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Journalism of Courage
It’s a condition where an individual is intolerant to gluten — protein found in cereals like wheat, oats, barley, rye. In India, awareness is still limited, food options restrictive and food labelling inadequate, writes ISHI KHOSLA
What is food to one is bitter poison to another.” Roman philosopher Luceritius had stated this centuries ago. Celiac disease cannot be described philosophically any better. With million metric tonnes of wheat grown and eaten, it is the world’s most consumed grain, yet it puts millions of humans at risk of illness.
Celiac disease is a condition where an individual is intolerant to gluten for life. Gluten is a protein found in cereals like wheat, oats, barley, rye and a few others. This may sound simple, but it is not so in reality — if we look at both the diagnosis of this condition and its management, particularly in our country at present. This is because awareness about this condition is still limited, food options restrictive and food labelling inadequate.
The disease occurs globally, has no socio-economic boundaries and can occur at any age. As much as 25 per cent cases are diagnosed in patients after they have crossed 60 years of age.
Eating foods with gluten causes an immune reaction in the small intestine that can damage its lining and lower the absorption of essential nutrients, leading to mal-absorption and nutritional deficiencies.
Typical symptoms of celiac disease include diarrhoea, gastrointestinal disturbances like abdominal distension, flatulence, pain, constipation, nausea, vomiting, growth problems, stunting and anaemia, though not everyone complains of all these problems. In fact, only 50 per cent cases may report with diarrhoea. Other symptoms include weight loss, lethargy, tiredness, bone problems like osteoporosis and cramps, skin problems, infertility, mouth ulcers, numbness and behavioural problems like depression, anxiety, irritability and poor school performance. The absence of typical symptoms makes the diagnosis difficult and often leads to life-threatening diseases.
People with hidden celiac disease are more in danger as they are at a higher risk of developing severe form of malnutrition, non-specific ill health, which can prove fatal if remain unnoticed. Celiac disease can increase the risk of disorders like Type-1 diabetes mellitus, autoimmune diseases, liver diseases, thyroid disorders, pulmonary diseases such as asthma, ulcerative colitis, Crohn’s disease as well as cancer.
Diagnosis can often be overlooked and many patients have been considered for growth hormone therapy for short stature, or been through rounds of hospital admissions due to debility and ill health, and even put on anti-tubercular treatment for unexplained diarrhoea and weight loss, only to worsen their condition.
Diagnosis is done using serological markers (blood tests) and endoscopy. Correct diagnosis is imperative.
Celiac disease is certainly more common than previously appreciated— fairly common in the West, with one in 100 people in Europe and one in 133 people in the US suffering from the disease. Data in India is still not available, but according to projections it is estimated that there may be at least 4 million celiac disease cases in India.
Celiac disease is a permanent condition and requires life long strict restriction to gluten, along with nutritional supplements to correct deficiencies. Gluten-free diet usually helps restore normal health.
Living with celiac disease in developed countries is easier as food labelling is better, conveniently packed food is available and restaurants and fast foods provide gluten free choices. The same however is not true for India, so far.
The writer is Director, WholeFoods
The disease
* It is a hereditary condition, in which a protein called gluten damages the small intestines. This causes inability to absorb food, vitamins and minerals. It gradually leads to serious illness, malignancies and can be fatal
The symptoms
The disease can present wide-ranging symptoms. Some typical symptoms are:
* Anaemia (low haemoglobin)
* Vague gastrointestinal complaints—hyperacidity, reflux, bloating, diarrhoea, constipation
* Lactose intolerance
* Mouth ulcers
* Low energy and chronic fatigue
* Short stature and growth failure
* Loss of weight
* Joint pains
* Osteoporosisosteopenia
* Itchy skin, blistery rash, eczema
* Depression, psychiatric disorders like Schizophrenia
* Ataxia (unstable balance and jerky movements)
* Many may not have anaemia, gastrointestinal symptoms or weight problems
* A person need not present all of the above symptoms. In some, these symptoms can be mild or silent or atypical
* If undiagnosed, it can lead to autoimmune diseases — thyroid, multiple sclerosis, lupus, liver disease, alopecia, fibromyalgia, rheumatoid arthritis, Type-1 diabetes. Other problems are osteoporosis, epilepsy, migraines, infertility, schizophrenia, depression, malignancies like adenocarcinoma, oesophageal cancer, on Hodgkin’s lymphoma, melanomas, thyroid cancer.
The treatment
* Celiac disease is completely manageable with strict gluten-free diet. This has to be a lifelong discipline, both while eating at home and outside. Due to better awareness of the disease in western countries, there are more options for the patients. There are also many food companies who are dedicated to making ‘gluten free foods’. As the awareness in India is still in its infancy stage, most people diagnosed with the disease may find it difficult to get gluten-free diets. Regular follow-ups with physician, nutritionist, blood tests and biopsies are recommended
The cause for worry
Celiac disease is a significant medical condition often masked or mistaken for other diseases. Celiac disease is a huge iceberg, moving not so silently, across many of our lives.
