This Monday (16), World Celiac Disease Awareness Day, experts draw attention to the difficulty that people with this disorder have to maintain gluten-free diets. The problem is cross-contamination, as this protein can appear as a hidden ingredient in many processed foods.
Celiac disease is autoimmune, and is characterized by affecting the small intestine, reaching about 1% of the population and being triggered by intolerance to gluten, which is a set of proteins naturally present in cereals.
Gustavo Patury, a surgeon of the digestive and bariatric system and member of the Brazilian Society of Bariatric and Metabolic Surgery, explained to CNN that the disease occurs when there is inflammation in the intestinal mucosa resulting from exposure to gluten in genetically predisposed people. The condition can result in atrophy of the intestinal villi, leading to intestinal malabsorption and other clinical manifestations.
Celiac disease is not an allergy. However, like allergies, it is an immune system reaction to a food. However, rather than generating an immediate reaction, the condition may progress more slowly, with symptoms ranging from mild to severe and manifesting over a longer period of time.
The World Gastroenterology Organization (OMG) warns that one difficulty patients often face is sticking to a gluten-free diet. That’s because gluten is widely used in processed foods and can be a hidden ingredient. While there are cereals such as gluten-free flours and starches, there can be problems with so-called cross-contamination with wheat and barley, which contain the protein.
Patury explains that some food products that do not contain gluten in their composition can end up showing traces of the protein – which are tiny particles measured in milligrams – and that can affect celiacs. This can occur, for example, when a gluten-free bread is baked in the same oven as a bread containing the protein. Or when a knife is used to cut gluten-containing foods.
For this reason, says the expert, it is necessary to analyze starches and flours for a preliminary detection of gluten before allowing use in the diet of celiac patients.
In Brazil, the Law No. 10,674/2003 obliges all industrialized foods to inform on their labels the presence or absence of gluten, to protect the right to health of people with celiac disease.
“The ideal for a celiac is to follow up with a doctor and nutritionist specialized in the disease”, says Patury.
He explains that, in addition to not eating food, there are cases in which the patient should avoid any product with gluten, such as some cosmetics. He also advises that patients use unique cutlery and kitchen utensils.
Symptoms and causes
Celiac disease occurs in people with a genetic tendency to this condition. Individuals with a first-degree relative who have celiac disease (parents, children, siblings) are at greater risk of developing the pathology, according to the National Health Council (CNS).
In addition, there is a higher frequency among females, in the proportion of two women for every man.
There are three types of the disorder: celiac disease, wheat allergy, and non-celiac gluten sensitivity. Conditions usually present in childhood, in children aged between 1 and 3 years. However, as the surgeon explains, it can appear at any age.
“The disease is now known to affect all age groups, including the elderly: more than 70% of new patients are diagnosed over the age of 20,” he said.
The clinical presentation of the disease varies greatly from person to person. Both the disease and the symptoms can appear at any stage of life.
According to Patury, some patients with celiac disease have few gastrointestinal or extraintestinal symptoms, while a minority have malabsorption (classic celiac disease).
The main symptoms in adults are chronic diarrhea, weight loss, iron deficiency anemia, bloating, malaise and fatigue, edema (hypoproteinemia), and osteoporosis.
In children, the signs involve vomiting, diarrhea, abdominal distension and weight loss.
According to the CNS, the lack of information about and the difficulty for the diagnosis impair adherence to treatment and limit the possibilities of improving the clinical picture. If left untreated, celiac disease can lead to serious additional health problems.
Diagnosis and quality of life
Small amounts of gluten can be harmful. For this reason, early diagnosis is critical, says the CNS. According to the council, it is essential to perform upper digestive endoscopy, with small intestine biopsy for histopathological examination of the biopsied material, which is considered the ‘gold standard’ in the diagnosis of the disease. Blood tests or a strict gluten-free diet may also be required by your doctor.
The only treatment for celiac disease today is a strictly gluten-free diet for life. No food or medication containing wheat, rye and barley gluten or derivatives can be ingested without causing persistence of symptoms.
“Recurrent symptoms can trigger secondary problems and even serious diseases, not only in the gastrointestinal tract”, says Patury. Some of them include growth retardation, delayed puberty, osteopenia, osteoporosis, small bowel cancer, lymphomas, mouth and pharyngeal tumors.
According to the World Gastroenterology Organization, other pathologies can also cause problems such as irritable bowel syndrome, bacterial overgrowth, microscopic colitis and other benign and malignant complications, with a higher risk of mortality.
One of the functions of gluten in the body is to help the small intestine to proliferate bacteria considered good to aid digestion.
According to the organization, the gluten-free diet is low in fiber. Celiac patients should be advised to eat a high fiber diet supplemented with brown rice, corn, potatoes and abundant vegetables. Any dietary deficiencies such as iron, folic acid, calcium and, very rarely, vitamin B12 must be corrected.
The ideal way to get on a gluten-free diet is to consult a nutritionist, especially during the first year after diagnosis.
Not all nutritionists are familiar with the complexities of a gluten-free diet, and local or national support groups can often provide most of the information needed.
Source: CNN Brasil