|
You can get e-magazine links on WhatsApp. Click here
|
|
|
Gluten-free foods
|
Tuesday, 03 March, 2015, 08 : 00 AM [IST]
|
Rashmi H Poojara
|
fiogf49gjkf0d Gluten is a protein found in wheat, rye, barley and all foods that are made with these grains. When people with celiac disease eat gluten their body mounts an immune response that attacks the small intestine. These attacks lead to damage of villi, small finger like projections that line the small intestine, that promote nutrient absorption. When the villi get damaged, nutrients cannot be absorbed properly into the body.
When someone with celiac disease eats food containing gluten, their body reacts by damaging the small intestine. Uncomfortable symptoms such as abdominal pain often occur. The damage to the small intestine also interferes with the body's ability to make use of the nutrients in food. Left untreated, celiac disease can lead to additional serious health problems. These include the development of other autoimmune disorders like type I diabetes and multiple sclerosis (MS), dermatitis herpetiformis (an itchy skin rash), anaemia, osteoporosis, infertility and miscarriage, neurological conditions like epilepsy and migraines, short stature, and intestinal cancers. The histologic findings of celiac disease, that is, gluten-sensitive enteropathy (GSE), are dominated by increased intraepithelial lymphocytes, villous blunting, lymphoplasmacytic infiltration of lamina propria, and crypt hyperplasia.
The classical presentation of celiac disease, with symptoms referable to the gastrointestinal tract, may account for only a proportion of the cases. We now realise that celiac disease is actually a multi-system disorder which is highly variable in its clinical expression, may occur at any age, and may present with a variety of manifestations5. The diagnosis is often delayed for these reasons. Gastrointestinal manifestations may include diarrhoea, weight loss, failure to thrive, stunting, abdominal pain, bloating and distension, anorexia, vomiting and constipation.
Meanwhile, celiac disease patients are often present with extraintestinal manifestations with minimal gastrointestinal symptoms. They may present to the internist or relevant sub-specialist with one or more manifestations including iron deficiency anaemia, stunting, osteoporosis, vitamin deficiencies, or fatigue. They may present to the obstetrician/ gynaecologist with delayed puberty, infertility, or recurrent foetal loss. They may present to the dental surgeon with recurrent aphthous ulceration or dental enamel hypoplasia. Celiac disease may be associated with autoimmune endocrinologic disorders such as thyroiditis and type 1 diabetes mellitus. It is associated with neuropsychiatric conditions such as depression, anxiety, peripheral neuropathy, ataxia and epilepsy. Asymptomatic elevation of transaminases may occur in these patients and an unusual association of celiac disease is with chronic liver disease and non-cirrhotic portal fibrosis.
Celiac disease is hereditary, meaning that it runs in families. People with a first-degree relative with celiac disease (parent, child, and sibling) have a 1 in 10 risk of developing celiac disease. Celiac disease is a digestive disorder. Celiac disease can develop at any age after people start eating foods or medicines that contain gluten. The estimated population prevalence of diagnosed celiac disease in many Western countries approaches 1 per cent. The highest prevalence rates of the disease are noted in the Saharawi people of Africa in whom celiac disease prevalence is believed to be around 5 per cent. There is little information on celiac disease prevalence in South Asia, and indeed celiac disease is believed to be under-diagnosed in this part of the world. About 1% of the total population has celiac disease. It is more common in people with type 1 diabetes. Celiac disease affecting adults are also now well recognised in northern India, and in many of these individuals the presentation is atypical, i.e. without diarrhoea or overt malabsorption. The prevalence of celiac disease in southern India is not known. Anecdotal experience of physicians and gastroenterologists in southern India suggests that it is very infrequent in southern India. Differences in celiac disease prevalence between north and south India could be ascribed to differences in dietary patterns (rice being the staple cereal in south India) or due to differences in genetic make-up.
The only way to manage celiac disease is to completely avoid all foods that have gluten. Following a gluten-free diet will prevent permanent damage to your body and will help you feel better. A gluten-free diet is a diet that excludes the protein gluten. Gluten is found in grains such as wheat, barley, rye and triticale (a cross between wheat and rye). A gluten-free diet is used to treat celiac disease. Gluten causes inflammation in the small intestines of people with celiac disease. Eating a gluten-free diet helps people with celiac disease control their signs and symptoms and prevent complications. Initially, following a gluten-free diet may be frustrating, but there are many foods that are gluten-free and substitutes exist for gluten-containing foods that are consumed.
Cross-contamination occurs when gluten-free foods come into contact with foods that contain gluten. It can happen during the manufacturing process, for example, if the same equipment is used to make a variety of products. Some food labels include a "may contain" statement if this is the case. But be aware that this type of statement is voluntary. You still need to check the actual ingredient list. If you are not sure whether a food contains gluten, do not buy it or check with the manufacturer first to ask what it contains. Cross-contamination can also occur at home if foods are prepared on common surfaces or with utensils that were not thoroughly cleaned after being used to prepare gluten-containing foods. Using a common toaster for gluten-free bread and regular bread is a major source of contamination, for example. Consider what steps you need to take to prevent cross-contamination at home, school or workplace.
Foods to be avoided strictly Cereals: Atta, maida, sooji, rye, barley, dalia Processed Cereals: Noodles, pastas, bread, bread rolls, pizzas, wheatflakes, breadcrumbs, soupsticks, semiyan, dalia, double roti, rusk, cake Snacks: Patty, burger, kulcha, nan, upma, crackers, biscuits, cutlets and other wheat products Cooked cereals: Roti, parantha, poories, dalia, halwa Beverages: Barley water, hot chocolate, Complan, Horlicks, Boost, Bourvita, soups made of soup cubes or soup powder Desserts: Cakes, pastries, pies, ice cream, laddu with atta, eclairs, chocolates, milk cakes, jalebi and so on Tinned & Canned Foods: Vegetable sauces, instant curry mixes, baked beans Processed Meats: Sausages, hams, seek kabab, tikka and so on.
Food which can be taken Cereals: Rice, makki (bhutta), makki ka atta, tapioca, sago, bajra, jawar, sighara ka atta, arrowroot Pulses: All dals, besan, channa, besan papad, soyabean, rajmah Processed Cereals: Chirwa, murmura, rice flakes, cornflakes, puffed rice, popcorn, rice noodles, rice papad, sago papad and so on Snacks: Idlis, dosa, vadas, rice murukku, arrowroot halwa, aloo cutlets, roasted corn, roasted and so on Cooked cereals: Boiled rice, pulao, curd rice, makki ki roti, bajra, jawar roti, besan ki chapati Desserts: Freshly prepared rice kheer, sago kheer, fresh paneer, caramel custard, carrot halwa, sliced fruits with sugar, honey Beverages: Fresh juices, tea, coffee, fresh milk, fresh curd, lassi, soda, fresh soup with / without corn starch. Eat freshly cooked vegetables, fresh fruits, any kind of fats and oils, whole/ ground spices and condiments Freshly cooked meat, fish, chicken, eggs. Bottom of Form
The author is assistant professor, department of home science, St Teresa’s College, Ernakulam. She can be contacted at rashmipoojara@rediffmail.com)
|
|
|
|
|
|
|