Search

Hemophilia

Hemophilia is usually an inherited bleeding disorder in which the blood does not clot properly. This can lead to spontaneous bleeding as well as bleeding following injuries or surgery. Blood contains many proteins called clotting factors that can help to stop bleeding. People with hemophilia have low levels of either factor VIII (8) or factor IX (9). The severity of hemophilia that a person has is determined by the amount of factors in the blood. The lower the amount of the factor, the more likely it is that bleeding will occur which can lead to serious health problems.

Types of hemophilia 

Type A 

Hemophilia type A is caused by a missing or defective factor VIII protein. It has three stages depending on the ratio of clotting protein in the blood: mild, moderate, and severe. People with hemophilia A bleed longer than others, internally or externally. Those with mild cases generally bleed only after serious injury, trauma, or surgery. Often, the disease is diagnosed after one of these situations due to prolonged bleeding, and the first episode may occur only in adulthood.​

Type B 

Hemophilia type B is caused by a missing or defective factor IX clotting protein. This type is rarer than type A; however, the severity and symptoms are similar. A subtype of hemophilia type B, known as hemophilia B Leyden, causes episodes of excessive bleeding in childhood, which gradually disappear after puberty.​

Type C 

Hemophilia type C is caused by a missing or defective factor XI clotting protein. Unlike hemophilia A and B, symptoms don’t correlate with factor XI levels in the blood. People with lower levels may bleed less than those with higher levels of clotting protein. Patients often experience nosebleeds or soft tissue bleeds, as well as hemorrhaging after tooth extraction. Factor XI concentrates are unavailable in the U.S. as yet, so doctors normally treat hemophilia C with fresh frozen plasma.​

Acquired Hemophilia 

Acquired hemophilia is an autoimmune disorder in which the body’s immune system mistakes self-proteins as foreign and starts producing antibodies against them. In this type of hemophilia, the immune system mistakes the blood clotting protein called factor VIII as foreign and starts to produce antibodies against it. As a result, factor VIII activity is inhibited, which leads to excessive bleeding.

 

Symptoms of hemophilia 

Common signs of hemophilia include:​(3)​ 

  • bruising 
  • hematomas, which is when there is bleeding into the muscle or soft tissues 
  • bleeding from the mouth and gums 
  • bleeding after a circumcision 
  • blood in the stool 
  • blood in the urine 
  • nosebleeds that are frequent and difficult to stop 
  • bleeding after vaccinations or other injections 
  • bleeding into the joints 

According to the National Organization for Rare Disorders, the severity of hemophilia can also affect symptoms. 

In mild cases, a person will most likely experience:​(3)​ 

  • spontaneous nose bleeds 
  • bleeding from the mouth or gums 
  • easy bruising or hematomas 
  • excessive bleeding following dental or other surgical procedures or injury 

Symptoms for people living with the mild form may not show until adulthood. 

In moderate cases of hemophilia, a person may experience: 

  • easy and excessive bruising 
  • excessive bleeding following surgeries or trauma 

In severe cases of hemophilia, a person may experience spontaneous bleeding, often in the muscles or joints. This can lead to pain and swelling. 

Without treatment, it can result in arthritis in the affected joints. Doctors can often diagnose severe cases when the person is an infant 

causes of hemophilia 

Certain genes create clotting factors. In inherited hemophilia, the genes carrying instructions for making normal clotting factors mutate or change. The mutated genes may give instructions that end up making abnormal clotting factors or not enough clotting factors. That said, about 20% of all hemophilia cases are spontaneous, meaning someone has the disease even though there’s no family history of abnormal bleeding.​(1)​ 

Risk factors 

The biggest risk factor for hemophilia is having family members who also have the disorder. Males are much more likely to have hemophilia than females.​(4)​ 

How do healthcare providers diagnose hemophilia? 

A healthcare provider will start by doing a complete history and physical examination. If you have hemophilia symptoms, the provider will ask about your family’s medical history. Providers may do the following tests:​(5)​ 

  • Complete blood count (CBC): Providers use this test to measure and study blood cells. 
  • Prothrombin time (PT) test: Providers use this test to see how quickly your blood clots. 
  • Activated partial thromboplastin time test: This is another blood test to time blood clot formation. 
  • Specific clotting factor test(s): This blood test show levels of specific clotting factor levels (such as factor 8 and factor 9). 

  

Treatment 

The main treatment for severe hemophilia involves replacing the clotting factor you need through a tube in a vein. 

This replacement therapy can be given to treat a bleeding episode in progress. It can also be given on a regular schedule at home to help prevent bleeding episodes. Some people receive continuous replacement therapy.​(6)​ 

Replacement clotting factor can be made from donated blood. Similar products called recombinant clotting factors, are made in a laboratory, not from human blood. 

Other therapies include:​(6,7)​ 

  • Desmopressin. In some forms of mild hemophilia, this hormone can stimulate the body to release more clotting factors. It can be injected slowly into a vein or used as a nasal spray. 
  • Emicizumab (Hemlibra). This is a newer drug that doesn't include clotting factors. This drug can help prevent bleeding episodes in people with hemophilia A. 
  • Clot-preserving medications. Also known as anti-fibrinolytic, these medications help prevent clots from breaking down. 
  • Fibrin sealants. These can be applied directly to wound sites to promote clotting and healing. Fibrin sealants are especially useful for dental work. 
  • Physical therapy. It can ease signs and symptoms if internal bleeding has damaged your joints. Severe damage might require surgery. 

First aid for minor cuts. Using pressure and a bandage will generally take care of the bleeding. For small areas of bleeding beneath the skin, use an ice pack. Ice pops can be used to slow down minor bleeding in the mouth.

 

Living with hemophilia 

With treatment, most people with hemophilia can live a normal life. 

However, you should:​(8)​ 

Looking after your teeth and gums helps you avoid problems such as gum disease, which can cause bleeding. Most non-surgical dental treatment can be done at a general dental surgery. 

  

Food to eat and avoid with hemophilia:​(9)​ 

  

1: Iron-rich food 

Maintaining iron levels is particularly important for people with hemophilia, as an estimated 0,75 micrograms of iron is lost with each 15 ml of blood. Iron-rich foods include liver, lean red meat, poultry, and leafy green vegetables such as spinach, broccoli, dried beans, grains, and raisins. Combining iron-rich foods with good sources of vitamin C can enhance iron absorption by the body. 

2: Whole grains 

Increasing your whole grain intake – making half of your grain consumption come from oats, barley, whole wheat, bran, brown rice, or pasta is a good way to satiate your appetite, lower your cholesterol, and stabilize blood glucose levels. 

3: Low-fat or no fat 

Switching to low-fat dairy products – skimmed milk or low-fat cheeses- are good sources of vitamins and minerals as well as calcium, without the unnecessary fats. Also: reduce your fat intake by choosing baking, boiling, or grilling instead of frying. And use vegetable oils over butter or animal fats. 

4: Avoid hidden sugars and fatteners 

Many people don’t realize how much sugar is contained in soft drinks, but also ‘healthy’ fruit juices can be full of calories and sugar. Especially notorious are smoothies and yogurt shakes. Also risky are salad dressings and condiments: have them on the side if possible. And choose mustard instead of mayonnaise or ketchup: mustard mostly consists of vinegar. 

5: Be careful with supplements 

If you are considering dietary supplements, discuss your choices with your doctor before taking any supplements, as some might increase bleeding tendency or clotting times in the same way as aspirin or non-steroidal anti-inflammatories do. Some supplements — such as vitamin E, fish oil, ginkgo biloba, bromelain, flax seed, garlic, or ginger — may need to be avoided altogether. 

causes of hemophilia 

Certain genes create clotting factors. In inherited hemophilia, the genes carrying instructions for making normal clotting factors mutate or change. The mutated genes may give instructions that end up making abnormal clotting factors or not enough clotting factors. That said, about 20% of all hemophilia cases are spontaneous, meaning someone has the disease even though there’s no family history of abnormal bleeding.​(1)​ 

Risk factors 

The biggest risk factor for hemophilia is having family members who also have the disorder. Males are much more likely to have hemophilia than females.​(4)​ 

How do healthcare providers diagnose hemophilia? 

A healthcare provider will start by doing a complete history and physical examination. If you have hemophilia symptoms, the provider will ask about your family’s medical history. Providers may do the following tests:​(5)​ 

  • Complete blood count (CBC): Providers use this test to measure and study blood cells. 
  • Prothrombin time (PT) test: Providers use this test to see how quickly your blood clots. 
  • Activated partial thromboplastin time test: This is another blood test to time blood clot formation. 
  • Specific clotting factor test(s): This blood test show levels of specific clotting factor levels (such as factor 8 and factor 9). 

  

Treatment 

The main treatment for severe hemophilia involves replacing the clotting factor you need through a tube in a vein. 

This replacement therapy can be given to treat a bleeding episode in progress. It can also be given on a regular schedule at home to help prevent bleeding episodes. Some people receive continuous replacement therapy.​(6)​ 

Replacement clotting factor can be made from donated blood. Similar products called recombinant clotting factors, are made in a laboratory, not from human blood. 

Other therapies include:​(6,7)​ 

  • Desmopressin. In some forms of mild hemophilia, this hormone can stimulate the body to release more clotting factors. It can be injected slowly into a vein or used as a nasal spray. 
  • Emicizumab (Hemlibra). This is a newer drug that doesn't include clotting factors. This drug can help prevent bleeding episodes in people with hemophilia A. 
  • Clot-preserving medications. Also known as anti-fibrinolytic, these medications help prevent clots from breaking down. 
  • Fibrin sealants. These can be applied directly to wound sites to promote clotting and healing. Fibrin sealants are especially useful for dental work. 
  • Physical therapy. It can ease signs and symptoms if internal bleeding has damaged your joints. Severe damage might require surgery. 

First aid for minor cuts. Using pressure and a bandage will generally take care of the bleeding. For small areas of bleeding beneath the skin, use an ice pack. Ice pops can be used to slow down minor bleeding in the mouth.

 

Living with hemophilia 

With treatment, most people with hemophilia can live a normal life. 

However, you should:​(8)​ 

Looking after your teeth and gums helps you avoid problems such as gum disease, which can cause bleeding. Most non-surgical dental treatment can be done at a general dental surgery. 

  

Food to eat and avoid with hemophilia:​(9)​ 

  

1: Iron-rich food 

Maintaining iron levels is particularly important for people with hemophilia, as an estimated 0,75 micrograms of iron is lost with each 15 ml of blood. Iron-rich foods include liver, lean red meat, poultry, and leafy green vegetables such as spinach, broccoli, dried beans, grains, and raisins. Combining iron-rich foods with good sources of vitamin C can enhance iron absorption by the body. 

2: Whole grains 

Increasing your whole grain intake – making half of your grain consumption come from oats, barley, whole wheat, bran, brown rice, or pasta is a good way to satiate your appetite, lower your cholesterol, and stabilize blood glucose levels. 

3: Low-fat or no fat 

Switching to low-fat dairy products – skimmed milk or low-fat cheeses- are good sources of vitamins and minerals as well as calcium, without the unnecessary fats. Also: reduce your fat intake by choosing baking, boiling, or grilling instead of frying. And use vegetable oils over butter or animal fats. 

4: Avoid hidden sugars and fatteners 

Many people don’t realize how much sugar is contained in soft drinks, but also ‘healthy’ fruit juices can be full of calories and sugar. Especially notorious are smoothies and yogurt shakes. Also risky are salad dressings and condiments: have them on the side if possible. And choose mustard instead of mayonnaise or ketchup: mustard mostly consists of vinegar. 

5: Be careful with supplements 

If you are considering dietary supplements, discuss your choices with your doctor before taking any supplements, as some might increase bleeding tendency or clotting times in the same way as aspirin or non-steroidal anti-inflammatories do. Some supplements — such as vitamin E, fish oil, ginkgo biloba, bromelain, flax seed, garlic, or ginger — may need to be avoided altogether. 

References:  

​​1. What is Hemophilia | CDC [Internet]. [cited 2023 Jul 6]. Available from: https://www.cdc.gov/ncbddd/hemophilia/facts.html 

​2. Types of Hemophilia - Hemophilia News Today [Internet]. [cited 2023 Jul 6]. Available from: https://hemophilianewstoday.com/types-of-hemophilia-2/ 

​3. Hemophilia: Causes, types, symptoms, and treatment [Internet]. [cited 2023 Jul 6]. Available from: https://www.medicalnewstoday.com/articles/154880#symptoms 

​4. Hemophilia - Symptoms and causes - Mayo Clinic [Internet]. [cited 2023 Jul 6]. Available from: https://www.mayoclinic.org/diseases-conditions/hemophilia/symptoms-causes/syc-20373327 

​5. Diagnosis of Hemophilia | CDC [Internet]. [cited 2023 Jul 6]. Available from: https://www.cdc.gov/ncbddd/hemophilia/diagnosis.html 

​6. Hemophilia - Diagnosis and treatment - Mayo Clinic [Internet]. [cited 2023 Jul 6]. Available from: https://www.mayoclinic.org/diseases-conditions/hemophilia/diagnosis-treatment/drc-20373333 

​7. Weyand AC, Pipe SW. New therapies for hemophilia. Blood. 2019 Jan 31;133(5):389–98.  

​8. Haemophilia - NHS [Internet]. [cited 2023 Jul 6]. Available from: https://www.nhs.uk/conditions/haemophilia/ 

​9. Haemophilia: five things to eat and five things to avoid - BJH [Internet]. [cited 2023 Jul 6]. Available from: https://www.bjh.be/haemophilia-five-things-to-eat-and-five-things-to-avoid/ 

Maintaining the health of the digestive system

Maintaining the health of the digestive system is an important thing to do, so how do we maintain the health of the digestive system?

Here is a group of advice that we have collected specifically for you, which will help protect the digestive system from various health problems:

Diet plays an important role in maintaining your digestive health, so you should start with your diet, for example;

1- Yogurt:

Yogurt is made from fermented milk, usually by lactic acid bacteria.
It contains friendly bacteria known as probiotics, which are good bacteria that live in your digestive tract and can help improve digestion. (1)
Probiotics can help with digestive issues, such as bloating, constipation, and diarrhea. (1)
Probiotics naturally occur in your gut, you should boost your intake of food like yogurt or supplements that can ease your digestion. (1)

2- Chia Seeds:

Chia seeds are a source of fiber. They work like a prebiotic, supporting the growth of healthy bacteria in your gut and improving your healthy digestion.
Their fiber content also helps promote bowel regularity and healthy stools.(1)

3- Whole Grains:

Whole grains like oats and quinoa can improve your digestion as fiber helps add bulk to your stool and can reduce constipation, and some grain fibers act like prebiotics that help feed healthy bacteria in your gut. (2)

4- Salmon:

Salmon is an excellent source of Omega-3. Omega-3s found in salmon, decreases inflammation in your gut, thus improving your digestive process. (3)

5- Peppermint:

Peppermint and peppermint oil can decrease symptoms of IBS; including bloating, stomach discomfort and bowel movement issues. (4,5)

6- Apple: 

Apple is a rich source of pectin (soluble fiber). It will help you resolve constipation and diarrhea. (1)

Now that we have outlined recommended food for improving digestive health, here are the some diets and food you should avoid:

1- Acidic food: 

Tomato sauce and citrus fruits, such as lemons, limes, oranges, and grapefruit, are acidic and can irritate the stomach lining, causing digestive problems. (6)
High acidic food and drink:(7)

  • certain dairy products, including cheese
  • processed meats, such as corned beef and turkey
  • carbonated beverages, such as soda
  • high protein foods and supplements with animal protein

2- Dairy products: 

Dairy products can be hard to digest for some people, mainly because of lactose. This case is called lactose intolerance.

What is lactose intolerance? (8)

Lactose is a type of sugar that occurs naturally in the milk of most mammals.
Within humans exists an enzyme called lactase, which is the enzyme that breaks down and digests lactose. The majority of people lack the proper enzyme to digest lactose, making them lactose intolerant.
It may still be okay to eat yogurt and lactose-free milk.
The signs and symptoms of lactose intolerance usually begin from 30 minutes to two hours after eating or drinking foods that contain lactose.
Symptoms of lactose intolerance:

  • Diarrhea
  • Nausea, and sometimes, vomiting
  • Stomach cramps
  • Bloating
  • Gas

When to see a doctor:
Make an appointment with your doctor if you frequently have symptoms of lactose intolerance after eating dairy foods, particularly if you're worried about getting enough calcium.

3- Fatty foods:

Fatty foods stimulate contractions in the digestive tract, which can slow down the emptying of the stomach and worsen constipation or speed up movement, leading to or worsening diarrhea (9).
You should put low-fat foods on the menu and eat small meals spaced throughout the day, which can put less pressure on your stomach. Avoid high-fat food, like butter, ice cream, red meat, and cheese.
You can get your fat needs from healthy fat sources.
Foods that contain healthy fats:(10)

  • Avocado
  • Dark chocolate
  • Whole eggs
  • Salmon
  • Raw nuts
  • Chia seeds
  • Extra virgin olive oil
  • Yogurt

4- Fried food:

The problem with fried food is the same as with fatty foods. Fried foods are low in fiber and take time to digest, so they slow down the digestive process. (9)

5- Processed food:

Processed food should be generally avoided in all cases but specifically, if you have chronic constipation because it contains preservatives, artificial colors, lactose, and is low in fiber. (11)
Some examples of processed foods include:(11)

  • frozen or ready meals
  • baked goods, including pizza, cakes, and pastries
  • packaged bread
  • processed cheese products
  • breakfast cereals
  • crackers and chips
  • candy and ice cream
  • instant noodles and soups
  • reconstituted meats, such as sausages, nuggets, and fish fingers
  • sodas and other sweetened drinks

6-Artificial sweetener:

The artificial sweetener that causes digestive problems is Sorbitol. (9)
Sorbitol has a different name on food labels like D-sorbitol, 50-70-4, E420, and D-glucitol.
So If you have diarrhea, read food labels so that you can avoid Sorbitol.
Processed food products that contain Sorbitol:

  • sugar-free candies for those with diabetes
  • sugar-free chewing gum
  • sugar-free jams and marmalades

Sorbitol can also be found in the juice forms of the high sorbitol fruits such as pear juice and plum juice. Be sure to check the label carefully for such ingredients in food products such as pre-prepared smoothies, trail mixes, cereals, and sauces. (12)

7- Caffeine:

Coffee stimulates gastrin release and gastric acid secretion, leading to heartburn and GERD. Excessive amounts of caffeine can give anyone diarrhea. It’s not recommended to switch to decaf coffee because it still has some caffeine. So if you have heartburn or any digestive problems, try to control coffee, chocolate, soda, and energy drinks. (13,14)

8- Spicy food:

Spicy foods can trigger abdominal pain. For people with inflammatory bowel disease (or IBD — Crohn’s disease or ulcerative colitis), spicy foods can also trigger some symptoms. (15)
If you are suffering from IBS, there are a few tips to deal with IBS:

  • Avoid foods that trigger your symptoms
  • Eat high-fiber foods
  • Drink plenty of fluids
  • Exercise regularly
  • Get enough sleep

Are you aware of gluten intolerance?
Do you know what gluten is?

Gluten is a family of proteins found in grains, including wheat, rye, spelled, and barley. Wheat is the most common grain that contains gluten. (16) When flour mixes with water, the gluten proteins form a sticky network that has a glue-like consistency. This glue-like property makes the dough elastic and gives bread the ability to rise during baking. It also provides a chewy, satisfying texture. (16) People may experience the following symptoms for several hours or days after they consume gluten:(17)

  • Abdominal pain.
  • Anemia.
  • Anxiety.
  • Bloating or gas.
  • Brain fog or trouble concentrating.
  • Depression.
  • Diarrhea or constipation.
  • Fatigue.
  • Headache.
  • Joint pain.
  • Nausea and vomiting.
  • Skin rash.
  • Many people with gluten intolerance also have irritable bowel syndrome (IBS).

Probiotics help increase the good bacteria in your gut. They may reduce symptoms of bloating, gas or constipation.Foods high in gluten that you should avoid:(18)

  • wheat
  • rye
  • barley
  • bread
  • pasta
  • cereals
  • beer
  • cakes, cookies, and pastries

Gluten-free grains that should be in your diet:(18)

  • rice
  • oats
  • quinoa
  • flax
  • millet
  • sorghum
  • arrowroot
  • amaranth

Gluten-free foods:(18)

  • meat
  • fish and seafood
  • eggs
  • dairy products
  • fruits
  • vegetables
  • legumes
  • nuts
  • tubers
  • fats, such as oils and butter

A person should always consult with a healthcare professional before adopting a gluten-free diet.

When to Seek Emergency Care

Severe abdominal pain should never be ignored. Go to your nearest emergency room or call 998 if you have any of these symptoms:(19)

  • Persistent nausea and vomiting
  • Pain accompanied by the inability to have a bowel movement (especially if you are vomiting)
  • Abdominal pain while vomiting blood
  • Profuse or continual bleeding from the bowels
  • Gastric pain accompanied by shortness of breath or difficulty breathing
  • Pain that is severe and sudden
  • Severe tenderness when you touch your abdomen
  • Skin that appears yellow
  • Swelling of the abdomen
  • Pain during pregnancy (or if you suspect you are pregnant)

References 

  1. The 19 Best Foods to Improve Digestion [Internet]. [cited 2022 Feb 14]. Available from: https://www.healthline.com/nutrition/best-foods-for-digestion#TOC_TITLE_HDR_3
  2. The Whole Truth About Whole Grains [Internet]. [cited 2022 Feb 14]. Available from: https://www.webmd.com/food-recipes/features/the-whole-truth-about-whole-grains
  3. Is Salmon Easy To Digest? The Definitive Guide - Foods Fact [Internet]. [cited 2022 Feb 14]. Available from: https://www.foodsfact.org/is-salmon-easy-to-digest/
  4. Sinagra E, Pompei G, Tomasello G, Cappello F, Morreale GC, Amvrosiadis G, et al. Inflammation in irritable bowel syndrome: Myth or new treatment target? World Journal of Gastroenterology [Internet]. 2016 Feb 21 [cited 2022 Feb 14];22(7):2242. Available from: /pmc/articles/PMC4734999/
  5. Cash BD, Epstein MS, Shah SM. A Novel Delivery System of Peppermint Oil Is an Effective Therapy for Irritable Bowel Syndrome Symptoms. Digestive diseases and sciences [Internet]. 2016 Feb 1 [cited 2022 Feb 14];61(2):560–71. Available from: https://pubmed.ncbi.nlm.nih.gov/26319955/
  6. Are acidic foods harmful to health? [Internet]. [cited 2022 Feb 14]. Available from: https://www.medicalnewstoday.com/articles/322557#the-acid-ash-hypothesis
  7. Acidic Foods: What You Need to Know [Internet]. [cited 2022 Feb 14]. Available from: https://www.webmd.com/diet/what-to-know-about-acidic-foods#091e9c5e8218ec9d-2-5
  8. di Costanzo M, Berni Canani R. Lactose Intolerance: Common Misunderstandings. Annals of Nutrition and Metabolism [Internet]. 2019 Feb 1 [cited 2022 Feb 14];73(Suppl 4):30–7. Available from: https://www.mayoclinic.org/diseases-conditions/lactose-intolerance/symptoms-causes/syc-20374232
  9. 11 Foods to Avoid During Digestive Problems and Disorders | Everyday Health [Internet]. [cited 2022 Feb 14]. Available from: https://www.everydayhealth.com/digestive-health/diet/foods-to-avoid-during-digestive-problems/
  10. 9 High-Fat Foods That Are Actually Super Healthy [Internet]. [cited 2022 Feb 14]. Available from: https://www.healthline.com/nutrition/10-super-healthy-high-fat-foods#TOC_TITLE_HDR_4
  11. Processed foods: Health risks and what to avoid [Internet]. [cited 2022 Feb 14]. Available from: https://www.medicalnewstoday.com/articles/318630#what-is-processed-food
  12. Sorbitol intolerance: an unappreciated cause of functional gastrointestinal complaints - PubMed [Internet]. [cited 2022 Feb 14]. Available from: https://pubmed.ncbi.nlm.nih.gov/6847853/
  13. Coffee and gastrointestinal function: facts and fiction. A review - PubMed [Internet]. [cited 2022 Feb 14]. Available from: https://pubmed.ncbi.nlm.nih.gov/10499460/
  14. Boekema PJ, Samsom M, van Berge Henegouwen GP, Smout AJPM. Coffee and gastrointestinal function: facts and fiction. A review. Scandinavian journal of gastroenterology Supplement [Internet]. 1999 [cited 2022 Feb 14];230(34):35–9. Available from: https://pubmed.ncbi.nlm.nih.gov/10499460/
  15. A hot topic: Are spicy foods healthy or dangerous? - UChicago Medicine [Internet]. [cited 2022 Feb 14]. Available from: https://www.uchicagomedicine.org/forefront/health-and-wellness-articles/spicy-foods-healthy-or-dangerous
  16. Biesiekierski JR. What is gluten? Journal of Gastroenterology and Hepatology (Australia). 2017 Mar 1;32:78–81.
  17. Gluten Intolerance: Symptoms, Test, Non-Celiac Gluten Sensitivity [Internet]. [cited 2022 Feb 14]. Available from: https://my.clevelandclinic.org/health/diseases/21622-gluten-intolerance
  18. Gluten: What is it, gluten-free diet, intolerance, and sensitivity [Internet]. [cited 2022 Feb 14]. Available from: https://www.medicalnewstoday.com/articles/318606#gluten-free-diet
  19. When to See a Healthcare Provider for Abdominal Pain [Internet]. [cited 2022 Feb 14]. Available from: https://www.verywellhealth.com/when-to-see-a-doctor-for-abdominal-pain-770762
Back to Top