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Your Questions Answered by Dr. Mohinish Chabbra

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:

  1. Inadvertent intake of gluten which you are not aware
  2. Micros scopic colitis
  3. Secondary bacterial overgrowth
  4. 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.?

 
Answer: Any product with gluten less than 20 ppm can  be taken with no problem at all
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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 Mohinish Chhabra

Dr Mohinish Chhabra
Director, Department of Gastroenterology and Hepatology at Fortis Hospital, Mohali