GLUTEN INTOLERANCE- SIGNS, SYMPTOMS AND ASSOCIATED CONDITIONS

Gluten Intolerance is an impending epidemic in India.  According to Dr. Wadhwa of Sir Ganga Ram Hospital, Delhi, every 3 to 5 of 100 children in India are suffering from gluten intolerance. But this disorder is not confined to children only. A lot of adults  who had been eating gluten all their lives without any ill effects are being diagnosed for gluten intolerance for various health disorders. According to a report published by TOI, about 16% of the Diabetics (298 children and 318 adults) who were screened for gluten sensitivity at NIMS, Hyderabad were tested positive for celiac sprue/ celiac disease / gluten intolerance.

One of the reasons why more and more people are being diagnosed for gluten intolerance nowadays is that  the tests for gluten allergy have been introduced in our country just a few years back. Due to the lack of specific tests in the past the problem had remained undiagnosed and treated for something else.

Even today 99% of people with gluten allergy are not aware of their condition and blame their ill health or symptoms on something else.

More than 300 symptoms of gluten intolerance have been documented. However, these symptoms and their manifestation vary from one individual to another.

Listed below are the symptoms and conditions associated with gluten intolerance/ sensitivity. If you have any of the subsequent symptoms or suffer from any the conditions mentioned below it could be a sign that you are suffering from gluten intolerance.

• Digestive issues like gas, bloating, nausea, diarrhea, constipation, vomiting, abdominal pain, heartburn, gum bleeding, lactose intolerance, steatorrhea, gastric ulcer, irritable bowel syndrome, defective tooth enamel, unexplained bleeding, cow’s dairy intolerance, Crohn’s disease, gastrointestinal occult bleeding (blood in stools not visible to naked eyes).

• Disorders of skin, hair and nails like alopecia areata (patchy hair loss), alopecia (balding), thinning of hair, eczema, dermatitis herpetiform, nails with white spots, nails with rounded and curved down ends- dark and dry, psoriasis, follicular hyperkeratosis, scleroderma, seborrhea, vitiligo, itchy skin rash.

• Disorders of glands like autoimmune hepatitis, autoimmune thyroiditis, Addison’s disease, grave’s disease, Type 1 Diabetes, non-alcoholic fatty liver disease, idiopathic hypoparathyroidism, pancreatic insufficiency.

• Disorders of muscular system like muscle weakness, muscle wasting, muscular pain and tenderness, muscle spasm and cramps,  severe potassium deficiency, tetany, polymyositis, osteomalacic myopathy.

• Disorders of Nervous System like anxiety, depression, epilepsy, tremors, dementia, chronic fatigue syndrome, ataxia, multiple sclerosis, irritability, insomnia, inability to concentrate, frequent headache, migraine.

• Reproductive issues in females like amenorrhea (loss of menstrual period), infertility, dyspareunia (painful intercourse), early menopause, pre- menstrual syndrome, late menarche (late start of menstrual periods), vaginitis, dysmenorrhea (painful periods).

• Reproductive issues in males like infertility, impotence, sperm abnormalities, hypogonadism.

• Chromosomal Disorders like Down Syndrome and Turner Syndrome.

• Child Development issues like autism, developmental delay, hyperactivity, growth retardation, delayed puberty in boys and girls, rickets, iron deficiency anemia that is unresponsive to iron therapy, glycogenic acanthosis, hypotonia, impaired penicillin V absorption.

• Disorders of kidney and urinary tract like frequent urinary tract infection, hypercalciuria, IgA nephropathy.

• Disorders of sensory system like blurred vision, loss of taste, loss of smell, cataract.

• Disorders of pulmonary system like non- response to tuberculosis treatment, bronchial pneumonia, bronchiectasis.

• Disorders of immune system like IgA deficiency, chronic urticaria (hives), asthma, hay fever, sarcoidosis, Sjogren’s syndrome.

• Cognitive issues like hallucinations, delusion, disorientation, poor memory, scattered thinking, reduced learning, slow thinking, confabulation.

• Blood test abnormalities like folic acid deficiency anemia, iron deficiency anemia, vitamin B12 deficiency anemia, elevated liver enzymes, elevated homocysteine levels;  low levels of zinc, phosphorus, calcium, magnesium, copper, and potassium;  prolonged prothrombin time,  low levels of plasma proteins in the blood, elevated bone alkaline phosphatase enzyme, haemochromatosis, neutropenia.

• Skeletal symptoms like osteoporosis, psoriatic arthritis, recurrent monoarthritis, enteropathic arthritis, bone pain.

Having any of the above symptoms does not necessarily mean that you are gluten intolerant.  As mentioned above, that the manifestation of symptoms of gluten intolerance vary from one individual to another. So if your body is not responding to any of the treatment as prescribed by your doctor for any of the above symptoms or if you are experiencing multiple symptoms from the above list it could be a sign that you are gluten intolerant or gluten sensitive.

Try a gluten elimination diet (100% elimination) for at least 3 weeks and then reintroduce it.  If you feel significantly better on a gluten free diet or feel worse when it is reintroduced it is likely that gluten is the cause of your problem.

Also note, that many of the symptoms mentioned above have recently been diagnosed. Hence, many doctors still do not link gluten with the above conditions.

HOW GLUTEN AFFECTS YOUR BODY

As discussed in the earlier post, Gluten is a protein composed of gliadin and glutenin and is found in cereal grains like wheat, barley, rye and triticale. This gluten can play havoc in the intestines of individuals who lack certain enzymes (tissue transglutaminase- tTG) necessary for breaking down gluten into its constituent proteins i.e gliadin and glutenin.

As the food passes through the digestive tract, the gastrointestinal immune system of susceptible individuals identifies gliadin as a foreign substance and starts producing antibodies against it.  These antibodies not only attack gliadin but they also attack tissue transglutaminase enzyme and cause damage to the microvilli of the small intestine which eventually atrophies and erodes. 

The main function of microvilli in our body is to absorb nutrients through the intestinal wall. However, in gluten-sensitive or intolerant individuals, their this ability of absorbing nutrients is highly decreased. This results in a host of problems like malnutrition, diarrhea, constipation, etc. This flattening of microvilli is a distinctive feature of celiac disease, an autoimmune disorder.

Unfortunately, the action of these antibodies is not restricted to tTG alone, they may also attack any other organ or system in the body like head, skin, pancreas, thyroid etc. leading to a host of other autoimmune disorders. 

CHICKEN SALAD

A low calorie, easy to prepare, a colourful nutritious salad rich in antioxidants, fiber and many other vitamins and minerals.     
Preparation Time: 30 minutes     

Cooking Time: 15 minutes

Serves: 2

 Tags: gluten free, dairy free, egg free, soy free,

INGREDIENTS

Boneless Chicken, thinly sliced	1 cup
Fresh pineapple pieces	½ cup
Fresh Red Capsicum, chopped	1/8  cup
Fresh Green Capsicum, chopped	1/8 cup
Corn kernels, boiled	¼ cup
Homemade Garlic Paste	¼ tsp
Apple Cider Vinegar	¼ cup
Salt	To taste
Black Pepper Powder	To taste
Oregano	¼ tsp
Olive Oil	¼ tsp

METHOD

•          Marinate the chicken pieces with 1 tsp vinegar, garlic paste and salt and set it    aside for 30 minutes.
•           Heat oil in a non-stick pan and place the marinated chicken pieces on it. Cook  on both sides till the chicken is slightly browned and tender.
•          Transfer the chicken to a bowl and add chopped green capsicum, red  capsicum, and boiled corn kernels to it. Mix well.
•           For the dressing, heat the remaining vinegar in pan and add salt and black  pepper powder to it. Bring to boil and simmer over medium heat 1-2 minutes.
•           Remove from fire and mix in oregano.
•           Pour this dressing over the salad, mix lightly and serve.

Being a Nutritionist, I come in contact with a lot of people, both children and adults, who show adverse reactions on the consumption of gluten. Some of these have eaten gluten all their lives without any trouble, but now their body is reacting to it negatively. Many of these people are not celiac/ gluten intolerant. They do not even test positive for gluten allergy nor do they show any associated signs or symptoms. Yet these people show tremendous improvement when gluten is eliminated from their diet.

My main purpose of starting this blog is to educate people regarding the ill-effects of gluten. Unlike many, I am not of the opinion that gluten must not be consumed by anyone but I strongly believe that if you are suffering from any of the conditions or signs and symptoms I will be mentioning in my blogs you must get yourself tested for gluten immediately and even if the results are negative, try eliminating gluten from your diet completely for at least 3 weeks and see if there is any difference. If yes, then this means you are gluten sensitive continue with this diet, else revert back to your previous diet. Also, I would like to mention over here that for many of these conditions the role of gluten has not yet been scientifically proven. The studies are still going on in this field and due to the absence of scientific data for most of these conditions doctors do not recommend a gluten-free diet. But  since a large number of people have reported improvement in their condition after following a gluten-free diet, the role of gluten for the condition cannot be ruled out.

Also in my counselling sessions I have noticed that a number of people who had been following a gluten-free diet for months are not fully aware of all the precautions that they must be taking while following this diet and hence even after following the diet for months they have not yet seen any improvement in their health condition. People are also not aware of the various gluten-free alternatives that are available in the market nowadays, nor do they know from where they can buy these stuff.

This blog aims to give you complete information on gluten, gluten free diet, do’s and dont’s, gluten-free alternatives, gluten free stores, gluten free cooking tips, recipes, etc. In short, everything you need to know about gluten and gluten-free living will be covered here.

Following a gluten-free diet is not very difficult. It's only about making a few changes in your lifestyle. Also, if taken care of in the early years, the problem can be completely reversed and you can get back to your normal lifestyle.

GLUTEN – WHAT IS IT??

Gluten is a protein that is present in the endosperm of cereal grains viz. Wheat, barley and rye and is not found in the young  grasses that sprout from its seed.

It is composed of two different proteins:  gliadin and glutenin. Gliadin is responsible for elasticity whereas glutenin gives toughness to the gluten. The two proteins (gliadin and glutenin) when combined in the presence of water along with mechanical action form a tough elastic complex known as Gluten.

 True Gluten is sometimes referred to as being specific to Wheat, gluten is often considered to be a part of other cereal grains like rye, barley, triticale (hybrid cereal obtained from a cross breed between wheat and rye).

Gluten is present in a wide variety of processed foods that we consume daily like pizza, pasta, cakes, muffins, pastry, chips etc. Gluten helps with the rising of bread and other baked products while also adding to the texture and chewiness.  The elastic nature of the gluten makes it possible for it to be easily rolled into chapatti. It can also be used as a thickener, binder, stabilizer, flavour enhancer and protein supplement.

It is often present as a hidden source in beer, soy sauce, ketchup, ice cream and many other food products.

It is also used in shampoos, cosmetics and other dermatological preparations.