Gluten Intolerance

People with gluten intolerance usually experience symptoms within 1 hour of consuming gluten. Some individuals may have a delayed reaction, with symptoms developing up to 12 hours later. The common symptoms include:

I. Intestinal Symptoms

• Abdominal pain (most commonly observed symptom)
• Diarrhea
• Nausea
• Bloating

II. General Bodily Symptoms

• Headache
• Joint pain
• Muscle contractions
• Numbness, especially in the hands and feet
• Tiredness

III. Behavioral Symptoms

• Difficulty focusing
• Depression
• Anxiety
• Hyperactivity
• Lack of balance and coordination while walking

IV. Skin-Related Symptoms

• Redness of the skin
• Dry and itchy patches on the skin

Gluten is a type of protein primarily found in wheat. Other sources include rye, barley, and oats.

What causes gluten allergy?

Proteins are typically digested by enzymes present in the stomach. However, gluten is not completely digested by these enzymes due to its high content of indigestible protein.

The undigested gluten usually enters the small intestine, where it remains in the body for 1-2 days before being excreted with other waste products.

What causes gluten intolerance?

In some individuals, gluten can cross the epithelial barrier of the small intestine and activate the immune system. This can lead to symptoms in two ways:

• Triggering an allergic reaction
• Initiating an autoimmune reaction by remaining in the small intestine

This causes significant changes in the gastrointestinal tract and leads to intestinal and extraintestinal symptoms, as mentioned in the ‘Symptoms’ section. Most symptoms develop due to damage to the lining of the small intestine caused by antibodies developed as an immune reaction.

Anybody can have gluten intolerance, but certain factors increase its risk:

• Family history: Individuals with a positive family history of celiac disease or lactose intolerance are more prone to develop gluten intolerance.
• Genetic conditions: Certain genetic conditions, such as Down syndrome, Williams syndrome, or Turner syndrome, make the person more sensitive to gluten-containing foods.
• Colitis: Colitis, which is inflammation of the colon (large intestine), also increases the risk of developing gluten intolerance.
• Diabetes: Type 1 diabetes increases the risk of celiac disease, in which the immune system mistakenly attacks the body’s own cells.

1. Ruling out the possibility of other digestive conditions

Celiac disease, wheat allergy, and gluten intolerance have similar symptoms upon ingestion of gluten. Individuals are kept on a gluten-free diet for several weeks to monitor symptoms. If symptoms begin to resolve with the removal of gluten from the diet, other diseases are ruled out.

2. Diagnosing celiac disease

The diagnosis of celiac disease is typically made through the identification of several antibodies in the blood. Some of these antibodies include:

• Tissue transglutaminase antibody - IgA
• Tissue transglutaminase antibody - IgG
• Gliadin antibody - IgG
• Endomysial antibody - IgG
• Endomysial antibody - IgA
• Endomysial antibody - IgM

In some cases, a biopsy (tissue examination under the microscope) may be needed for confirmation.

3. Diagnosing wheat allergy

Wheat allergy marker blood test: IgE is a type of antibody that is usually elevated in allergies. This test determines the total IgE level.

Skin test: In this test, the doctor scratches the skin with a needle containing wheat. Skin reactions are examined to detect allergies.

4. Diagnosing Non-celiac gluten sensitivity (NCGS)

Initially, individuals are given a diet containing gluten for a few weeks.

This is followed by administering a placebo.

A washout period occurs in which neither placebo nor gluten is given.

Symptoms are monitored in both cases, helping to establish the correlation between gluten and symptoms.

In some instances, intestinal tissue examination under the microscope is required for confirmation.

Gluten intolerance cannot be entirely prevented. However, episodes of allergic reactions can be minimized by adopting the following lifestyle changes:

1. Go Gluten Free

   Gluten is naturally present in wheat, rye, and barley. Foods made from wheat have the highest amounts of gluten. If you have a gluten allergy, avoid consuming the following food items:

   • Flour
   • Bread
   • Crackers
   • Baking mixes
   • Pasta
   • Cereal
   • Sauce
   • Processed meat
   • Beer
   • Malt vinegar
2. Identify the Trigger

   The quantity of gluten varies in different products. It is not necessary that all gluten-containing food items trigger an allergic reaction. The trigger can be identified by eliminating all food, beverages, medications, and cosmetics that contain gluten. This is followed by adding items one by one to determine the trigger based on the appearance of symptoms.

3. Be More Conscious While Dining Out

   Many individuals may experience symptoms while dining out. It is advisable to ask for gluten-free options that can be safely consumed.

4. Check the Hidden Gluten Content

   Some food items contain gluten that people may not be aware of. These include emulsifiers, dextrin, mono- and di-glycerides, seasonings, and caramel colors. Additionally, food can be contaminated with gluten during preparation and packaging. These can often be identified through warning labels. Here are some foods and beverages that may contain gluten:

   • Brown rice syrup
   • Candies
   • Wafers
   • Cold cuts
   • Hot dogs
   • Sausage
   • French fries
   • Readymade gravies
   • Fish
   • Rice mixes
   • Sauces (soy sauce and vegetable sauce)

Gluten intolerance cannot be treated. However, the symptoms can be avoided through adopting a gluten-free diet. It is also important to follow all the points mentioned in the ‘Prevention’ and ‘Living with’ sections.

Anti-allergic medications and steroids may be prescribed to manage symptoms in some cases.

Adrenaline is administered in the event of anaphylaxis.

The following home remedies and supplements can help in pacifying the digestive symptoms associated with gluten intolerance. However, make sure to consult your health care provider before initiating any of them.

• Ginger (adrak): It helps relieve an uneasy stomach and muscle cramps experienced after the ingestion of gluten-containing food. It can be consumed in the form of an extract prepared by boiling a few pieces of ginger in water.
• Turmeric (haldi): A natural anti-inflammatory agent known to ease stomach cramping, bloating, and nausea. One teaspoon of turmeric powder can be swallowed directly with water or taken as readily available turmeric supplements.
• Fish oil: Celiac disease, one form of gluten intolerance, damages the intestinal lining. Preparations like fish oil help coat the lining of the small intestine and reduce the level of injury.
• Yogurt: Loaded with beneficial bacteria, yogurt aids in digestion by supporting gut health.
• Apple cider vinegar: It helps reduce bloating and other intestinal symptoms associated with gluten intolerance.

1. Nutritional deficiencies:

Avoidance of many food items can lead to malnutrition and nutritional deficiencies. In such cases, it is important to support your diet with dietary supplements. Make sure to consult your doctor before taking any supplement.

2. Weight gain:

Inflammation can block nutrient absorption in the body. When the body perceives a shortage of nutrients, it craves more food to obtain the necessary nutrients. This is why some patients with Celiac disease may gain weight despite being undernourished.

Gluten intolerance is a lifelong condition characterized by several relapses and remissions. However, the condition is manageable. In addition to the points mentioned in the "Prevention" section, the following adjustments in daily life may prove to be beneficial:

Know About What to Eat

It can be challenging to find gluten-free nutritious foods. Here is a list of foods that are not only gluten-free but also nutrient-rich:

• Rice
• Quinoa
• Millet
• Amaranth
• Oats (use oats labeled "gluten-free," as oats are often cross-contaminated with wheat and barley)
• Corn
• Buckwheat
• Potatoes and potato flour
• Sorghum
• Teff

You can also consult a registered dietitian for a proper meal plan. They will customize the diet and possibly recommend specific dietary supplements such as fiber and calcium.

Other Important Tips

• Educate yourself about gluten-free dietary options at home.
• Inform others about your condition to minimize accidental exposure.
• Consider the positive effects of gluten-free diets, such as maintaining optimal weight and improving bone health.
• Stay motivated by incorporating new gluten-free recipes into your kitchen.
• Choose fresh ingredients over processed ready-to-eat gluten-free options.
• Consume a variety of citrus fruits like oranges, lemons, and limes to help the body assimilate nutrients and benefit from their antioxidant content.