Celiac Disease

Celiac disease, also known as gluten-sensitive enteropathy, is an autoimmune disorder, characterized by sensitivity to gluten, a protein found in foods like wheat, barley and rye. An autoimmune disorder is when the immune system mistakenly attacks and destroys healthy cells in the body, by releasing antibodies. If a person has Celiac disease, the immune system releases antibodies against gluten. These antibodies attack the lining of the small intestine and also damages the villi, small finger-like structures, lining the small intestine. The villi are responsible for the absorption of vitamins, minerals and other nutrients from food. Damage to this part of the small intestine makes it difficult for the person to absorb the nutrients from food into their bloodstream which then makes them malnourished.

Apart from malabsorption, the damage to the small intestine can commonly cause weight loss, diarrhoea, bloating, fatigue and anaemia. The damage to villi is a slow process and may take approximately 2-3 years for the disease to manifest. Celiac disease can occur at any age but the onset is common during infancy and early adulthood and while some people are detected early in childhood, for some people, the detection is as late as in their 30s or 40s. The exact cause of the Celiac disease is still unknown but according to doctors, it is mainly genetically passed on and is hereditary, meaning that it runs in families.

Celiac Disease in India

According to Dr Deepak Goyal, Consultant, Gastroenterology, Institute of Digestive and Hepatobiliary Sciences, Medanta-The Medicity, the disease is most common in people living in Punjab, Haryana, Uttar Pradesh, Rajasthan and Bihar, which are typically wheat-eating states. The condition is accentuated in these states as genetic predisposition is combined with high wheat consumption; children are introduced to a wheat-based diet from the age of 4-6 months itself. These areas are now jointly called the Celiac belt. Dr Goyal reveals that in spite of growing numbers, there is early detection of the condition as doctors are now better trained to detect the disease, there are better lab facilities and parents are much more aware of the condition.

“It is important to know that once someone is detected with Celiac disease, it doesn’t make them a patient. For Celiac disease, one just needs to eat a diet that eliminates gluten, also commonly known as a ‘gluten-free’ diet,” he says.

What Are the Signs of Celia Disease?

The disease has various signs and may develop differently in adults and children.

Symptoms in Adults	Symptoms in Children
Diarrhoea	Chronic diarrhoea or constipation
Bloating and/or gas	Loss of appetite
Stomach Ache	Vomitting
Pale Stools	Swollen Belly
Fatigue	Headaches
Mouth Ulcers	Muscle Wasting
Muscle Cramps	Short Stature
Joints and Bone Pain	Irritability in Stomach
Dermatitis herpitiformis, a serious skin problem, that appears on the elbows, knees, and buttocks.	Growth and development problems like ADHD (Attention-Deficit/Hyperactivity Disorder) and muscle coordination
	Delayed Puberty
	Seizures

Parents should take their child to a doctor if diarrhoea lasts for more than two weeks or is recurrent. It is serious if the child has foul-smelling and bulky stools and a potbelly.

Treating Celiac Disease

There is no treatment available for Celiac disease but it can be managed by implementing a gluten- free diet. A doctor also prescribes some medications consisting vitamins, minerals and proteins to compensate for the need of required nutrients in the body, but only for a few weeks.

What is Allowed	What to Avoid
Rice, Soybean, Maize, Corn, and Oats	Wheat, Barley, and Rye
Fruits and Vegetables	Sooji or Semolina and Refined flour
Eggs and Meats	Bread and Pastries
Oil, Ghee, and Butter	Chhole Bhature, Burger, Pizza, Noodles, and Pasta
Pulses

*It is advised to consult a doctor or dietician for a diet plan and choose food items correctly.

How Can a Gluten-Free Diet Help?

Once someone adheres to a gluten-free diet, it repairs the villi and the symptoms disappear. One has to live forever with the condition which means they can never have gluten in their diet.

“Food and beverage which has less than 20 parts per million (ppm) amount of gluten is allowed. This works out to be 20 milligrams of glutinous elements, per kilogram of food. Anything beyond that can trigger problems,” adds Dr Goyal.

Complications of Celiac Disease

Malabsorption is a factor that triggers other problems in people with Celiac disease.
-In general, it can cause anaemia (due to Iron and Vitamin B 12 deficiency) and weight loss.
-In women, malabsorption of calcium and Vitamin D can cause reproductive issues like infertility and miscarriage.
Calcium and Vitamin D deficiency can lead to osteoporosis (loss of bone density) in adults and rickets (soft and weak bones) in children. Children can also have growth problems and short height due to a lack of proper absorption of nutrients in the body.
Neurological disorders like seizures can occur.
Peripheral neuropathy, a disease where the nerves are damaged, causing weakness and numbness mainly in the hands and feet, has been linked to Celiac disease.
Some people can become lactose intolerant due to Celiac disease. While some can start consuming dairy products with proper management of Celiac disease, some continue to remain lactose intolerant.
Though rare, not following a gluten-free diet sometimes causes small bowel cancer and intestinal lymphoma (lymphoma is a type of blood cancer that mainly develops in the lymph nodes).

Points to Remember

Be a good label reader. This will help detect gluten in food items such as chips and certain nutritional, vitamin and herbal supplements. Some non-food items with a possibility of gluten include toothpaste, lipstick, lip balm and some medications.
It is important for parents to regularly monitor the weight and height of children with Celiac disease.
Talk to a doctor before adopting a gluten-free diet.
Visit a doctor if a first-degree relative already has Celiac disease.

Medanta Medical Team