Your Questions Answered By Our Experts
Q. I have been getting diarrhoea multiple times a day for the past 2+ years. Stopped gluten a year ago but I still get painful diarrhoea off and on. Done tests for igA and igE with no conclusive results against gluten. I am also type1 diabetic for 25 years and on insulin with hba1c under control. I am 30 years old as of date
A. Diarrhoea can have many reasons. It could be infective, inflammatory or secretory. If it is happening multiple times a day over 2 years you need to rule out inflammatory bowel disease. I suggest you get in touch with your treating physician or take a gastroenterologist opinion.
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: How to check whether any medicine is gluten free or not?
Answer: First and foremost, the reliable way is to ask the manufacturer of drug via sending and email on their customer care.
If they fail to respond, get the medicine checked at NABL accredited Lab for Gluten testing by Elisa Sandwich method. If results are below 20 ppm of gluten, medicine is safe to be consumed.
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
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.
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:
- Inadvertent intake of gluten which you are not aware
- Micros scopic colitis
- Secondary bacterial overgrowth
- 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.?
Our Expert:
Director, Department of Gastroenterology and Hepatology at Fortis Hospital, Mohali