BEING GLUTEN INTOLERANT

Ishi Khosla

There was this chubby child in my family. When he was three, we noticed he had become very picky about eating. He would only want to eat sweet and soft food. His paediatrician was dismissive of our concerns as growth seemed normal. By the time he was seven, we noticed he did not have much energy for playing, was crabby all the time, and had dark circles under his eyes.

This went on for some more years. When he turned 11, I asked his paediatrician, why we weren’t considering the probability of celiac disease. He called me crazy. This was 1998. We got basic tests like the ‘anti-gliadin’ and ‘anti-gluten’ antibodies done. The results were positive. But paediatricians dismissed these as non-specific. One referred me to a psychiatrist!

The kid was still not gaining weight despite subsisting on meethi roti, chocolate shakes and butter. The doctors were dismissive because there were no regular symptoms like diarrhoea and there was no awareness about secondary symptoms.

We consulted many super specialists, there was even an AIIMS researcher working on celiac. Not a single expert was ready to confirm. The mother had become desperate by then. I advised her to quietly stop giving him wheat. The boy was in Class X by that time. One day, his tuition teacher called, wondering if he was taking extra classes. “Because he is paying a lot of attention and is very different in the class now.”

In 2001, I got a celiac patient with the same issues in my clinical practice and we got to know about new tests with 99.9 per cent reliability. These, too, were positive. The gastroenterologist still recommended an endoscopic biopsy, which confirms gluten intolerance. The confirmation was almost a relief, marking the end of a 14-year struggle for the family just for an accurate diagnosis.

For me, a major lesson was that despite anaemia, digestive disorders and malnutrition being major public health problems, even experts were not aware about the root cause and how many people will remain undiagnosed or are misdiagnosed.

That prompted me to set up the Celiac Society of Delhi in 2006 that was later expanded to the Celiac Society of India. Many experts who had denied us are members now. My book, ‘Is Wheat Killing You?’ (2011), made it to the press only after the editor’s friend’s daughter was discovered with celiac. We have been working to create awareness among people and experts alike.

‘Celiac triggered Diabetes’

Delhi-based Shruti (22) was diagnosed with celiac disease five years ago. “She lost 7-8 kg in a month and had become very weak,” recalls her mother. “When we got her blood work done, her HbA1c levels were extremely high. She was admitted to a hospital immediately and put on insulin. Celiac had triggered the type-1 diabetes.” Shruti has been on a gluten-free diet since and has to daily check her sugar levels and take insulin injections to keep her sugar levels in check. Lactose foods have also been banned.

COMMON SIGNS & SYMPTOMS

Recurrent digestive complaints such as bloating, gas and/or stomach cramps, diarrhoea, constipation

Liver dysfunction

Mouth ulcers

Lack of appetite, growth failure, weight loss

Unexplained fatigue

Difficulty in losing or gaining weight

Flattened nails, easy bruising

Anaemia (iron deficiency)

Frequent headaches or migraines

Bone & joint pain, easy fractures

Infertility

Recurrent miscarriages

Giddiness and imbalance

Epilepsy

Numbness, tingling sensation

Depression, anxiety

Poor attention span

Itchy, blistering rash

Eczema, psoriasis, unexplained contact dermatitis

At risk, if diagnosed with any of these

Irritable bowel syndrome

Fibromyalgia (musculoskeletal pain with fatigue, sleep, memory and mood issues)

Chronic fatigue syndrome

Nervous stomach (non-ulcer dyspepsia)

Lactose intolerance

Osteopenia or osteoporosis

Autoimmune disorders

Thyroid disease (hypo/hyper)

Diabetes mellitus (type 1)

Sjgren’s syndrome

Chronic liver disease

Peripheral neuropathy

Non-Hodgkin’s lymphoma

Small intestinal cancer

Psychiatric disorders or depression

Causes

Celiac is caused by a complex interaction of genetics and environment. Some of the associated environmental risk factors, particularly in children, include repeated infections and early introduction of cow’s milk, wheat, and egg. The intake of processed foods and toxic chemicals in food and environment may be behind the rising numbers in India that have incresed four times since 1974.

Risks: Celiac disease increases the risk of diabetes, thyroid disorders, liver diseases, asthma and certain types of cancers. The intake of genetically different wheat contributes to disabilities such as autism, ADHD, schizophrenia, ataxia, epilepsy, migraine, etc.

Celiac disease & non-celiac and wheat sensitivity

Celiac disease: It is an autoimmune disorder. The body cannot tolerate gluten, a protein found in grains, including wheat, oats, barley, rye, etc. Eating even a small amount of gluten damages the small intestine and reduces the body’s ability to absorb food. A lifelong, strictly gluten-free diet helps in recovery.

Non-celiac gluten sensitivity (NCGS)/gluten intolerance: Symptoms are similar to celiac disease. NCGS begins with dysbiosis (imbalance) and a leaky gut. The risks are similar to celiac disease. It’s not an auto-immune problem but can lead to auto-immunity.

Wheat allergy: Body’s immune system overreacts to wheat. It can be life-threatening. However, unlike celiac disease, this immune response can be temporary. A wheat allergy does not cause continuous harm to the intestine unless it leads to an anaphylaxis reaction (life-threatening reaction that can cause the body to go into shock). Wheat allergy can be outgrown, unlike celiac disease and gluten intolerance.

— The writer is a clinical nutritionist

(As told to Renu Sud Sinha)