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02 December 2023

Gluten-free? Food, medicines can contain this protein

Certain foods with hidden ingredients can still trigger reaction (Shutterstock)


Patients of celiac disease must ask for every product they consume whether it is gluten-free, while on a life-long gluten-free diet.
Celiac disease was the topic discussed at the weekly Twitter clinic of the Dubai Health Authority (DHA). Up to one per cent of Dubai’s population has celiac disease, said the experts.

Celiac disease is the inability of the body to digest gluten (a protein found in wheat, rye, barley, and processed oats). When people with this disease eat gluten their body mounts an immune response that attacks the small intestine. These attacks lead to damage on the villi (small finger-like projections that line the small intestine, that promote nutrient absorption.) When the villi get damaged, nutrients cannot be absorbed properly into the body.

How the disease manifests can vary from person to person. “Children may experience growth problems, decreased appetite and failure to gain weight, chronic diarrhea, iron deficiency, chronic constipation, vomiting, abdominal bloating and pain, fatigue and irritability. Children may also show signs of malnourishment. That's because the disease prevents the body from absorbing essential nutrients,” explained Batoul Bashir Samarji, paediatric gastroenterologist at Dubai Hospital

“For adults, the symptoms include iron deficiency, bone or joint pain, arthritis, depression or anxiety, bone loss or osteoporosis, tingling numbness in hands and feet, erratic menstrual periods, fertility problems and dermatology problems.

“The biggest problem we see is the lack of awareness. It is important for people to understand that wheat allergy is different from celiac disease.  To diagnose celiac disease an allergy test is not required and is an incorrect method,” pointed the doctor out.

The correct method to diagnose the disease is through a blood test to check the antibody level against gluten, a test also known as Tissue Transglutaminase Antibody (TTGA), in addition to an IgA test to measure the blood level of immunoglobulin A. The doctor will decide whether to do an upper endoscopy or not, he explained.

A lifelong adherence to a strict gluten-free diet is the only method to deal with the disease. Foods containing the slightest bit of wheat, rye, barley or processed oats must be avoided, but also products such as stabilizers and emulsifiers that are used in processed foods, as they may contain gluten.

“Oats are often harvested and processed with the same equipment that is used for wheat, and are therefore easily contaminated. However, pure, uncontaminated oats consumed in moderation are generally tolerated by most people with celiac disease,” said Wafa Ayesh, director of clinical nutrition at the DHA.

Patients must learn to check labels to ensure the food is absolutely gluten free, she pointed out. “Look for items labelled gluten-free in all products especially for processed foods such as granolas and granola bars.”

Fatima Saeed Al Khurousie, senior clinical dietician at Dubai Hospital, said: “People with celiac disease must also check their medication labels carefully because not all medicines and vitamins are gluten-free. They must speak to the pharmacist before buying medications and vitamins.”

Celiac disease is often hereditary, noted Mustafa Sabri, consultant physician and gastroenterologist, digestive diseases unit at Rashid Hospital. “People with a first-degree relative with celiac disease (parent, child, and sibling) have a 1 in 10 risk of developing celiac disease but this does not mean that those without a family history will not develop celiac disease.

“High-risk patients include patients with other diseases like thyroid , irritable bowel syndrome, low immunoglobin A, down syndrome, or type 1 diabetes. These patients may be asked to undergo a test even if they don’t have symptoms of the disease.”

DHA’s Rashid hospital runs a dedicated adult gastroenterology clinic and Dubai Hospital runs a paediatric gastroenterology clinic.

“Cutting out gluten from your diet may seem like a difficult and limiting task. Fortunately, there are many healthy and delicious foods that are naturally gluten-free. People with celiac disease can consume all fresh fruits and vegetables, meats, milk and milk products, legumes and nuts, rice, quinoa, corn, potato, tapioca, millet etc,” assured Nisreen Abu Ghoush, clinical dietician at Rashid Hospital.