Do you get stomach aches after eating bread or noodles? Could this be Celiac Disease?

Have you ever wondered why, after eating something like bread, roti, or noodles, you sometimes feel a strange, painful, or full feeling in your stomach? For some people, this happens all the time. We think to ourselves, "Oh... I can't eat that." But behind this discomfort that comes with eating flour, there may be a serious story that we don't know. That story is celiac disease, or as we say in English, `(Celiac Disease)`. Today, we will talk about this very simply, in a way that you can understand.

Simply put, what is Celiac Disease?

Imagine that you have a very smart, strong defense army inside your body. We call this the immune system. The job of this army is to find, attack, and destroy enemies like viruses and bacteria that enter your body, protecting you from disease.

But in someone with celiac disease, this defense system makes a small mistake. It mistakes something harmless and normal for an enemy. In this case, that "enemy" is a protein called gluten .

So, when someone with celiac disease eats a food containing gluten, the immune system gets a signal saying, "Here comes an enemy!" Then the immune system goes and starts fighting the gluten. But this battle takes place inside your small intestine . In this battle, unfortunately, not only is the gluten damaged, but the walls of your small intestine are also damaged.

Okay, so what is this gluten that everyone is talking about?

Gluten is a protein found in grains like wheat, barley, and rye. It is what gives bread dough its stretchy, or elastic, quality when kneaded. This is what helps breads and cakes rise and rise beautifully.

Many of the foods we eat in Sri Lanka contain gluten. Just think...

• Breakfast: Wheat flour, which is added to some curries eaten with bread, buns, toast, and milk rice.
• For lunch: Sometimes I eat noodles and pasta.
• Afternoon tea time: cakes, biscuits, patties, rolls, fish cakes.
• For dinner: roti, paratha, kottu.

In addition to this, gluten can be hidden in many things that we don't think about. For example, gluten is added to sauces, soup packets, some processed meats, and even ice cream to make it thicker. Therefore, someone with celiac disease needs to be very careful.

Can this disease be dangerous?

Yes, this can be serious if left untreated. As we discussed earlier, every time we eat gluten, the small intestine is damaged. The inner wall of our small intestine has millions of tiny finger-like projections. We call these `(villi)`. The main function of these is to absorb nutrients (vitamins, minerals, proteins) from the food we eat.

In celiac disease, when the immune system attacks, these villi flatten and are destroyed. It's like someone trampling a beautiful lawn. What happens then? The body doesn't absorb nutrients from food properly. We call this condition malabsorption.

If this continues, malnutrition will occur. This is the most dangerous thing. This especially affects young children.

• Children may have stunted growth (not growing taller, not getting bigger).
• It can affect the mental and physical development of children.

Therefore, it is not a good idea to dismiss this as "just a normal stomach ache."

What are the symptoms of celiac disease?

One problem with this disease is that the symptoms vary greatly from person to person. Some people may not show any symptoms at all. But the damage is happening inside the body. There are usually two age groups in which this disease occurs.

1. In early childhood: Around the age of one year, that is, when you start giving small children foods containing gluten, such as biscuits and cereals.

2. Middle age: Between the ages of 40 and 60.

Let's look at the table below to see what the main symptom categories are.

Why does this disease occur? What are the risk factors?

Celiac disease is a hereditary condition . This means that it has a genetic link. Almost everyone with celiac disease has one of the gene mutations called `(HLA-DQ2)` or `(HLA-DQ8)`. However, not everyone who has these genes will develop the disease.

Doctors believe that in addition to genes, other factors may play a role in the development of this disease. But they have not yet found out exactly what they are. Some say that this disease can suddenly appear due to something like major surgery, a serious illness, or pregnancy.

These people are at higher risk:

• If someone in the family (mother, father, sibling) has celiac disease.
• If you have another autoimmune disease (e.g., Type 1 diabetes, thyroid disease).
• If there are chromosomal abnormalities such as Turner syndrome or Down syndrome.
• Women are more likely to develop this disease.

What are the long-term effects if left untreated?

This is also very important. If the disease is not recognized or ignored, serious complications can develop over time.

How do you know for sure if you have this disease?

If you have the symptoms mentioned above, the first and most important thing to do is see your doctor. Don't just decide, "I'm gluten intolerant," and stop eating gluten. Doing so can lead to inaccurate diagnostic test results.

The doctor mainly uses two testing methods to confirm the disease.

1. Blood Test: This checks to see if your blood contains special antibodies that the immune system produces against gluten.

2. Endoscopy: If the blood test results are ``positive``, a gastroenterologist will then perform this test. In this, a thin tube with a camera attached is inserted through the mouth and the small intestine is examined. At the same time, a very small piece of tissue ``(biopsy)`` is taken from the wall of the small intestine and sent to the laboratory. There, the ``(villi)`` that we mentioned are examined under a microscope to confirm whether they are damaged.

What are the treatments? Will I have to take medication for the rest of my life?

Here's the good news. The only and most effective treatment for celiac disease is a lifelong 100% gluten-free diet. Yes, you don't have to take a bunch of pills. All you have to do is change your diet.

When you stop eating gluten completely, the damage to your small intestine stops. Then it gradually begins to recover, or heal. Over a few months, nutrient absorption begins to return to normal.

In addition to this, your doctor may recommend the following:

• If nutritional deficiencies are severe, consider vitamin and mineral supplements (e.g. iron tablets).
• Medicines to treat skin rash (dermatitis herpetiformis).
• If the inflammation in the intestine is too severe, short-term corticosteroids may be used to control it.

How do you adapt to a gluten-free life?

This may seem a little difficult at first, because we have to give up a lot of the foods we are used to. But this is an investment in your health. Over time, this will become a normal part of your life.

Here are a few tips that might help you:

• Get into the habit of reading labels: Read the ``ingredients'' on every package you buy from the store. Check to see if it says ``Contains wheat, barley, rye.''
• Identify things that are naturally gluten-free: Rice, vegetables, fruits, meat, fish, eggs, and dairy products are naturally gluten-free.
• Our local substitutes: Instead of bread flour, you can eat foods made from rice flour, semolina flour, chickpea flour, and green gram flour (indiappa, pittu, roti, those).
• Be careful when eating out: If you're eating out at a restaurant, ask them if they have gluten-free options. In places where things like kottu and paratha are made, gluten can be added to the same pan as gluten-free food (cross-contamination). Be careful about that too.
• Create a home menu: Think of a few easy-to-prepare meals that you can eat, and keep the ingredients at home. Then you won't have to worry about getting hungry.

Being diagnosed with celiac disease is a big change in your life. But it's a good change. Now you know the cause of your long-standing discomfort. The solution is in your hands. With the right diet, you can live a full, healthy, and happy life.

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