Gluten Glut
It’s
hidden in most of the food we eat and yet a growing number of Indians cannot
tolerate it. What is gluten and why should you keep a watch on it?
Jeeva
George-Abraham was 26 when her life seemed to spiral out of control. An
economic policy researcher with a leading industry organisation, she found
herself complaining constantly of stress, fatigue, sleeplessness and, in the
worst trough, persistent diarrhoea. “I was running to the loo up to nine times
a day,” she says. “I had a history of stomach-related ailments, and had also
been treated for irritable bowel syndrome. All my tests were normal but the
symptoms just wouldn’t go away.”
Apprehending that work-related stress was aggravating her health condition, Jeeva quit her job in end-2009. An uncle-in-law suggested she see Dr BS Ramakrishna, a renowned gastroenterologist at Christian Medical College, Vellore. He put her through several more tests, including a biopsy of the upper intestine. And finally, Jeeva arrived at an accurate diagnosis: she was suffering from coeliac disease, an extreme form of gluten-intolerance.
Grain Power
Even those of us clued into the finer points of food would be forgiven for not knowing about gluten. Gluten is not glamorous. It is invisible to the naked eye, being found in the endosperm of grains of wheat, rye, barley, oats and all their processed derivatives. Ironically, its absence would be noticed immediately: this humble protein constituent lends the flours of these grains their strength, texture, elasticity and lightness.
The most common way we ingest gluten in India is through atta (a strong wheat flour that retains the grain’s germ, endosperm and bran) and maida (wheat flour stripped down whiteness). Whether used unleavened (roti, chapatti, puri) or leavened (naan, breads, cakes), the gluten content of wheat flour decides how the final product tastes. The more the batter or dough is mixed or kneaded, the more the molecules absorb water (or other liquids), cross-link with each other and pull and stretch into flexible strands. Introduced to heat on the tawa or in the oven, gluten expands, capturing the carbon dioxide released during the kneading and/or leavening process and leading to the creation of a light phulka, an airy croissant or a melt-in-the-mouth sponge cake.
Once the gluten is consumed, it triggers a whole set of reactions determined by the particular genetic make-up of a person. “About one- third of Indians have the type of HLA [human leukocyte antigen] pattern that potentially makes them allergic to gluten,” says Dr Ramakrishna, who redflagged the damage potential of gluten intolerance in India with a paper in the Indian Journal of Medical Research in January 2011.
“However, very few of these people will ever develop coeliac disease. One factor may be the total amount of gluten they eat daily. And there are almost certainly other genetic factors that may decide whether or not the individual is susceptible to coeliac disease. What we
do know is that the two-thirds of the population that does not have this HLA pattern will not get coeliac disease even if they eat a lot of gluten.”
What is also certain is that, for a population, the occurrence of coeliac disease corresponds to the amount of wheat consumed in the diet. So, currently, the incidence of the disease in northern India — where wheat is the mainstay of the diet — is estimated at around 1% of the population. It is thought to be far less in rice-eating eastern and southern India.
The ABC of Coeliac
In its classical form, coeliac disease is a chronic digestive disorder: as little as 10 mg of gluten can trigger an immune reaction that attacks the small intestine, causing both stomach distress and nutritional deficiencies.
Recent research, however, indicates that “coeliac disease is a multi-system disorder... highly variable in its clinical expression, may occur at any age and may present with a variety of manifestations.” Apart from the gastrointestinal effects, it may express itself as iron deficiency, fatigue, osteoporosis, delayed puberty, infertility, canker sores, depression and epilepsy – and this is not even an exhaustive list.
Though many of these symptoms can have other root causes, there are no foolproof tests to confirm coeliac disease. Doctors use blood serum tests to confirm the presence of antibodies to tissue transglutaminase (anti-tTG). However, false positives are common and further tests, including a biopsy, are necessary to confirm coeliac disease.
There’s a chance, though, that someone will exhibit many of the symptoms of coeliac, yet test negative for the disease. This form of wheat intolerance is called non-coeliac gluten sensitivity (NCGS). “From a physician’s point of view, coeliac disease occurs in people of a certain HLA type. There is also a characteristic antibody in the blood and the intestinal lining may be flattened. NCGS [on the other hand] can be diagnosed when a person clearly has allergic symptoms to wheat or gluten) but the HLA/antibody/biopsy may not be characteristic of coeliac,” explains Dr Ramakrishna.
Clinical nutritionist and founderpresident of the Coeliac Society of Delhi, Ishi Khosla, concurs: “Unlike coeliac, which is an autoimmune or allergic reaction, NCGS describes those who experience symptoms like bloating, diarrhoea and cramps but without the intestinal damage.”
What About Wheat?
Be it full-fledged coeliac disease or NCGS, there’s only one treatment: cease gluten consumption. Which means no breads, rotis, pastas, noodles, muesli, b re a d - c r u m b e d fries, wheat flakes, oat bran etc (for a more comprehensive list, see Chief Offenders). After some symptomatic treatment for her cramps and allergies, that’s the path George-Abraham adopted. “For almost three years now, I have not tasted regular bread,” she says. “I yearn for a croissant. But I know the pain and discomfort I will suffer won’t be worth it. So I resist the temptation.”
Considering the sneaky ways gluten enters our diet, this is harder than it sounds. “For instance, commercial asafoetida manufacturers use maida as an anti-coagulant. So a pinch of that hing in sambar could be dangerous for me,” says George-Abraham. “Reading food labels has become second nature to me. At a party, people will try urge me to have just a bite of the birthday cake or the papri chaat, saying a small portion won’t do any harm. Now I tell them upfront about my health condition, something that didn’t come easily to me for a long time. Before I step into a restaurant, I call ahead to check if they can serve me a gluten-free meal. If I go on a journey, I carry foodstuff with me.”
The Alternatives
Besides those diagnosed with coeliac and NCGS, a growing number of urban Indians are dropping wheat from their diet by choice. Among them is Jyoti Gupta, 35, and a Mysore-based digital marketing consultant, who, with her entire family, went gluten-free more than a decade ago on her chiropractor’s advice.
“None of us was ever diagnosed with coeliac, though we suffered from bloating, gas problems, wheezing, diarrhoea and lack of appetite. We used to have a regular north Indian diet of rotis and parathas, but now we have switched to rotis and breads made with amaranth and millet flours, besides rice, usually red rice,” says Gupta. “The impact has been immense. We feel lighter. There’s no more bloating, gas, colds or wheezing. Even the chronic back pain is gone.”
Healthcare professionals, however, are cautious about the trend. “Self-diagnosis and going off gluten can lead to a missed diagnosis of more serious coeliac disease,” says Khosla. “It is always advisable to seek professional help when in doubt.”
If the symptoms are bothersome, a gluten-free diet may be used on a 1-3 month trial basis to see if coeliac disease is at their root, says Dr Ramakrishna. “It is up to each individual what he or she eats or does not eat. However, wheat has the highest protein content among cereals and it will not make sense for the majority of normal people to avoid it,” he adds.
At the population level, where coeliac is increasingly becoming manifest in India, policymakers are recommending greater use of rice, maize, ragi, jowar etc, alongside increased consumption of milk, dal etc, to address the protein imbalance.
Gluten-abstaining individuals, says Khosla, could actually acquire a nutritional advantage by including indigenous and often-ignored grains such as millets (ragi, bajra), amaranth (ramdana) and brown rice, which have exceptional quantities of protein, calcium, iron and fibre.
Apprehending that work-related stress was aggravating her health condition, Jeeva quit her job in end-2009. An uncle-in-law suggested she see Dr BS Ramakrishna, a renowned gastroenterologist at Christian Medical College, Vellore. He put her through several more tests, including a biopsy of the upper intestine. And finally, Jeeva arrived at an accurate diagnosis: she was suffering from coeliac disease, an extreme form of gluten-intolerance.
Grain Power
Even those of us clued into the finer points of food would be forgiven for not knowing about gluten. Gluten is not glamorous. It is invisible to the naked eye, being found in the endosperm of grains of wheat, rye, barley, oats and all their processed derivatives. Ironically, its absence would be noticed immediately: this humble protein constituent lends the flours of these grains their strength, texture, elasticity and lightness.
The most common way we ingest gluten in India is through atta (a strong wheat flour that retains the grain’s germ, endosperm and bran) and maida (wheat flour stripped down whiteness). Whether used unleavened (roti, chapatti, puri) or leavened (naan, breads, cakes), the gluten content of wheat flour decides how the final product tastes. The more the batter or dough is mixed or kneaded, the more the molecules absorb water (or other liquids), cross-link with each other and pull and stretch into flexible strands. Introduced to heat on the tawa or in the oven, gluten expands, capturing the carbon dioxide released during the kneading and/or leavening process and leading to the creation of a light phulka, an airy croissant or a melt-in-the-mouth sponge cake.
Once the gluten is consumed, it triggers a whole set of reactions determined by the particular genetic make-up of a person. “About one- third of Indians have the type of HLA [human leukocyte antigen] pattern that potentially makes them allergic to gluten,” says Dr Ramakrishna, who redflagged the damage potential of gluten intolerance in India with a paper in the Indian Journal of Medical Research in January 2011.
“However, very few of these people will ever develop coeliac disease. One factor may be the total amount of gluten they eat daily. And there are almost certainly other genetic factors that may decide whether or not the individual is susceptible to coeliac disease. What we
do know is that the two-thirds of the population that does not have this HLA pattern will not get coeliac disease even if they eat a lot of gluten.”
What is also certain is that, for a population, the occurrence of coeliac disease corresponds to the amount of wheat consumed in the diet. So, currently, the incidence of the disease in northern India — where wheat is the mainstay of the diet — is estimated at around 1% of the population. It is thought to be far less in rice-eating eastern and southern India.
The ABC of Coeliac
In its classical form, coeliac disease is a chronic digestive disorder: as little as 10 mg of gluten can trigger an immune reaction that attacks the small intestine, causing both stomach distress and nutritional deficiencies.
Recent research, however, indicates that “coeliac disease is a multi-system disorder... highly variable in its clinical expression, may occur at any age and may present with a variety of manifestations.” Apart from the gastrointestinal effects, it may express itself as iron deficiency, fatigue, osteoporosis, delayed puberty, infertility, canker sores, depression and epilepsy – and this is not even an exhaustive list.
Though many of these symptoms can have other root causes, there are no foolproof tests to confirm coeliac disease. Doctors use blood serum tests to confirm the presence of antibodies to tissue transglutaminase (anti-tTG). However, false positives are common and further tests, including a biopsy, are necessary to confirm coeliac disease.
There’s a chance, though, that someone will exhibit many of the symptoms of coeliac, yet test negative for the disease. This form of wheat intolerance is called non-coeliac gluten sensitivity (NCGS). “From a physician’s point of view, coeliac disease occurs in people of a certain HLA type. There is also a characteristic antibody in the blood and the intestinal lining may be flattened. NCGS [on the other hand] can be diagnosed when a person clearly has allergic symptoms to wheat or gluten) but the HLA/antibody/biopsy may not be characteristic of coeliac,” explains Dr Ramakrishna.
Clinical nutritionist and founderpresident of the Coeliac Society of Delhi, Ishi Khosla, concurs: “Unlike coeliac, which is an autoimmune or allergic reaction, NCGS describes those who experience symptoms like bloating, diarrhoea and cramps but without the intestinal damage.”
What About Wheat?
Be it full-fledged coeliac disease or NCGS, there’s only one treatment: cease gluten consumption. Which means no breads, rotis, pastas, noodles, muesli, b re a d - c r u m b e d fries, wheat flakes, oat bran etc (for a more comprehensive list, see Chief Offenders). After some symptomatic treatment for her cramps and allergies, that’s the path George-Abraham adopted. “For almost three years now, I have not tasted regular bread,” she says. “I yearn for a croissant. But I know the pain and discomfort I will suffer won’t be worth it. So I resist the temptation.”
Considering the sneaky ways gluten enters our diet, this is harder than it sounds. “For instance, commercial asafoetida manufacturers use maida as an anti-coagulant. So a pinch of that hing in sambar could be dangerous for me,” says George-Abraham. “Reading food labels has become second nature to me. At a party, people will try urge me to have just a bite of the birthday cake or the papri chaat, saying a small portion won’t do any harm. Now I tell them upfront about my health condition, something that didn’t come easily to me for a long time. Before I step into a restaurant, I call ahead to check if they can serve me a gluten-free meal. If I go on a journey, I carry foodstuff with me.”
The Alternatives
Besides those diagnosed with coeliac and NCGS, a growing number of urban Indians are dropping wheat from their diet by choice. Among them is Jyoti Gupta, 35, and a Mysore-based digital marketing consultant, who, with her entire family, went gluten-free more than a decade ago on her chiropractor’s advice.
“None of us was ever diagnosed with coeliac, though we suffered from bloating, gas problems, wheezing, diarrhoea and lack of appetite. We used to have a regular north Indian diet of rotis and parathas, but now we have switched to rotis and breads made with amaranth and millet flours, besides rice, usually red rice,” says Gupta. “The impact has been immense. We feel lighter. There’s no more bloating, gas, colds or wheezing. Even the chronic back pain is gone.”
Healthcare professionals, however, are cautious about the trend. “Self-diagnosis and going off gluten can lead to a missed diagnosis of more serious coeliac disease,” says Khosla. “It is always advisable to seek professional help when in doubt.”
If the symptoms are bothersome, a gluten-free diet may be used on a 1-3 month trial basis to see if coeliac disease is at their root, says Dr Ramakrishna. “It is up to each individual what he or she eats or does not eat. However, wheat has the highest protein content among cereals and it will not make sense for the majority of normal people to avoid it,” he adds.
At the population level, where coeliac is increasingly becoming manifest in India, policymakers are recommending greater use of rice, maize, ragi, jowar etc, alongside increased consumption of milk, dal etc, to address the protein imbalance.
Gluten-abstaining individuals, says Khosla, could actually acquire a nutritional advantage by including indigenous and often-ignored grains such as millets (ragi, bajra), amaranth (ramdana) and brown rice, which have exceptional quantities of protein, calcium, iron and fibre.
GLUTEN-FREE GRAINS
• Rice, wild rice
• Corn, maize, cornmeal
• Sorghum ( jowar)
• Chestnut flour (singhara)
• Quinoa
• Pearl millet (bajra)
• Finger millet (ragi)
• Buckwheat (kuttu)
• Amaranth (ramdana)
• Sago (sabudana)
(Information courtesy nutritionist Ishi Khosla)
CHIEF OFFENDERS
• Wheat, wheat germ, wheat bran, wheat starch, bulgur, kibbled wheat, semolina, farina (cream of wheat), spelt, kamut, einkorn
• Barley, barley malt and barley extract
• Rye
• Triticale
• Oats, oat bran, oat germ
• Semolina (sooji) Urban Indians largely consume gluten in rotis, puris, parathas, papris, golgappas, mathris, theplas, khakras, breads, noodles, pastas, couscous, wheat flakes, wheat pops, breakfast cereals containing wheat, oats, barley or rye, corn or rice cereals containing malt/ malt extract (barley), muesli, porridge (dalia), wheat germ, wheat bran, oat bran, barley bran, crackers, biscuits, pretzels, doughnuts etc. Besides foodstuff, gluten may also be found in asafoetida, soup cubes, soya sauce, cosmetics and medications.
Cotent Courtesy: Good Food Magazine
India
::
Sumana Mukherjee ETM130331
No comments:
Post a Comment