Doctors told what is really dangerous gluten intolerance

About such a diagnosis as celiac disease, even doctors often did not hear anything. And often adults find out that they suffer from gluten intolerance, having already acquired serious health complications. But more often they don’t even know: a rare doctor, faced with a patient, for example, with bowel cancer, will send him to be checked for celiac disease.

Unlike allergies, this disease is autoimmune, it is incurable, and with it, even in the absence of clinical manifestations, it is necessary to follow a diet for life, that is, to give up gluten completely and forever. This is the only way to avoid the development of severe complications, including not only gastrointestinal cancer, but also miscarriage, type 1 diabetes, anemia, and much more.

During the 1st National Forum Forum “Children’s Health and Safety” held in Moscow, doctors came up with an initiative to introduce mass screening for celiac disease in the country.

According to expert estimates, about every hundredth Russian suffers from celiac disease (gluten intolerance). In Sweden, every 56th citizen has this autoimmune disease. Sometimes minor symptoms speak of the disease: anemia, hair loss, brittle nails. Not even all doctors today know about celiac disease, many consider it extremely rare (although it occurs in 4% of patients with gastrointestinal manifestations) or even a childhood disease that can be “outgrown”. And if an adult patient is not treated for a long time and does not follow a diet, unfortunately, he encounters complications – mainly oncological diseases. Thus, gastrointestinal cancer in people with celiac disease occurs 60-80 times more often than in the general population. Although oncologists in such situations are the last to be examined for celiac disease. It is also unlikely that a patient with type 1 diabetes mellitus or with autoimmune thyroidin, which is also caused by gluten intolerance, will be referred there. In addition, it can become a direct cause of habitual miscarriage. Early diagnosis and a strict diet could save such people from developing complications, experts say.

According to the deputy director for scientific work of the Moscow Clinical Research Center, gastroenterologist Elena Sabelnikova, habitual miscarriages are significantly more common in patients with celiac disease. A few years ago, she initiated a study of patients with infertility, miscarriages and miscarriages in three obstetric facilities in Moscow: “Many gynecologists actively resisted. They said in plain text: what a nonsense, celiac disease is extremely rare and has nothing to do with reproductive function! But we diagnosed it in 7 out of 217 women, put them on a diet – and two of them became pregnant and had children shortly thereafter. Then they came to us with flowers to say thank you that we helped them understand the exact cause of their condition. This confirmed the speculation that it is necessary to examine patients at risk.”

… In the old days, celiac disease was called a disease of the abdomen – patients with general thinness are distinguished by large waists. Of course, some adults do not suspect celiac disease for many years (for example, the oldest patient who first learned about this pathology, Dr. Sabelnikova turned out to be an 80-year-old lady). And yet, most often, celiac disease makes itself felt in early childhood: on average, it is detected at the age of 5-7 years. The first “bells” may be iron deficiency anemia, a lag in physical development (height and, especially, weight). A detailed examination helps to establish the diagnosis, but the first and most important marker of the disease is the level of antibodies to tissue transglutaminase.

Diagnosed children need to be closely monitored for health indicators such as iron levels in the blood (they are often diagnosed with iron deficiency anemia), folic acid levels, vitamins B12 and D, calcium, thyroid hormones. This allows you to identify serious pathologies before they make themselves felt. As Ekaterina Skorobogatova, head of the 2nd pediatric department of the Children’s City Clinical Hospital named after Bashlyaeva, says, even if the child does not have diarrhea, but has anemia, celiac disease must be ruled out: “If children follow a diet, but antibodies do not decrease and grow, this may be an early symptom of diabetes mellitus 1 type. Alas, not all mothers understand the seriousness of the diagnosis, and sometimes as soon as the child improves, gains weight, they forget about the diet. “We look for celiac disease wherever there is malnutrition, anemia, alopecia, diabetes; often it is combined with ulcerative colitis, Crohn’s disease, rheumatoid arthritis. Every hundredth is sick, so every pediatrician with 1,000 children should have 10 patients. It is important for us not to instruct diagnoses, but to prevent complications. By the way, we recently talked with colleagues from the Moscow ambulance – they told us about a noticeable increase in the number of children with type 1 diabetes mellitus with diarrhea, ”says Professor, Honored Doctor of Russia, Head of the Department of Pediatrics with a course of outpatient pediatrics named after. Academician G.N. Speransky FGBOU DPO RMANPE Ministry of Health of the Russian Federation Irina Zakharova.

But even more careful monitoring is needed for the adults around the children. Practice shows that even if a mother swears that she is watching the child’s diet, she cannot be trusted.

– First of all, you have to fight with older relatives. Whatever scientific data we cite, they still believe that the threat is exaggerated, and that it is necessary to accustom the child to gluten gradually. Even the fact that dieting patients with celiac disease have a 300-fold increased risk of malignant intestinal lymphoma is not convincing. And the grandmother begins to feed her grandson with bread that is strictly forbidden for him. As a result, after a few years, the child turns into a wreck with a huge belly and a general lack of body weight. Celiac disease is not an allergy to gluten, but a serious autoimmune disease, says Irina Zakharova.

– We never trust what the mother says, we ask you to write down everything that the child eats in the diary – this is how we identify violations, – says a pediatric gastroenterologist, head of the Functional Center for Children with Celiac Disease of the Children’s Clinical Hospital named after. Bashlyaeva Yulia Dmitrieva. – If celiac disease is manifested by a lack of weight, abdominal pain, the diet works amazingly. But it happens that a mother, accepting the diagnosis, is so afraid of giving something to her child that she cuts the diet so that the calorie content suffers. In addition, if the diagnosis is made late and children have developmental delays, it will be more difficult to achieve peer performance. For example, once endocrinologists sent a 10-year-old boy to us, who had been observed for 6.5 years for delayed physical development, we identified markers of celiac disease in him. On a gluten-free diet, six months later, his antibody levels returned to normal, but the child did not grow. When celiac disease is established late, it is much more difficult to get a child out of growth retardation than out of underweight. There is a complex contingent of children who do not complain, and their celiac disease manifests itself in a form without intestinal symptoms – it is very difficult to convince them of a diet, because nothing bothers them.

However, the need for a lifelong diet (alas, there are no other options for celiac disease) often causes depression in patients. “For example, one teenager, having learned about this, said – will I really be deprived of bread all my life? Although before that he did not love him at all, – says Professor Zakharova. – I have to explain that everything is not so scary: fruits and vegetables are completely safe for such people. Everything that is not cooked and everything without gravy can be taken. Today in shops and cafes you can find products for such patients, there are bread substitutes. I know colleagues who have established such a diagnosis for themselves – they carry with them the bread they are allowed to (can be corn). Patients with multiple polyvalent allergies are much worse. I had a patient, a young man who was allergic to all foods – half an hour after eating, he did not leave the toilet. I could only eat at night, I could not attend the institute. Until they picked up canned medical food for him.

In recent years, nutrition for patients with celiac disease in the country has improved, restaurants have appeared offering me gluten-free. However, in kindergartens, such menus are the exception, not the rule. “A huge problem is the lack of specialized nutrition in kindergartens,” says Yulia Dmitrieva. – In St. Petersburg there are many kindergartens with a gluten-free menu, and in Moscow – at best, one per district. There are dairy-free diets, but gluten-free ones are hard to find. At the same time, according to sanitary standards, it is strictly forbidden to bring food with you, and sometimes the issue is resolved by filing an application with the prosecutor’s office. Recently, an order was issued by the capital’s Department of Education, which will allow individual parents to bring food to kindergartens. Why, even in hospitals we don’t have a menu for celiac patients.

Adding fuel to the fire are numerous bloggers who distribute diet advice on the Internet, which often makes doctors hair stand on end. Patients later say that they do not eat chicken meat because they smoke wheat or bananas, which supposedly contain gluten, do not brush their teeth and do not kiss those who have drunk something wrong.

The reverse side of the coin is the fashion for gluten-free diets for everyone, even for those who do not have celiac disease. According to Dr. Sabelnikova, after five years, such people begin to lose hair, exfoliate nails, and teeth fall out: “I am not a supporter of any diets. But if a person decides to give up something (from red meat, gluten), he must understand that he will have a shortage of substances that need to be replenished. With gluten-free diets, there is, first of all, a deficiency of B vitamins, which are needed for the functioning of the intestines, microflora, as well as a deficiency of magnesium and calcium. Any diet entails a deficiency of intestinal enzymes.

Irina Zakharova says that there are parents who create dietary restrictions for their children: “We categorically do not support vegetarianism in children, it entails both growth deficiency and depression, and micronutrient and macronutrient deficiencies. I remember once I ran into a dad who made a three-month-old baby a raw foodist: he did not go to the doctors, and the child simply stopped gaining weight. He fed the child with basil, parsley and dill – a vegetable will grow out of such a child. You need to eat everything, but in moderation.

Another problem is the issue of social support, which has not been resolved in the country. Specialized products are expensive. Therefore, many European countries provide benefits to such patients. We have only some regions (for example, in Chelyabinsk they are allocated 60 thousand rubles a year, and in St. Petersburg monthly payments are provided). Sometimes parents make their children disabled – this is the only way you can count on at least some support from the state.

Meanwhile, the prevalence of celiac disease in the world is growing: diagnostics are improving, and more and more cases are being detected with atypical symptoms – (for example, baldness). “The frequency of all autoimmune diseases is growing: rheumatological, Crohn’s disease, celiac disease. Both nutrition and viral infections can play a role: for example, there are publications that coronavirus can be a provocateur of autoimmune diseases,” says Dr. Dmitrieva.

It used to be thought that the frequency of gluten intolerance was decreasing in southern latitudes, but then it turned out that among the Bedouins of the Sahara this is a serious problem, because they eat tortillas all the time, and their life expectancy is short.

Experts believe that it is important to conduct mass screening in the country in order to create a unified register of patients, which does not exist. There will be a register – it will be possible to calculate how many kindergartens are needed with gluten-free food, how many children’s camps. They will start from Moscow, where a population study will soon take place. It will be held at the Children’s Hospital. Bashlyaeva among 10 thousand children without gastrointestinal symptoms. It is possible that further screening will be extended to the whole country.