A Silent Battle: Daily Struggle Against Gluten | Alumni Association | College of Pharmacy

We all grow up listening to the proverb “All five fingers are not equal” which means that the world is not the same for everyone and not everyone experiences life in the same way, everybody faces different circumstances and struggles. A perfect example of this proverb is the people with gluten resistance or celiac disease. For many people, gluten is part of every meal and some people struggle daily in search of gluten-free meals at every place where they are urged to eat food and this continues lifetime, making dietary choices is essential for them to maintain health. This article explores the hidden battle against gluten, emphasizing the daily struggles and the need for greater awareness, understanding, and support.

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What is Celiac Disease?

Celiac disease is a serious autoimmune disorder in which the body’s immune system reacts aggressively to gluten, and produces antibodies against it. This causes inflammation (swelling) in your gut, which damages the small intestine’s lining and villis. This damage impairs nutrient absorption and can lead to malnutrition, chronic fatigue, and other complications if untreated. In those with celiac disease, the ingestion of gluten triggers an inflammatory response that harms the villi, tiny finger-like projections in the small intestine that are vital for absorbing nutrients. Celiac disease is chronic, meaning that individuals affected by it must avoid gluten for life.

Symptoms and Diagnosis

The symptoms of celiac disease can vary widely, making it challenging to diagnose. Common digestive symptoms include bloating, abdominal pain, Pale, foul-smelling stool, and diarrhea, but others experience non-digestive symptoms such as weight loss, delayed puberty, slow growth, anemia, joint pain, migraines, skin rashes, or depression. Some people may be asymptomatic, meaning they show no outward signs but still suffer internal damage. This variability often results in delayed diagnosis, with many suffering for years without knowing the cause of their symptoms. Untreated celiac disease has been linked to infertility in both females and males. Females with celiac disease face irregular periods, Early menopause, and Miscarriage.

Diagnosis typically involves a combination of blood tests to detect specific antibodies against gluten and an endoscopy to assess intestinal damage. Early diagnosis is essential for preventing complications, but with celiac disease affecting individuals in such diverse ways, it is often overlooked or misdiagnosed.

The Daily Struggles of Living with Celiac Disease

Living with celiac disease requires immense careful observation and discipline. While the gluten-free diet has gained popularity in recent years, for those with celiac, it is not a choice or a trend; it’s a medical necessity. Here are some of the daily challenges:

Dietary Restrictions: Following a strict gluten-free diet is not easy, as gluten is present in a wide range of foods and ingredients. Even in products labeled “gluten-free,” traces of gluten can be present due to cross-contamination in manufacturing.
Cross-Contamination Risks: People with celiac disease must be extremely cautious about cross-contamination. Using a shared toaster, frying pan, or even cutting board can lead to inadvertent gluten exposure, which can trigger symptoms. Dining out or eating at social gatherings is challenging, as even well-meaning hosts may not understand the stringent requirements needed to prevent cross-contact.
Emotional and Social Impact: The need for constant attentiveness around food can lead to anxiety, frustration, and social isolation. Dining out or attending gatherings can become stressful events where the individual must advocate for their health, often facing misunderstanding or skepticism. The risk of social isolation is high, as others may not fully understand the gravity of accidental gluten exposure.
Nutritional Challenges: A gluten-free diet can be restrictive and sometimes lacks essential nutrients like fiber, iron, calcium, and B vitamins. Individuals with celiac disease must be mindful of these potential deficiencies and may need supplements or fortified foods to ensure balanced nutrition.

Treatment and Lifestyle Adaptation

Currently, the only treatment for celiac disease is a lifelong gluten-free diet for the rest of your life. After the patient has been on the diet for a few weeks, the small intestine begins to heal, and the patient will start to feel better. There is no medication or cure, adapting to a gluten-free lifestyle is critical for managing symptoms and preventing further complications. Here are some tips for adaptation:

Finding Safe Foods: Learning to read labels and understanding gluten-containing ingredients is essential. Many gluten-free products are now available, making life easier for those with celiac disease, but not all foods are labeled accurately so require extra care.
Preparing Gluten-Free Meals: The safest route for people with celiac disease is home cooking. Dedicated gluten-free cookware, utensils, and careful cleaning are necessary to avoid cross-contamination.
Understanding Gluten-Free Labeling: The “gluten-free” label does not always guarantee absolute safety, as standards may vary across countries. The U.S., for instance, permits products labeled gluten-free to contain up to 20 parts per million of gluten, an amount that is generally safe but may still cause concern for the highly sensitive person.
Seeking Support: Joining support groups and online communities can provide emotional support and practical tips, helping individuals with celiac disease feel less isolated and more empowered.

People with celiac disease must be aware of hidden gluten sources in food and non-food products alike. Many unexpected foods, such as sauces, marinades, and processed items, contain gluten. Additionally, gluten can be present in medications, cosmetics, and even household items, meaning that alertness is essential. Individuals must constantly be on the lookout for hidden gluten and educate themselves to avoid accidental exposure, which can quickly lead to painful symptoms and internal damage.

Advancement in Research

Research into celiac disease is advancing rapidly, with scientists exploring innovative ways to provide relief beyond the strict gluten-free diet. Each advancement brings us closer to treatments that may one day allow those with celiac disease to manage their condition more easily to tolerate gluten without adverse effects.

Enzyme Therapy: Developing enzymes that can break down gluten proteins in the stomach before they reach the small intestine. Enzyme therapies work similarly to lactase pills for lactose intolerance, aiming to reduce or neutralize gluten proteins in the digestive tract before they cause harm. If successful, enzyme therapy could offer a protective measure for accidental gluten exposure, though it wouldn’t allow for full gluten consumption.

Immune-Modulating Therapies: Therapies that could selectively modulate the immune response in celiac disease. These therapies aim to suppress the specific immune cells or antibodies involved in the reaction to gluten without affecting the overall immune system. By reducing the body’s overreaction to gluten, these treatments could minimize or even eliminate the inflammatory response that causes damage to the intestines.

Gluten Deactivation: Scientists are researching methods to neutralize gluten proteins in foods before they’re consumed. One approach is to use genetically modified wheat with reduced gluten content, although this method faces challenges with both effectiveness and public acceptance. Another approach focuses on using chemical treatments to alter gluten proteins in foods, making them less likely to trigger an immune response. However, such methods are still in their early stages.

Novel Diagnostic Tools: Advances in diagnostic tools make it easier to detect celiac disease. For example, some researchers are working on blood tests that can detect immune responses to gluten almost immediately after exposure. Others are developing devices similar to breathalyzers that could help people identify accidental gluten ingestion through breath or saliva analysis.

Vaccine Development for Immune Tolerance: Development of vaccines to retrain the immune system, so that individuals with celiac disease tolerate gluten without triggering inflammation and irritation. Some trials were done but they were not successful so new vaccines are being developed.

Gene Therapy: Gene therapy is to address the genetic and immune-based root causes by modifying or correcting specific genes responsible for the immune reaction to gluten. Till now gene therapy in celiac disease is not possible but future advancements in methods of gene therapy may offer switching of autoimmune response to gluten.

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Crafted By: Subham Yadav, B Pharm 23