City wakes up to cases of celiac disease


•People who can’t take gluten, a protein found in wheat and other grain, are being advised to consume gluten-free grain. Pune has seen 300 cases this year

Via Pune Mirror

Wheat and wheat products contain gluten

Wheat and wheat products contain gluten (Image curtsey Pune Mirror)

For much of his young life, Rajendra Wable remembers suffering from vomiting and diarrhea after his meals. At six, he weighed just six kg, which an infant of six months weighs, and was only 78 cm in height — that of a two-year-old child. Frequent visits to doctors in his native Hingoli district did not improve his condition. His father, Shivshankar, consulted a doctor in Aurangabad, 220-odd km from where he stays, who redirected him to Pune. Here, he was finally diagnosed him with celiac disease — a permanent allergy to gluten, a protein present in certain food grains including the widely-consumed wheat.
Shivshankar was then advised by Dr Vishnu Biradar to go in for a completely gluten-free diet and keep a separate grain grinder for his flour. The family went in for a traditional grain grinder that would be used to make flour only for his consumption. Soon enough, Rajendra started putting on weight and his height increased by around five cms. “We maintain a separate set of utensils for him, besides the grinder. For his sake, the rest of the family has reduced consumption of wheat and wheat products,” said Shivshankar.
The allergy to gluten — found in wheat, barley and rye — is well known in western countries, with gluten-free products being easily available. In India, the northern states have been found to have a high prevalence of people with celiac disease but for Maharashtra, the extent of incidence of this health problem is just about surfacing.
For those who are allergic to it, consuming gluten triggers an immune response in the small intestine. Over time, this reaction produces inflammation that damages the small intestine’s lining and prevents absorption of nutrients. In children, this can affect growth and development and cause stomach ache.
This intestinal damage can also lead to weight loss, bloating, and on occasion, diarrhea. Eventually, it may also deprive the brain, nervous system, liver and other organs of vital nutrition. There is no cure besides a lifelong adherence to a strict gluten-free diet.
Until 2010, doctors in Maharashtra were under the impression that the state was free of this disease. While only 20 to 50 cases used to be registered across Maharashtra before 2010, in 2013 till date this figure has shot up to over 300 in Pune alone.

The Pantry in Mumbai serves gluten-free dishes

The Pantry in Mumbai serves gluten-free dishes (Image curtsey Pune Mirror)

City doctors put down the increase in celiac disease cases to rising awareness among their fraternity. “The blood test to identify celiac disease is called TTG-IGA, where TTG stands for tissue transglutaminase and IGA for immunoglobulin A, an antibody produced by the body to help it fight viruses, bacteria, and other threats from toxins. The disease is later confirmed by endoscopy. This test was available in the state since 2005, but doctors here were not aware of the prevalence of this disease. It was only recently that more tests were conducted and doctors started testing for celiac disease,” said Dr Vishnu Biradar, consultant pediatric gastroenterologist at Deenanath Mangeshkar Hospital and Aditya Birla Hospital. He added, “People allergic to gluten should not ingest it in even small portions. They are generally advised to have their own grinding machines for grinding gluten-free flour.”

Grains that can be eaten

Grains that can be eaten (Image curtsey Pune Mirror)

Dr Mrunmaya Panda, a consulting gastroenterologist with Aditya Birla Hospital, said, “Since the prevalence has also increased, the awareness and detection has gone up too. Some of these patients are migrants from northern states where this disease is known to be prevalent. Besides, there are changes in food patterns. Pizza and burgers contain maida, a highgluten product. This has also made the problem more evident. Earlier, people mostly ate rice, which did not trigger the allergy.”
Dr Harshal Gadikar from Deenanath Mangeshkar Hospital seconded this. “We have even arranged a support group meeting on September 27 for these patients. Since the prevalence is much higher in states like Delhi, people from there and living here are coming for guidance to us.”
The ailment need not become evident in childhood, as 28-year-old Pratiksha Patil (name changed) learnt. Patil used to suffer from diarrhea frequently. In the span of six to nine months, she had it at least 10 to 12 times. Along with diarrhea, she also experienced mild abdominal pain. Her body weight was low and she kept losing weight. Finally, it was found she was anemic and the TTG-IGA tests showed she was suffering from celiac disease. Shunning gluten stopped this and there was muscle growth in her body. With time, even her fatigue and general weakness vanished.
Probably the worst effect of gluten was on seven-year-old Ashish Shah (name changed), in whom celiac disease ultimately triggered seizures almost every alternate day. Later, it became evident that there was calcification in the occipital region of the brain. A visit to a neurosuegeon and an MRI scan confirmed celiac disease. Doctors say Ashish’s was a rare case of celiac disease. He was then referred to a gastroenterologist, who put him on a gluten free diet. Now, Ashish’s life is back to normal.
In Mumbai, a couple of restaurants have gluten-free items on their menu. Otto Infinito has the option of glutenfree pasta and The Pantry at Kala Ghoda has gluten-free pancakes and cake. “We have gluten-free pancakes and chocolate cakes. The pancakes are made of organic ragi flour and contains eggs, sugar, butter and milk. It is served with bananas. The cake is flourless and contains 70 per cent chocolate, butter, eggs and sugar,: said Jay Bhatt, a chef with The Pantry.
“Before starting the restaurant, we actually conducted a market survey. We realised that there are many people who demand gluten-free products, so we included those in our menu. We are now trying to find more options for people who prefer gluten-free food,” said Ronnie Gomes, manager, The Pantry.
“Some people are highly sensitive to some allergens. Celiac disease is one such allergy. Because of lifestyle changes, people have started becoming hypersensitive to allergens these days and we are seeing a lot of celiac cases. I counsel at least one such case everyday. Wheat has become a substantial part of our daily diet, so much so that people get upset about having to stop consuming wheat. We then give them tips and options such as corn roti, rice roti which are actually better alternatives and easier to digest,” said Dr Geeta Dharmatti, president, Indian Dietic Association, Pune chapter.

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