Diet Clinic Artical Memory with celiac patient


“Celiac disease is an autoimmune disorder that results in damage to the lining of the small intestine when foods with gluten are eaten.” Says dietitian Sheela Seharawat.  It is also known as celiac sprue or gluten-sensitive enteropathy. It is a very rare kind of disease. Many researches are going on in this field and scientists are trying to get better solution. 
Gluten is a form of protein found in some grains like wheat, Barley, Bulgur, Durum, Farina, Graham flour, Malt, Rye, Semolina, Spelt (a form of wheat) and Triticale. 
“As the blood test report says about anyone as a patient of celiac disease the doctors are soon sending the patient to a dietitian.” Says dietitian Sheela Seharawat.  It is the first and the most important step to plan a gluten free diet then gradually inflammation from the small intestine starts to reduce, patient starts to feel relieve. It takes a few weeks but as patient starts to feel better then he gets back to normal within a few days.    
“It is also very important to note that gluten free diet comes out from gluten free kitchen.” Says dietitian Sheela Seharawat. This celiac disease demands gluten free diet and the best way to avoid gluten is to stop its entrance at home. It is also important for the rest of the family to show support and understanding as cross contamination can make situation critical.

The worst thing is that this disease has no cure and diet is the only way to deal with it. If diet is not regulated, then difficulties will further increase and like any other fatal disease it can also surely lead to death. Precaution is the only way. Keep yourself gluten free. 
Researchers have found that there are several risk factors that increase the chance of getting celiac disease like having multiple doses of antibiotics during early years of life. It is also found that infant feeding pattern, early infections, gut microbiota and the amount and timing of initial gluten exposure also plays an important role in exposure to this celiac disease. 

We have also noted that Celiac disease can develop in genetically predisposed children (HLA DQ2 and/or DQ8 positive) at any point from 9 months of age through adulthood. We have several tests that help in knowing this disease. 
Our body carries certain antibodies like - Anti-tissue transglutaminase (tTG) - Anti-endomysium (EMA) - Anti-deamidated gliadin peptides (DGP). A positive antibody test suggests that a person might have celiac disease; it is accurate to a good extent however an endoscopic biopsy of small intestine can confirm with certainty. 

It is also important that during these tests patient must not stop taking gluten free diet as it can further complicate the process of testing. 
As celiac patients eat any gluten foods then their immune system gets invaded. Their antibodies fight with gluten and that result into intestinal lining that causes inflammation in the intestines and damages the villi. 
Villi are the most important part of intestine as all the nutrients are normally absorbed by the villi. If the villi are damaged, the person cannot absorb nutrients properly. That means that patient will have nourishment problems; generally, such patients find it hard to absorb nutrients like fat, calcium, iron and folate, no matter how much one eats. 
A Celiac patient (name withhold) says: “When I first came to know about it, I got a mixed kind of feeling. I felt now all is over and I’d better die soon, second I felt why I? I was very depressed and sad thinking how I got this disease and what can help me now. The real fear was my children, husband and other family members. I needed to inform them and ask them to get screened. Things didn’t seem easy so thinking was gradually destroying me. But it was the very moment I needed to stop all and focus to believing as at the end of the tunnel there is light, there is hope. Dietitians were the only hope. I felt like exploding with all my emotions and to beg for help. Indeed, having gluten free diet helped me in some ways but the fear that it can grow in my family tree is next to impossible to word.”
Indeed, it is also important to have a genetic testing as the entire family is now at risk of this celiac disease as it is possible that they can have this disease sometime in their life. A simple genetic test can say whether further screening is required or not. If needed, then everyone must have regularly their antibodies screening. 
Genetic test can be done by blood test and will assure whether the person is carrying the genes which are responsible for the development of this disease. If this test says person or individual doesn’t carry any genetic predisposition then that person does not need to have regular antibodies test, else it is required.  

These genes are found in the HLA-class II complex and are called DQ2 and DQB. 


 It is very important to note: The gene test does not diagnose celiac disease. It only tells that an individual has the possibility and carry a risk and needs to be closely monitored with antibody testing in the future. Indeed there are other factors which also play an important role in the development of this celiac disease.  
In fact, up to one-third of the US population has the genes for celiac disease. This means that people with DQ2 or DQ8 can develop celiac disease at any time. 
“Now I would also like to say that there is a link between celiac and type 1 diabetes disease as both carry the same genes. They both are autoimmune diseases. It is also found that approximately 4 to 9% of people with Type 1 diabetes will also have coeliac disease. There is no such risk associated with type 2 diabetes patients.” Says Sheela Seharawat.
As we can see this disease has its roots very deep inside as it directly affects our DNA so finding cure is not so easy. If you have celiac disease it is very important to save yourself and others in your family too. If one child has it and the parent doesn’t have, even then there is a possibility that siblings may have this disease and it is important for parents to know which children need more attention. 


Memory with celiac patient

The memories of a dietitian are not necessarily always sweet and beautiful. Sometime it is arid and sad too, mostly when it comes to a celiac patient. 

As celiac disease has affected 1% of the world population and we Indians are also touched by it so the memories seriously go from bad to worst. Before I go into the seriousness of the problem let me begin with other influencing factors that help in shaping the situation even more difficult. 

In India we know the joint families’ norms are gradually getting belittled and singular family unit concept is growing very rapidly. So it becomes very difficult to face a bad situation when one is like this and unfortunately mind stops to work under such circumstances. 

Under such an influence and havoc, one evening I met a lady who was in her 40’s and had children and husband and all of them seemed tensed as the lady had the Celiac disease. Well with the lady I could understand the horror which had invaded her mind but this was further enhancing my problem as if I can’t smile and tell the patient that there is nothing to worry then how on earth one can feel good. 

She has to feel positive so matter what is her complication. No matter what will be her condition in future but her present is something that really matters as it can make or break everything. 
I saw her reports and her families’ report and luckily only she was affected by this. I tried to sound normally and naturally although I can say for sure that I was also under the influence of sadness and horror. 
Question was not the problem of diet but the arid situation that had hit the family and she was also my first patient with celiac disease. She wanted to inform her other family members but the question was how as there were many relatives with some their relation was not very good. 

That was the very moment I really believed internet can be the worst thing if it is with you at the wrong time. Her family was reading a lot about this disease and the deeper they were going the worse feeling was growing on their faces. 
I needed to stop them at once. It is fine that their probing the internet paved them to a dietitian but it was not good to go into the complex details of the disease. And most importantly you must understand the stage at which your complication is and try not to exasperate things.  
I needed to tell them that celiac disease is not the end. It only means you have to avoid food that has gluten which is wheat and wheat related families like rye, etc.
Now she had to understand that she was susceptible to gluten and should not eat it even by mistake. So she should depend on the foods made in her kitchen which are fully under her control. 
It does not necessarily mean that if the patient has one bite it is the end. It all depends on how much intolerance one has. Some patient can have a small amount of gluten (of course by mistake) but for other it can lead to major severity like diarrhea or such symptoms. 
Yes, it is very important to stop taking gluten in any form. Stop wheat, rye and barley and other high breeds.  One has to stop eating breads, cereals, pasta, crackers, cakes pies, cookies and gravies. 
In case of oat, one has to first get this cleared by their doctor as some patients can have and some can’t. This decision is majorly taken by your doctor but if you ask me then I never suggest eating oats as there is a good possibility of cross-contamination which can be dangerous for the patient. 

There is no way to go for any kind of processed food as it can have wheat. Wheat flour is a very common ingredient in many processed foods. Some examples are canned soups, Salad dressings, Ice creams, candy bars, instant coffee, meats, ketchup, mustard etc. 
It is also important to avoid milk and other dairy products that contain lactose. A very common reaction to this is: why milk and other dairy products? Research has found that untreated celiac patients are also intolerant to lactose; however, they can start gradually consuming dairy products once they are well treated. 
It is also important to be careful before taking any medicine, capsules and vitamins as they can have gluten. As we know wheat starch is used in tablets and capsules due to its binding properties. 
It is good that in India society women are not so much fond of alcoholic drinks so they don’t need to face any challenge or many difficulties in avoiding them. These patients should not have beer at any cost however they can have wine, brandy whiskey and other alcoholic drinks provided they are sure that there is no barley in its ingredients.  

Especially for ladies, I would like to say that they have to pay extra attention to their lipstick and other cosmetic products as they can have gluten in them.  

The main thing with this disease is your precaution to be away from gluten. Don’t buy anything that has even iota amount of gluten. First be sure. There are many branded products that say no gluten in one country but can have it in another. Or the manufacturer has changed its manufacturing style and he is now using gluten which you may not be aware of. So be sure, be careful before buying and eating anything. 
One more important thing is that these patients face deficiencies of vitamins and minerals and need supplements which must be given under the knowledge of their doctor. 
Diseases are diseases and are never welcomed but if one has a disease then one should see how best to deal with it. Don’t get depressed and feel hopeless. Don’t give up. There is always some way to protect you and live better. 
It is very important to trust your dietitian and follow your gluten free diet without fail. It will give you the best results and soon within week or more you will feel almost normal. It is also noted that some celiac patients started to feel better within 48 hours of starting their gluten free diet. Children with celiac disease gave much better and quicker results after their strict gluten free diet intake. 
There is nothing to panic about, just first know the disease and if disease is there so find the best possible way to deal with it. I also suggest the same thing to each of my celiac patients and request them all to be thankful to god and live happily. 

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