Gluten Intolerance And Its Dietary Approach
Gluten Intolerance or Celiac Disease (CD) is an autoimmune disorder occurring in a genetically susceptible host, triggered by ingestion of wheat, barley and rye whose gluten/prolamines, peptides result in enteropathy and varied symptoms affecting multiple organs of the body. One percent of the population is affected by the disease. For any symptomatic case there are nine asymptomatic cases in the community, thereby indicating a very high load of the disease, especially reported from North Western States of India. The clinical presentation of the disease is protean affecting multiple systems of the body such as gastrointestinal tract, liver, endocrine, hematology, reproductive, musculoskeletal and CNS. The clinical picture depends upon the dominant involvement of the particular system. The disease earlier used to be characterized by chronic diarrhea, anemia and failure to thrive but is now largely replaced by an atypical presentation.
The high index of suspicion to think of celiac and the investigations are rewarding. The diagnosis of celiac diseases is based upon modified ESPGHAN criteria which include the clinical picture, duodenal biopsy showing villus atrophy and then the response to gluten free diet. Now, especially in tropical countries, the added advantage of positive celiac serology further confirm the diagnosis. After the intake of GFD, the serology shows a decline. The advantage of early diagnosis is to avoid the long term complications like stunned growth, rickets, osteoporosis and primary sterility.
The harmful effects of various food items available in the market should be explained to the patient and family. Most of the readymade food items in our country contain wheat flour or refined flour. The maida is often used in bakery products and other items to make the cooking materials sticky. The mixing of other cereal flour during grinding in mills should be explained to them and they should be encouraged to use their small electric atta chaki at home. This is useful to prepare the gluten free atta/besam for the whole family. The individual has to avoid outside food items especially bakery products, sweets, candies, chocolates. Various recipes made from cereals like rice, maize, jowar, bajra, all kind of pulses, besan, soybean Atta and milk products should be taught.
- Read labels of food while purchasing them from markets.
- Gluten free products available in the market are not so reliable, hence ensure before buying. International gluten free products can be used safely.
- Do not eat anything about which you are not sure
- Even occasional intake of small quantity of gluten is harmful.
- All item should be prepared at home to make food 100% safe.
- If milk or any other food creates any allergy it is better to avoid it for the time being.
The treatment of CD lies in the hands of the whole family to ensure compliance to GFD and follow up in celiac disease clinic to monitor at regular intervals. The disease is life-long, so 100% compliance to GFD for one’s whole life and monitoring growth, hemoglobin are mandatory. Any breach in the compliance can be picked and timely corrective measures can help to avoid long term complications.
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