In an individual with a healthy digestive system, food that has been broken down in the stomach and duodenum passes through the small intestines, where finger-like folds (villi) absorb the essential nutrients.
When a celiac patient consumes food containing gluten, the intestine responds to the food as if it were a foreign body, and produces an immune reaction causing inflammatory damage to the villi. This in turn leads to the shortening or blunting and flattening of villi, thus impairing their ability to absorb nutrients. This is referred to as villous atrophy. Depending on its severity, it may be classified as partial, sub-total or total villous atrophy. Untreated celiac disease can cause weight loss and wasting, which along with malabsorption and malnutrition leads to variable, complex and serious effects as the disease progresses.
Celiac disease can therefore, be referred to as a malabsorption syndrome.
Wheat related Disorders
Wheat related Disorders manifest in different ways, on the basis of the effect they have on our immune system. This includes:
Celiac Disease, Non- Celiac Wheat Sensitivity (NCWS), Wheat Allergy.
Signs and Symptoms of Wheat Related Disorders:
An impaired gut leads to a variety of complications, the most prevalent include :
- Gastrointestinal disturbances (abdominal bloating, flatulence, abdominal pain, constipation, chronic diarrhoea, reflux ,nausea & vomiting )
- Dermatitis Herpetiformis
- Stunted growth & developmental delay
- Attention Deficit Hyperactivity Disorder (ADHD),
- Ataxia ( Imbalance)
- Psoriasis and eczema
- Increase risk of disorders like diabetes, thyroid disorders, liver diseases and certain types of cancers .
Non-Celiac Wheat Sensitivity:
The difference between celiac disease and non- celiac wheat sensitivity is in intestinal permeability and genes regulating the immune response in the gut. Intestinal permeability connotes the ability of the mucosal layer of the digestive tract to prevent bacteria, antigens, and undigested food proteins from seeping through the gastrointestinal barrier.
Those who have celiac or wheat sensitivity often have a high degree of permeability, called the leaky gut.
The type of damage to the mucosa in celiac disease is however distinct .
In other words the mechanisms of intestinal damage are different but the manifestations & management in both conditions are similar .
Listed among the top eight food allergens (others being soy, peanuts, tree nuts, dairy, egg, fish and shellfish), adverse reactions to wheat, apart from celiac disease, can be in the form of an allergy, skin rashes or non-celiac wheat intolerance. Most common symptoms for allergies could be respiratory, asthma, atopic dermatitis, urticaria, anaphylaxis and colic & vomiting.
Health Impact of Wheat related Disorders :
That there is a wide range of diseases and medical conditions that are associated with intake of wheat is revealed by the statement of Dr. Alessio Fasano (Director of Pediatric Gastroenterology at the Massachusetts General Hospital for Children, Boston). He claims that around 300 health conditions are linked to wheat/gluten intolerance.
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Epidemiological research shows that the frequency of celiac disease continues to be on the rise. In the United States, for example, the frequency has increased over the last 40 years from 2 cases per thousand to 10 cases per thousand (1%). Though authentic data is unavailable about prevalence in India, according to projections, it is estimated that 1-2% of the Indian population suffers from celiac disease. It has gone up four times since the 1960s.
Highly Under-diagnosed Condition:
Wheat sensitivity is often compared to an iceberg where the visible tip represents those with the symptomatic ailment. The greater proportion of the iceberg represents thtose with silent or latent forms of the disease. It is estimated that over 90% remain undiagnosed. According to estimates, it can take more than 10 years from symptoms to diagnosis, even in the Western countries.