. A product that was gluten-free in the past may now contain gluten. Even branded products may be gluten-free in one country but contain gluten in another country. If one is not certain after reading the labels, call the manufacturer.