Dr. Desh Pal SinghUser Stories

Dr. Desh Pal Singh

image
Dr-Desh-Pal-Singh

I've had a wheat allergy since childhood, although I only became aware of it in 2013. Since then, I've been relying on Wheafree products, which offer a variety of flours, biscuits, bread, cakes, namkeens, sweets, and breakfast items. These food options have allowed me to lead a regular life and carry out my daily tasks, including working in OPD and surgery. I'm thankful to Wheafree for preserving my well-being and enhancing my comfort through its extensive selection of gluten-free products.

Dr. Desh Pal Singh
MBBS, M.S. (General Surgery)
Retd. Deputy Civil Surgeon
Yamuna Nagar, Haryana.

READ MORE
HPS Lamba (CEO, Wheafree) in conversation with Annika Dhariwal (Founder Gluten Free Jio)Articles

HPS Lamba (CEO, Wheafree) in conversation with Annika Dhariwal (Founder GlutenFreeJio)

image
HPS Lamba (CEO, Wheafree) in conversation with Annika Dhariwal (Founder Gluten Free Jio)

You are a celiac, when and how were you diagnosed?

I was diagnosed with Celiac disease when I was 8 years old. It was not an extremely straightforward experience. Initially, I fell sick with a fever and temperature every few months and was extremely weak and short for my age. I did not realize this at the time but it was because I was immunocompromised due to celiac disease. I never had the classic symptoms that usually affect the digestive system. I was constantly misdiagnosed in India with other diseases which the doctors had assumed based on how weak I was. I was finally diagnosed in the US when my pediatrician decided to run a TTG test. My TTG number was extremely high but to confirm that I had celiac disease I had a biopsy. Straight after the biopsy, it was confirmed I had celiac disease and I have been on a 100% gluten-free diet ever since.

You had been in India and UK (and many other countries) so what difference have you noted in relation to the availability of gluten free food in the market?

I was diagnosed 10 years ago and back then the availability of gluten free grocery items at stores in India was extremely limited. I usually carried most things back from the US and my mum made gluten free atta at home using a chakki. When I went to boarding school in the UK at 11 I realized how easily available gluten free items were in all supermarkets. Similar to the supermarket’s restaurants in India barely had knowledge of how to cater for someone with celiac whereas many restaurants in the UK had GF items clearly marked. Over the past 10 years, it has been exciting to see how the levels of awareness have increased and restaurants and supermarkets have adapted to this.

How did you come up with the idea of Glutenfreejio app and how is this serving the celiac community? Please share what this app is all about with our readers.

Whenever I visited other countries on holiday, I realized that most countries had an app that can easily help locate restaurants with gluten free menu’s. I realized that the Indian celiac community really needed something like this. Hence, I decided to create an app that can help locate gluten free restaurants near you once you put in your location. I felt that more features could be incorporated into the app so I decided to add a function where users can also locate grocery stores selling gluten free items near them. Further, the app also has all the resources that are available on the gluten free jio website. I hope this app helps anyone living with celiac disease in India as well as foreigners when they are on holiday in India.

What changes would you like to see in the Indian scenario regarding Celiac/ gluten intolerance and gluten free food?

Firstly, I hope that there is an increase in awareness and that the misconceptions regarding celiac disease are cleared up. I feel that sometimes people don’t take Celiac Disease seriously as they don’t understand the effects that it has on people who are suffering from it, so I hope this changes in the future. Secondly, I hope that more restaurants that are celiac-friendly start to appear.

Is the Indian govt /FSSAI sensitised about the gravity of the situation and problems being faced by gluten intolerant? What changes would you like to bring?

Over the past few years, FSSAI has stated that any product that has less than 20ppm mg per kg can be labelled as gluten free. However, there is no way to check that food item labelled as gluten free are actually gluten free. The reason it cannot be 100% trusted is that there is no specific penalty for these regulations not being followed. For eg. sometimes items I have come across at the grocery store say Gluten Free but when I read the other information on the label it says that it is processed in a factory handling wheat etc. therefore it is not 100% GF. Such things need to be taken into account when companies are producing their food labels. The government is not particularly involved in rules and regulations regarding Celiac Disease. I think a step forward would be the government actually recognising the severity of food allergies in general and spending funding on awareness campaigns.

You are nominated as an Ambassador for Beyond Celiac .. how do you feel and what is your role being an ambassador?

It is extremely exciting to be an ambassador for beyond celiac. I have been working with them to develop Gluten Free Starter kits for people who are newly diagnosed with celiac disease. The idea with these kits is that once someone is diagnosed the hospital can give them the kit to help them transition to a gluten free lifestyle easily. These Kits contain an information pack which I wrote using material provided by beyond celiac. It also has some Gluten free goodies that are from Wheafree.

Wheafree is associated with you and your project for a long time, can you tell us more about this special relationship?

It has been extremely enjoyable working with the Wheafree team over the past few years. Initially, when I learnt about Wheafree I was really happy to discover that there was provisioning for gluten free Indian Sweets. I am looking forward to visiting Wheafree’s 100% gluten free factory and blogging about it on gluten free Jio’s social media pages.

Annika Dhariwal (glutenfreejio.com)

Annika Dhariwal
CEO – Gluten Free Jio
I am an 18-year-old girl, called Annika Dhariwal, who was diagnosed with Celiac disease at the age of 9. As someone who attends Cheltenham Ladies College, a boarding school overseas in the U.K., and has traveled to over forty countries, I hope to encourage and inspire other children and adults on a gluten free diet to dream big. Having a serious restrictive diet is no reason to mope at home and hide from the world. Through my blog and website, Gluten Free Jio which I started in 2018 when I was 14 years old, my goal is to share some personal experiences of being a gluten free teen in a boarding school abroad, and tips in leading a gluten free lifestyle while at home in India. Gluten Free Jio is a platform, where you can seek help and find a community for yourself or your loved ones, get comprehensive knowledge about being gluten free in India and abroad, and find comfort in knowing that you are not alone.

LinkedIn        

Website: www.glutenfreejio.com

READ MORE
An Interview with Jeeva Anna GeorgeArticles

An Interview with Jeeva Anna George

image
An Interview with Jeeva Anna George

You are a multidimensional personality, you are an entrepreneur, bakery specialist, diet consultant, Writer/Author. According to you, which is the main role you play and why?

I am a curious person in the sense I like to understand how things work! So, definitely the baker in me who tries to create new recipes that  is definitely what is close to my heart. As a Celiac I understand the struggles of fellow Celiacs and  by using my knowledge and skills if I can create foods which others can enjoy its a win for me. This is also reason why during the pandemic I started to teach baking online.

You became all of the above for some reason, would you like to share your story with our readers as I am sure, it will be an inspirational story?

It’s been long journey for me!

My childhood goal in life was to be an IAS officer. Well, inspite of being a favourite to crack it, I didn’t and then the 4th & last time I wanted to write it is when I kept falling sick.

Fast forward to 2010, I was so unwell that I quit my job and finally discovered I had Celiac Disease. I had to take time out to heal and even when I joined work back, when I had to take some emergency medical leave I was asked to leave. In the meanwhile I was cooking and baking gluten free foods for myself. I took an  active interest to read everything I could  find on Celiac Disease,  whether it was medical journals or articles, or websites.  I connected to Celiacs all over the globe. I went to stores in Bangalore and requested them if they could source gluten free ingredients for me and also whenever they needed to know more I spoke to the manager or store owner.

In 2013, when decided I might as well do something that can help me & others. I started commercially baking on a small scale, kept talking about Celiac Disease whenever I got an opportunity,  my baking helped me get noticed.  It created sone kind of awareness which was not there before and then people started asking me to talk and write about it. My willingness to share information and knowledge also was a reason for why I was recognized by  Chefs and many in the food industry.

It has not at all been easy for me, I have spent countless hours, money, effort into all that you see me doing today. However, thanks to my family, a good support system and my faith its kept me going inspite of the numerous challenges.

At the end of day it is very important for me that whatever I do makes a difference and that is exactly why I wanted to be in the Civil Services anyway.

I would say this to summarize my answer everything I am doing today is due to a necessity or because someone requested me to help them out with something 🙂

When you came to know that you are Celiac, was your family and friends supportive? How was the reaction of society ? Were they sensitive to your needs

For family it was a relief because my symptoms finally had a reason. I am blessed to have a very supportive family..Friends were surprised there could be such problems.  Society, oh well! Some were  kind and empathized. Some were surprised that something like this was there and many also thought it was temporary and never took it seriously. I would say I haven’t had much trouble with family or friends but people even now,  especially strangers feel its a fad diet and I doing it for losing weight!  There is so much awareness from 12 years back but still so much more to happen.

You have met Higher up officials of FSSAI, what is your assessment about their understanding of this disease? Do you think Labeling laws are strict and good  enough for food business operators .

I don’t think they still understand the problems we Celiacs face, sadly. Yes, we have good labelling laws but there is no accountability and that very fact makes the labelling laws ineffective. I know numerous manufacturers who never knew that they had to even list allergens or give a disclaimer about shared facilities.

There are manufacturers who happily put a gluten free label without even understanding the meaning of glutenfree. So its very clear that the labelling laws have not been clearly communicated and that companies are not held accountable if they do not declare allergens or all ingredients.

What made you think of writing the book ‘A Gluten Free Life’ My Celiac Story  and how the experience as an author?

I was speaking about food & my struggles with Celiac Disease at a conference and in the audience happened to be a consulting editor who worked with Harper Collins. A month later she wrote to me and asked me if I wanted to write a book about my struggles and my journey.
That is how I came a write a book. It is really a miracle that a book deal was given to me. However,eventhough I submitted the manuscript in 2015, it was published only in 2018.

To write this book I took 1.5 years, I had to maintain a disciplined schedule and as my book has 25 recipes it meant a lot of time was spent creating those recipes as well. It wasn’t easy for me to go back in time & share many of my personal struggles but in order for developing the connect with the reader and serving the purpose of writing the book, I had to do things which weren’t emotionally a pleasant experience.

Writing a book is a lot of work and on a topic like health it is even more of a challenge as you don’t want the reader to be bored. In a world where only celebrities or movie stars are asked to write on health I still believe I am highly blessed to get this opportunity.

What advice/suggestions you will give to the Celiac community from the lessons you have learnt in your life ?

Well, one thing you have to realise is that

  1. Try to not to stress too much because at the end of the day it just effects us.
  2. Plan – Do not restrict your life because you have Celiac Disease. Instead, research and plan and live your life whether it is travel or anything else.
  3. Do not be hassled by people’s opinions who might think you are fussy or following a fad diet.At the end of the day no one can bear your pain. Physical pain cannot be borne by anyone else so you should do everything to make sure you are safe. Health is wealth,  as cliché as it sounds,  it is true.
  4. Be kind, clear and courteous when you are  trying  to communicate your dietary restrictions to chefs, managers or wait staff. Clear communication always gets through to others.
  5. Please also be kind when new Celiacs ask you for help or direct them to resources and people who can help.
    Be kind to each other as well and support fellow Celiacs if they are trying to do something for the community.

The only way the Celiac community benefits is, if we have empathy for each other. There is always  strength in numbers. For example just look at the vegan community just in a few years vegan products are flooding the market. I have seen how united they are. Their unity puts pressure on all big manufactures and it they cater to them.

One more question which came from my daughter. At what age you came to know about your celiac disease and what was your reaction to this ?

I was diagnosed at 27. Needless to say it was a little tough to grapple with it. However, since I didn’t know much about it then it wasn’t a huge shock for me. It was probably only after few months after my diagnosis the seriousness of it struck me.

Jeeva Anna George - User Story

Jeeva Anna George
Co-Author – A Gluten Free Life, My Celiac Story.
Gluten free & allergen free recipe developer and baker based out of Bangalore, India.

LinkedIn        

Website: www.glutenfreeliv.in

READ MORE
Celiac Disease and Infertility - Blog by Dr. Reubina Singh - Fertility SpecialistBlog

Celiac Disease and Infertility

image
Celiac Disease and Infertility - Blog by Dr. Reubina Singh - Fertility Specialist

Celiac Disease & Infertility: Will cutting gluten from your diet boost your chances of getting pregnant?

According to experts at the All India Institute of Medical Sciences (AIIMS), celiac disease affects close to six to eight million people in India.

Recently, Miss Universe, Harnaaz Kaur Sindhu opened up about her struggle with celiac disease, addressing internet trolls who ruthlessly commented on her sudden weight-gain.

This redundant discourse over a woman’s body led to overshadowing a larger conversation, reducing a relevant platform for advocacy to a hostile space due to patriarchal narratives.

To shed some light on said ‘conversation’, it is estimated that every 1 in 100 people suffers from celiac disease. This number increases to 1 in 96 in northern India, considering wheat to be the staple diet of the community (God bless our punjabi mothers). Unfortunately, there exists a drastic gap between awareness around it and actual prevalence of the disease as experts believe that the condition is highly underreported across the nation.

This might come as an attack on all the moms out there but sadly, ghar ki roti can be bad for you sometimes, especially if you are diagnosed with celiac disease. Let’s see how.

What is Celiac Disease (CD)?

Celiac disease is an autoimmune, digestive disorder in which the digestive system reacts adversely to gluten, a protein abundantly found in wheat (gehu), barley (jau) and rye.

While it may seem similar, it should not be confused with gluten allergy or intolerance, as the latter can result in irreparable damage to the small intestine if left untreated.

Celiac Disease - Coeliac

About Celiac Disease

  • While it is difficult to ascertain the cause, an individual’s genes combined with eating foods with gluten and other factors can contribute to celiac disease. After surgery, pregnancy, childbirth, viral infection, or significant mental stress, the condition might become active.
  • Celiac Disease is more common in females than in males. Symptoms can include weight loss, constipation, diarrhea, abdominal pain, and bloating along with non‐gastrointestinal symptoms such as psychological comorbidity. In some cases, patients may not show any symptoms at all.
  • If taking gluten doesn’t make you feel like a main character of a fitness advertisement, you might want to get checked. Two blood tests can help diagnose it: Serology testing which looks for antibodies in your blood and can indicate an immune reaction to gluten along with Genetic testing for human leukocyte antigens.
  • Goodbyes are hard but to fully treat Celiac Disease, you will have to bid farewell to gluten forever. This will allow the intestinal villi to heal and to begin absorbing nutrients properly. It is important to consult a doctor for the same and follow their instructions as reverently as you follow your skin-care routine.
  • If you’re wondering whether a person with celiac is condemned to a life of Bunny’s Dal Chawal, the answer is NO! You can still enjoy a well-balanced diet with a variety of foods, including meat, fish, rice, fruits, and vegetables, along with prepared foods that are marked gluten-free. Luckily, the upcoming gluten-free diet fad has made gluten-free bread, pasta, and other products much more accessible.

Celiac Disease and Infertility

Over the past decade or so, various research studying the association between infertility and celiac disease have produced inconsistent results. While some researchers believe that untreated celiac women are more likely to experience fertility issues, others have found no strong evidence to support this theory.

infertility woman

In around one in five couples, infertility is unexplained. Some studies direct us towards celiac disease as the underlying cause, indicating a possible relationship between the two.

The precise correlation between celiac and infertility is ambiguous, though it has been shown that reproductive issues have been caused by untreated celiac disease. This includes amenorrhea or no menstruation, early menopause, low-weight birth, and even miscarriages. And in males can cause abnormal sperm motility, or their ability to swim abnormal sperm morphology, or sperm size and shape and reduced sexual activity or drive. The NICE guideline on the recognition, assessment and management of coeliac disease recommends that a blood test for coeliac disease should be considered in people with unexplained subfertility (below normal levels of fertility) or recurrent miscarriage.

It’s not clear, however, whether the erratic immune system may cause these reproductive problems, or whether malabsorption due to untreated celiac disease may be the culprit. However, a few theories may help explain possible connections:

Celiac Antibodies – The presence of high levels of antinuclear antibodies (ANA) could be a sign of a woman’s body attacking itself. Preliminary reproductive immunology research has shown that celiac-induced antibodies such as ANA, DGP (deamidated gliadin peptide), tTG (anti-tissue transglutaminase) and EMA (endomysial antibodies) could have an adverse effect during early pregnancy.

Natural Killer (NK) Cells – Despite their scary name, NK cells are a crucial part of the immune system, given that they are highly specialized white blood cells that help kill virus-infected and cancerous cells. Having high levels of natural killer cells, however, has been blamed for potentially causing recurrent miscarriage and loss of fertility.

Nutritional Deficiencies – If you have untreated celiac disease, you’re highly likely to be deficient in any or all of selenium, zinc, iron, calcium, iron, and folate, all of which are essential to a healthy reproductive life.

Hormonal Problems – Undiagnosed or untreated celiac women are more likely to have a lower BMI and body weight due to malnutrition and other health problems associated with malabsorption. This can cause hormonal issues leading to earlier menopause and delayed onset of menstrual periods. Hence, women with untreated celiac disease may remain fertile for fewer years than non-celiac females.

Conclusion

While some studies have shown there may be a correlation between celiac disease and an increased risk of infertility, others refute this claim. What most scientists do seem to agree on, however, is that untreated celiac disease may be linked to unexplained infertility, especially in women.

Closeup of Man and Woman Hands

Most women with treated coeliac disease do not seem to have a greater risk of fertility problems than women without coeliac disease, which means people on proper treatment, gluten-free diets and supplementations should not worry about anything. Not eating gluten has been found to restore fertility.

About the author:

Dr. Reubina Singh - Fertility Specialist - Grace Fertility - Gurugram

Dr. Reubina Singh
Founder & Senior Fertility Specialist – Grace Fertility
Gurugram

LinkedIn
READ MORE
Dr. Sandeep S. Chhatwal - Your question have been answeredArticles

Your Questions Answered By Our Experts

image
Dr. Sandeep S. Chhatwal - Your question have been answered

Question: I am facing gluten intolerance from last 4 years and I am taking gluten free diet. But now I start having bloated stomach. What’s the reason for that?

Answer: Bloating of the stomach can have many reasons other than gluten intolerance. Lactose intolerance may be a common associated condition. You could get yourself tested for that. One may be sensitive to some legumes or vegetables. You could maintain a food diary and check what all foods cause intolerance.

Question: Difference among wheat allergy, gluten intolerance and celiac disease ?

Answer: Wheat allergy usually presents with skin and bronchial symptoms like asthma when one is exposed to wheat. This is mediated by an antibody called IgE. Patients respond to removing wheat from diet or environment and are treated with antiallergics just as other allergies. The allergy is usually limiting meaning it gets over in a short period of time.

Gluten intolerance is a condition in which the intestine reacts to challenge by gluten i.e exposure to food products containing gluten in the form of bloating, pain or diarrhea. If there is no exposure there are no symptoms. Gluten, however, does not damage the intestine. Gluten intolerant people don’t have the gene or the antibody which is present in celiacs.

Celiac disease is an autoimmune disease in which the intestine gets damaged because of exposure to gluten in genetically predisposed people and can lead to a lot of serious consequences caused because of inflammation and malabsorption. Being an autoimmune disease, it can be associated with other autoimmune diseases the most common being hypothyroidism.

 

Question: Hello sir I am gluten sensitive since 2020. I get sick of gas. What I do for that?”

Answer: That’s easy…avoid gluten.

 

Question: Can a person with celiac disease face issues with menstruation/menstrual cycle?

Answer: Coeliac disease can have an impact on the menstrual cycle in many ways. Firstly, a young girl who is coeliac may have a delay in onset of periods (menarche). Secondly, periods may be irregular with variable flow and patients may have a higher incidence of dysmenorrhoea (painful periods). Lastly, celiacs remain fertile for shorter duration as they may have early menopause.

 

Question: “My son (age 15 years) is having celiac (last 7 years) at starting stage while eating gluten by mistake his body reacts with severe headache or stomach ache but now reactions is stopped….so can I think celiac diseases is cured? Just to know the level of celiac which test has to be done? Every year we have to test celiac?”

Answer: Not having reactions does not mean celiac disease is cured. Once a celiac…. always a celiac. One should regularly test for antibodies ( ttG IgA ) to check for exposure to gluten. Keep in mind that a negative test does not mean exposure is not happening or that your child has started tolerating gluten. Celiac disease is an autoimmune disease and can affect the body in more than one way.

 

Question: My daughter is celiac and facing problem of constipation. She is taking medicine on daily basis for the last 4 years.

Answer: Constipation can be a symptom of coeliac disease. This happens when the gut in coeliacs absorbs more moisture than it should.
What you should also know is that gluten free diet has less fiber. Build your child’s diet around fresh fruits, vegetables, salads and nuts Include gluten-free whole grains like quinoa, buckwheat, amaranth, millet and brown rice. Ensure that your child is drinking enough liquids. Increasing fiber intake without increasing fluid intake can actually make the situation worse.
Exercise should be a regular part of the daily routine.
Hypothyroidism is a common disease which causes constipation and is seen in coeliacs. Get your child’s thyroid profile done.
If your child continues to experience constipation then one needs to rule out other conditions that can occur along side celiac disease and trigger constipation. For this you need to talk to your treating doctor.

 

Question: Why doesn’t the gluten come zero on testing when there is no gluten like in Kissan ketchup and Bikano. To be more precise, Do the products of Wheafree or homemade completely gluten free products which are completely devoid of gluten also show such readings on testing like 2, 3, 1.5….ppm its confusing.

Answer: For testing one should use the accurate weight of the test sample as mentioned on the kit. Using a higher or lower quantity may give a false positive or negative result. It also depends on the method one uses for testing whether it is Lateral flow devices( LFD’s) vs ELISA which are beyond scope of this discussion.
As a thumb rule remember that if the test done accurately shows gluten <20 ppm, the product is safe for consumption.

 

Question: Hello sir I have been celiac since 2011 and it’s been 11 years and I have been taking gluten free diet. Recently, I have undergone ultrasound which shows that my gallbladder wall is thickening around 10.3 mm and a little bit of fatty liver. Please suggest what I can do to get this resolved.

Answer: Liver enzymes may increase in coeliac disease. There may be other diseases associated with coeliac disease. To start with get an LFT, GGT and ttGIgA tested. Get a Fibroscan liver done if it is available in your city. This would help get a more clear picture.
Follow up gall bladder thickening with a serial ultrasound every 6 months.

 

Question: My son 18 diagnosed celiac 10 yrs back. His ttg remains around 15-16.He is too skinny with lean bones .
How to increase his muscle mass and make bones stronger .(we are vegetarians)We strictly follow GF diet.

Answer: What is the cut off level of ttG for your lab? If ttG is higher than upper limit of normal think on lines of contamination or hidden gluten in his diet. Get him screened for iron and vitamin deficiencies. Get his sugar and thyroid profile tested . You should also see your doctor to rule out any other illness which may be associated with coeliac disease.
If all above is okay, see a qualified dietician to plan his diet.

 

Question: Hello sir I am gluten sensitive since 2020 . I get sick of gas. What I do for that.

Answer: That’s easy…avoid gluten

image

We have got experts to help you with your doubts and queries related to celiac/gluten intolerance. It’s time to have your questions answered!

Our Expert:

Dr. Sandeep S. Chhatwal

Dr Sandeep S Chhatwal
Senior Consultant Internal Medicine
Omni Clinics and Diagnostics
SCO 343-345 / 34 A
Chandigarh

Dr Sandeep S Chhatwal is a Senior Consultant Internal Medicine and Managing Director of Omni Clinics and Diagnostics. With over 25 years of experience, he has special interest in Allergies, Diabetes, Geriatrics and Adolescent health disorders. He is a member of various Medical forums and is actively engaged in community workshops, training and awareness programmes. Dr Chhatwal is the founder and Managing Trustee of NGO Veeranwali foundation. The NGO touches more than 3000 underprivileged children a month in fields of education and healthcare through its flagship project Nanhi Jaan.

Dr Chhatwal is also a Coeliac and that helps him relate better with his coeliacs under his care.

image
Your Questions Answered by Dr. Mohinish Chabbra

Question: My son(17yrs) being on gluten free diet since past 8 yrs… TTG levels controlled, hemoglobin levels maintained…still he’s too lean and skinny what can be done? (Vegetarian)

Answer: Lean and skinny may be normal till he is asymptomatic with good energy levels, good appetite with controlled ttg/normal Hb. Usually at this age basal metabolic rate is high weight gain may not occur. It’s important to calculate his calories intake and type of ingredients in his diet.

 

Question: Sir, I was diagnosed with celiac about three years ago, due to symptoms of diarrhea and since then I am on gluten-free diet and my TTG level comes below 22 from 159, but still today I am facing morning diarrhea one or two times, and my weight also does not increase, but blood level is increased, why?

Answer: One needs to check stool consistency also along with frequency. If stools are normal but more frequent you need to still check for inadvertent exposure to gluten, check for TTG levels. If a strict gluten free diet is being followed and TTG is falling or normal, an increase frequency of stool could be due to many other associated conditions like – IBS, microscopic colitis, pancreatic exocrine deficiency, secondary bacterial overgrowth

 

Question: How can we get ingredients list of medicine and supplements (vitamins etc) to know if they are gluten and soy and corn free?

Answer: According to the FDA, “The vast majority of oral drug products either contain no gluten or virtually no gluten. In the very rare cases where gluten may be present, we estimate based on drug formulation information that wheat starch and other ingredients derived from wheat would contribute no more than 0.5 mg gluten to a unit dose of an oral drug product. This amount is less than may be found in a single 30-gram serving of food labeled gluten-free according to FDA’s regulations.”

Gluten can be used in many medications as an excipient, so it is important for you to check that each medication you take is gluten-free. If you have Celiac disease and are filling a prescription, ask the pharmacist to verify the ingredients to ensure that it is gluten-free. You can ask their help in reading and understanding the list of ingredients or contact the manufacturer.

Some Excipients to look for:
Dextrins – Result from the hydrolysis of starch by heat or hydrochloric acid (from corn). It can also be obtained from wheat, rice or tapioca.
Dextrates (when source is not specified)
Dextri-maltose (when barley malt is used)
Maltodextrin – A startch hydolysate that is usually obtained from corn but can be extracted from wheat, potato or rice
Modified Starch (when source is not specified)
Pregelantinized Starch – a starch that has been chemically or mechanically processed. The starch can come from corn, wheat, potato or tapioca
Sodium Starch Glycolate – a starch that is usually obtained from potato but many come from any starch source

Answers can be found on the package insert and the key word to look for is starch. If the starch is listed as “cornstarch” or starch (corn) it can be assumed to be gluten-free. However, if starch is listed by itself the only way to confirm the source is to call the manufacturer

Question: Does Multifold TTG result in the range of 160 is enough for diagnosis of Celiac Disease as it reduces to 30 on Gluten Free Diet after 18 months?

Answer : Not enough for diagnosis. Gold standard of diagnosis is duodenal biopsy showing changes of villous atrophy. In children if TTG is more than 10 times the upper limit then you may avoid biopsy by performing other tests like antiendomysial antibodies plus HLA DQ 2/8

 

Question: I was diagnosed with celiac about three years ago, due to symptoms of diarrhoea and since then I am on gluten free diet and my TTG level comes down to 22 from 159, but still today I am facing morning diarrhoea one or two times, and my weight is not increasing, but blood level has increased, Why?

Answer: There are many other causes of diarrhoea persisting despite being on gluten free diet:

  1. Inadvertent intake of gluten which you are not aware
  2. Micros scopic colitis
  3. Secondary bacterial overgrowth
  4. Pancreatic exocrine dysfunction

 

Question: My daughter aged 17 years has been diagnosed with celiac disease in July 2021. Is there any medicine which can be given to her if she is accidentally glutened?

Answer: There is no specific treatment but only symptomatic treatment can be given.

 

Question: How many chances of celiac in new born baby if you are celiac?

Answer: First-degree relatives (parent, sibling, child) of someone with celiac disease have a 1 in 10 chance of developing celiac disease.

 

Question: If on testing any food product, gluten is 1.5 ppm as in Kissan ketchup testing, is it still preferable to avoid it as it is not 0 ppm( although less than 20 ppm) or can be taken without giving it any thought.?

 
Answer: Any product with gluten less than 20 ppm can  be taken with no problem at all

image

Our Expert:

Dr Mohinish Chhabra

Dr Mohinish Chhabra
Director, Department of Gastroenterology and Hepatology at Fortis Hospital, Mohali

image
READ MORE
Celiac Disease - Learnings from CanadaBlog

Celiac Disease – Learnings from Canada

image
Celiac Disease - Learnings from Canada

Senior R&D leader with nearly 15 years of experience in pharmaceutical, biotechnology and cannabis industry. Global expertise in research, product development, scale-up and commercialization. Presently settled in Canada

Celiac disease is an autoimmune disease that impacts the overall well-being of an individual when left untreated. While there is no cure for the disease today, the management of the Celiac disease requires the complete removal of ‘Gluten’ containing ingredients from one’s diet. Primarily because it is upon ingestion of gluten, the body reacts violently and releases antibodies that attack the lining of our stomach and intestine lining. Our stomach lining is critical to absorbing nutrients such as iron, folate, calcium, Vitamin D, other proteins, fats, and carbohydrates. The lack of nutrients due to the damaged gastrointestinal tract (Gut) creates a domino effect resulting in malnourishment and other diseases. Simply put, gluten is a protein present in grains such as wheat, rye, barley and oats. Scientists estimate that exposure to 20mg/kg of gluten is sufficient to trigger the autoimmune reaction in someone with celiac disease.

Recognizing that this disease affects nearly 1% of the Canadian population, the government has provided multiple resources to those impacted by it. Some of these have been discussed below to give the reader with resources.

1. Federally registered charitable organization – Canadian Celiac Association

The Canadian Celiac Association

This is a reputable and well-recognized organization across the country with offices and branches in each province (state) that helps everyone in need. It is a one-stop-shop for patients, healthcare professionals and food industry professionals. Guidance on Food Labelling to ‘Clinical Trials’ to ‘Budget tips’ you can find all the information you need in one place.

2. Disability Tax benefits

Recognizing that gluten-free products are critical to the healthy living of patients with celiac disease and that these products are usually more expensive than regular food products- the Government of Canada provides disability tax benefits for those with celiac disease. Persons with celiac disease can claim the incremental costs of buying gluten-free food products as a medical expense when filing their tax returns; persons with celiac disease can claim the total costs of purchasing gluten-free food products as a medical expense.

Disability Tax benefits

3. Canada Food Inspection Agency

Canadian Food Inspection Agency

Canada Food Inspection Agency, a division of the Government of Canada, clearly defines the requirements of ‘gluten-free’ claims and labelling and prohibits the use of ‘wheat-free’ as ‘gluten-free.’

CFIA also states – “Low gluten” or “reduced gluten” claims are not acceptable in Canada, including in relation to foods containing less than 20 ppm of gluten. These claims are considered to be misleading, as consumers with celiac disease may be led to believe that these foods are safe to consume, while medical advice recommends a gluten-free diet.”

4. Unlike the United States Food Drug and Administration (US FDA), which in 2017 issued guidance for the pharmaceutical industry on ‘gluten in drug products and associated labelling’ Health Canada- the governing body in Canada is yet to do so. However, any patient can request the pharmacist dispense the medicines to validate from the manufacturer whether the treatment contains gluten and is safe for those with celiac disease. Often, such queries are addressed within 24-48 hours.

We do not have to reinvent the wheel when providing care and a haven to patients with celiac disease. Many countries like Canada have established policies and regulations that enable patients with celiac disease to live a comfortable life. For example, in the United Kingdom, celiac patients receive gluten-free food as part of their prescription, which is covered by insurance – making them economical. Australia and New Zealand have the most rigid labelling laws globally and apply to all food, including imported for sale in the country. In Italy, those with celiac disease can receive up to 140 Euros per month towards their gluten-free product expense.

About the author:

Harpeet Kaur - Ph.D - Founder CeliacFoodie

Harpreet Kaur,
Ph.D
Founder – CeliacFoodie
Senior R&D leader with nearly 15 years of experience in pharmaceutical, biotechnology and cannabis industry. Global expertise in research, product development, scale-up and commercialization. Presently settled in Canada.

READ MORE