Wheat Intolerance

Many people find it hard to imagine that intestines could revolt against as innocuous and staple a food as wheat, and could be the cause of a disease that can even kill. Celiac Disease, a condition in which the body reacts to gluten, a protein present in wheat, is on a steep rise in India. Tables are now being turned on the long held view that it is a “Western disease” that does not occur in India.

Neha (name changed), a college student from Delhi, came in to see me for problems of 2 to 3 loose stools every day for 4 years.  Several doctors she had consulted had diagnosed her condition as IBS (Irritable Bowel Syndrome) and prescribed medicines either for infection or to slow her “hyperactive” bowels. Her relief had predictably not been lasting.

What struck me at the outset was her “thinness”. Although she claimed to eat well, she had a Body Mass Index of 17 (normal range 20-23.5). She also looked anaemic (Hemoglobin was 9).  Endoscopic examination of the stomach and large intestine had been normal.

 On my suggestion she got her blood tested for TTG (Tissue Trans-glutaminase) and Anti-Endomyceal Antibody, that detect wheat “allergy” and returned 2 weeks later with strongly positive reports for both.

Getting this young college girl to stop wheat, a staple food and a common ingredient in many items we commonly consume, posed a challenge.  Stopping roti, chapatti, paratha, puri and biscuits for life can be incredibly difficult especially for people from the “wheat eating” regions.

For Neha to say “NO” to biscuits, wheat noodles, snacks and cookies was even more difficult as she stayed in a hostel and did not have much food options. Fortunately, her elder sister who works as a dietician, understood the importance of diet-regime and offered to cook rice and rice noodles for Neha.

Neha gained 3 Kg of weight in the next 2 months, something she had not thought possible for 4 years. And her energy levels had tripled!

Celiac Disease has already emerged as the commonest cause of diarrhoea and weakness in children, says Dr Ujjal Poddar, Pediatric Gastroenterologist at the Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, who has worked on this condition for over 15 years. Diagnosing it in adults who present with milder manifestations now still remain a challenge.

It is quite a familiar entity in the Western world. People with this affliction come together through networks and form their own social groups in cities and regions. Further, a range of gluten-free food items are easily available in departmental stores and groceries to cater to their special needs.

While the formidable thing about Coeliac Disease is to stay off gluten-containing food for life, the encouraging fact is that life and growth reverts to “normal” without the requirement of any expensive medications. 

Neha has put on another 2 Kg in the last 2 months!

As published in HT City ( Hindustan Times) dated 23 December, 2012.