Gluten Contamination Warning

Every year, May 9th is celebrated as “World Celiac Day” to commemorate the millions of people who have to avoid gluten found in grains such as wheat, barley and rye. On this day, which aims to raise awareness of celiac disease, draw attention to the difficulties experienced by patients and emphasize the importance of a gluten-free lifestyle, Altınbaş University Faculty of Medicine Faculty Member, Prof. Dr. Orhan Kocaman gave detailed information and warnings.

“The absence of a special finding may cause a delay in diagnosis”

Prof. Dr. Orhan Kocaman pointed out that the disease does not show typical signs and symptoms and said, “The lack of specific findings related to the disease causes a delay in diagnosis. Patients may experience abdominal pain, iron deficiency anemia, bloating and gas, stool irregularities, elevated liver enzymes, bone weakness, joint pain, skin rashes and psychiatric complaints. Developmental delay and delayed puberty may be observed in children.” 

“The exact cause is unknown, it has a genetic structure”

“Celiac disease is a lifelong disease that manifests itself with an allergic response of our immune system to the ‘gluten’ protein found in wheat, oats, barley and rye on the intestinal wall.” Prof. Dr. Kocaman said that this causes damage to the small finger-like structures called villi on the inner surface of the small intestine and impaired absorption.  Underlining that although there is no definite cause of the disease, it has a genetic structure, Kocaman said, “Some patients have a genetic structure that carries the risk of developing celiac disease. If they come into contact with gluten, the immune system reacts in a way that can cause damage to the small intestine.” 

There are classic, unusual, hidden and treatment-resistant varieties

Stating that the disease has more than one type, Kocaman from Altınbaş University said, “There are different clinical types of celiac disease. In the 'classic' type, there are complaints and findings such as diarrhea, abdominal pain, bloating, weight loss and iron deficiency. Some patients do not have these classical findings. In this 'unusual' type, typical findings are not found. In this group, skin problems such as dermatitis herpetiformis, complaints related to the nervous system such as headache, balance disorder, numbness and bone weakness may be observed. In the 'occult' type, endoscopy and small bowel biopsy are normal and blood tests are positive. In the 'treatment-resistant' type, the disease does not improve despite a gluten-free diet. In this patient group, lymphoma, a cancer of the lymphatic system, may develop.” 

Stating that they utilize a number of tests to reach a diagnosis in patients with suspected celiac disease, Kocaman continued her words as follows:

“Blood tests constitute the first step. Antibodies such as anti-transglutaminase antibody and anti-endomysium antibody may indicate the presence of celiac disease. If blood tests are positive or symptoms are typical, an endoscopically guided small bowel biopsy is performed. If the biopsy findings are consistent with the disease, celiac disease can be diagnosed. In some cases, if blood tests and small bowel biopsy do not give clear results, a gluten-free diet can be tried. The patient eliminates gluten-containing foods from his or her diet and the symptoms can be checked to see if they go away. This process can be used to diagnose celiac disease.”

“Nutrition should be completely gluten-free, contamination of gluten-free products should be avoided”

Underlining that the only and effective treatment of the disease is a gluten-free diet, Kocaman said, “The daily diet of celiac patients should be completely gluten-free. Gluten-free foods such as fruits, vegetables, red/white meat, milk and dairy products and gluten-free alternative cereals such as corn and rice should be consumed. Celiac patients should also be careful to avoid contamination from gluten-free products. There is a risk of contact with gluten-containing products, especially in prepared foods and restaurants.” 
Special attention should be paid to ready-to-eat foods

Kocaman, who also warned about what to pay attention to in addition to nutrition, said, “There are several important issues that celiac patients should pay attention to in addition to a gluten-free diet. In daily life, food labels should be read carefully when purchasing gluten-free products to prevent gluten contamination. It should be noted that gluten-containing ingredients may be listed under different names. When eating out, gluten-free options should be preferred. The gluten-free diet of celiac patients should be balanced and include all the necessary nutrients. This can include a diet that includes a variety of fruits, vegetables, protein sources and healthy fats. Celiac patients should be followed up regularly by a gastroenterologist and nutritionist. A follow-up program in this way allows the appropriateness of nutritional plans to be evaluated and possible nutritional deficiencies to be detected early.” 

“Celiac patients may have an increased risk of developing certain types of cancer such as lymphoma”

Kocaman also gave information about the diseases that may develop in individuals with celiac disease and said, “Some diseases may accompany celiac disease or some additional diseases may occur during the disease process. Diseases such as type 1 diabetes, autoimmune thyroid diseases (Hashimoto's thyroiditis or Graves' disease), rheumatoid arthritis and lupus can be seen more frequently in celiac patients. Calcium malabsorption in celiac patients can lead to loss of bone density and increased risk of osteoporosis. Anemia may occur due to malabsorption of important nutrients such as iron, folic acid and B12. Itchy red blisters and rashes may appear on the skin. People with celiac disease may have an increased risk of developing certain types of cancer, such as lymphoma. However, this risk can be reduced with regular medical follow-up and proper nutrition. Women may experience problems such as infertility or low birth weight. Neurological problems such as migraine, numbness and seizures may accompany the picture.” 

Itching and burning on the skin, dry skin or flaking...

Finally, Prof. Dr. Orhan Kocaman explained the symptoms of the disease as it also affects the skin structure, “The skin symptoms of celiac disease are associated with a specific skin disorder called dermatitis herpetiformis. Dermatitis herpetiformis is a chronic and itchy skin rash seen in 10 percent to 20 percent of celiac patients. However, other skin symptoms can also be found in celiac disease. Skin conditions such as itching and burning, skin dryness or flaking, eczema, psoriasis or urticaria may be more common in celiac patients.”