By Punya Srivastava
Weakness? Diarrhea off and on? Abdominal pain? Progressive weight loss? You could be suffering from celiac disorder, a condition difficult to diagnose and hard to treat, says Punya Srivastava
Apart from dietary changes, a little shift in shopping habits would also help in going a long way to keep you gluten-free.
• The simplest way to be sure of the safety of ingredients while following a gluten-free diet, is to buy fresh foods.
• When shopping, carry your list of gluten-free ingredients and additives for ready reference when in doubt.
• Do not stop checking labels, even on foods you have been buying regularly, as there may be some ingredient changes.
• For dressings, look for non-malt vinegars, wine, rice, or balsamic, or simply make do with lime.
Nothing beats the taste of a thali meal served with straight-off-the-tawa rotis greased lavishly with ghee, or a plate of delicious chhole accompanied by king-sized, fluffy bhaturas. We North Indians cannot do without wheat. Be it roti, phulka, paratha, puri, naan, bhatura or an assortment of breads, cookies or other bakery goodies, wheat is rarely missing from our cuisine.
However, Anoop Bhatia, Assistant Vice President in ICRA and a true blue UPwalah from Moradabad who loved his rotis and parathas, has bid goodbye to wheat since 2008 – the year he was diagnosed with Celiac Disorder (CD). “I was shocked to be diagnosed with CD, having never heard of it before. Being a North Indian, I found it hard to believe that wheat could be the reason behind my dubious digestive health. I had been eating it all my life!” he exclaims.
Celiac disorder (or disease) is an autoimmune disease that affects the finger-like microscopic organs called villi lining the walls of the small intestine, causing it to inflame when gluten is digested. Gluten, a protein found commonly in grains including wheat, oats, barley (also in rye, triticale, and spelt, though not grown in India) damages the small intestine, reducing the nutrient absorption capacity of the system, in turn leading to many complex digestion-related issues.
What, how and why
CD is a bit difficult to diagnose, as its symptoms are quite common with other stomach-related diseases. They can range from mild weakness, bone pain, and aphthous stomatitis to chronic diarrhea, abdominal bloating, and progressive weight loss.
“I had recurring digestion-related problems along with fatigue and abdominal pain,” says Anoop. It all started around April 2008 with a phase of continuous stomach-related problems – the worst period of his life, according to him. His condition was misdiagnosed as Irritable Bowel Syndrome (IBS). It was only in September that year that he was asked to undergo a biopsy by a gastroenterologist at Sir Ganga Ram Hospital in Delhi, and was declared a celiac.
In the case of 10-year-old Tanisha (name changed), a patient of celiac disorder, the diagnosis was much more difficult. “She was only four when the first warning bell rang. Her hemoglobin level dipped alarmingly to 6.5. Prior to that, she would have prolonged bouts of diarrhea since she was two-and-a-half or three,” shares her mother, Dr. Juneja, adding, “We put her on iron supplements but within a year her condition returned. Meanwhile, she had started her mainstream schooling. It was then that we were referred to gastroenterologist Dr. Sarath Gopalan who immediately prescribed the CD test. Tanisha underwent a TTG (blood test to evaluate auto-immune disorders) followed by an endoscopic biopsy and was diagnosed suffering from celiac.”
Anoop Bhatia: Glutenfree and healthy The cause for CD is unclear and there are no simple answers. It is clearly a complex interaction of genetics and the environment. Some specific genes have been identified and some are yet to be identified. “After my diagnosis, my whole family underwent tests and my father was found to be a celiac too. So in my case, genetics is the cause, I believe,” says Anoop. On the other hand, no one in Tanisha’s direct family line was found to be wheat allergic, let alone b eing celiac. “We don’t know the real cause but I believe a very brief period of breast feeding and early introduction of wheat Cerelac in her diet (she was between six to eight months old then) might have caused the condition,” says Dr. Juneja who was a working mother – a practicing doctor – then.
Glutenfree options: rice roti, ragi bread and bajra chakli Some of the environmental risk factors associated with the development of celiac disease, particularly in children, include absence of breastfeeding, repeated infections, and early introduction of cow’s milk, wheat, and eggs. The type of wheat being consumed today is also believed to be genetically different from the one in earlier times, and has been implicated as a probable cause for increasing prevalence. In India, only a small proportion of patients with celiac disease are diagnosed on clinical grounds. According to Gayatri Chatrath, Secretary, Celiac Society for Delhi, “Today CD is not rare with 1-2 per cent of population suffering from it; nor is it a childhood disease, as a majority of cases are being picked up between 40 to 60 years of age. Nearly 25 per cent cases are diagnosed in individuals over 60 years of age. The disease occurs globally, has no socio-economic boundaries, and can occur at any age.” In our country, the prevalence of celiac disease is certainly more common than earlier, and since it is largely an undiagnosed condition; the real numbers may be much larger.
What can I eat?
CD certainly affects the lives of the patient as well as his/her family. The only cure it has is to stay away from wheat and wheat products, sticking strictly to the prescribed glutenfree diet. “Tanisha used to carry her tiffin box to her friends’ birthday parties. It was natural for her to get upset over such restrictions, being such a young kid. I used to feel bad about it. Then, I learnt to turn a wheat-restricted diet into a fun diet, and she learnt to adapt to newer tastes. It helped tremendously that she was young, and had not developed a strong liking for any particular taste. It became easy for us to take wheat away from her diet,” shares Dr. Juneja. CD turned Dr. Juneja into a master chef dishing out innovative, glutenfree dishes, like various types of pasta for her child. “Seeing her friends bring burgers in their lunch boxes, Tanisha used to ask for them too. I had to figure out a way to fulfill her demands. I used to make idlis, slice them into halves, and stuff potato tikkis in between, along with different chutneys. She loved her innovative burgers,” she adds.
Similarly, Anoop also found various other options after an initial brief period of being disheartened. “I have a fixed diet plan that I follow religiously,” he says, “My breakfast usually comprises glutenfree parantha, or a sabudana dish or rice-based items like an idli or a dosa. Moreover, I carry a packed lunch and evening snacks with me to avoid indulging in outside food items.” He, like the Junejas, bought home an atta-chakki to enjoy freshly made flour from jowar, bajra, makki, or sorghum.
On being asked whether CD had an adverse effect on him, Anoop chuckles. “No, I never asked, ‘Why me?’ However, I thanked God that I came to know about it. Many people discover it when too late. Yes, I have had my share of longings and temptations but not anymore. Now I am happy with my life, as I have discovered that a wheat-free diet is much better and healthier than the regular one. It keeps me away from all the junk food that would have gone in my system if not for CD,” he announces victoriously. Now he snacks on glutenfree cookies, biscuits and wafers available easily in organic shops. His father, also a celiac, finds it a bit difficult to access such options in a small town like Moradabad. For now, he makes do with homemade snacks like chana and rice puff mixtures, or munches on the goodies Anoop brings him on his visits.
However, CD does get in the way of enjoying a regular social life with so many restrictions. “Initially, people used to frown over my insistence on keeping Tanisha’s food contamination-free. I was very particular about using separate utensils, even separate kitchen cloths, while handling her food. Whenever visiting someone, I made sure that her food was not contaminated with other items; so much so that I did not even allow her to have a hing-tempered dal as it contains gluten. People used to think that we were making a mountain out of a mole hill. But seeing our seriousness, they started respecting Tanisha’s dietary requirements,” shares Dr. Juneja. Even better, her glutenfree food is a big hit among her friends! “I eat before going out for a social gathering and stick to fruit juices throughout the evening,” reveals Anoop. Earlier, he would feel bad about not getting to eat out of various dabbas during lunchtime. “Now, I have come to terms with my CD and treat it as a part of life. Just stick to your diet, do not give in to temptations and you will have no problem,” he adds. He credits Peter Greens and Rory Jones book, Celiac Disease: A Hidden Epidemic for making him understand his situation and highly recommends it to other celiacs as well.
Dr. Juneja advocates tightening the food-labeling laws in the country, just like in Australia, UK, and USA. “Earlier, shopping for glutenfree food was a nightmare. We had to source it from friends who visited abroad. Now, the situation is much better as they are available locally. In fact, many hotels like ITC Sheraton prepare glutenfree food when requested. However, my only grouse is that we still do not have food labels indicating gluten content. It should be dealt with stringently,” she adds.
According to Ishi Khosla, clinical nutritionist and Founder President of the Celiac Society for Delhi, “Awareness about the condition is limited. People often confuse celiac disease with wheat allergy. Wheat allergy and celiac disease are two different conditions. Celiac disease is only confirmed when both blood tests and biopsy are positive. In case, they are negative and you feel better without wheat, you are likely to be wheat intolerant and not celiac. Individuals with confirmed celiac disease are intolerant to gluten, a protein present in wheat and grains like barley, oats, and rye.”
In addition, the required amount of awareness about CD in the Indian health arena leaves a lot to be desired. Though we are waking upto the disease, there is a long way to go. In his article published in the Indian Journal of Medical Research, B S Ramakrishna, a professor of gastroenterology at Christian Medical College, Vellore, states that public authorities should examine infant feeding recommendations and wheat varieties cultivated in the country for finding ways to avert the epidemic of celiac disease.
Many organisations across the world as well as India have come up with public welfare schemes. Celiac Society for Delhi, formed in 2006, is quite instrumental in bringing together eminent practitioners in the field of medicine, education and the food industry to spread awareness about celiac disease. According to Anoop and Dr. Juneja, Celiac Society was their first guide to combating CD. Moreover, its Founder President, Ishi Khosla has come up with a book, Is wheat killing you? which aims to demystify the condition, and puts the condition in proper perspective by providing insights into gluten-free living. The book is a complete guide to gluten-free living, provides scientifically established principles of healthy eating, and includes essential facts about a balanced diet useful to everyone. So relax. There is life after wheat!
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