Once perceived as a “Western” phenomenon, celiac disease is making its presence felt in India too. In 2011, a study by AIIMS with 2,879 subjects had found that six to eight million Indians are estimated to have this disease—one in a hundred suffer from the disease in north India.
In 2015, a multi-centre study with 23,000 subjects found that one in 90 suffered from the disease in north India, while in south India, the incidence was only 1 in 1,000. Globally, about 40 to 60 million people suffer from the disease.
Not to be confused with 'wheat allergy', celiac disease is an autoimmune disease that occurs due to an inability to digest gluten–a form of protein, that also gives elasticity to cereals such as wheat. This indigestion leads to damage to the small intestinal mucosa (where the food is absorbed). Those affected —typically children, but adults too—will have stunted growth, have chronic diarrhea, anaemia and bone weakness.
Even as research is on for finding drugs to treat the disease, as of now, doctors say the only way to manage this genetic disease is to switch to gluten-free foods such as potato, rice, maize, millet and dairy products.
“Both doctors and patients need to be made aware of this disease, more prevalent in north India. People suffer for several years before the diagnosis is made. Studies have found that the amount of gluten present in even one piece of chapati (about 50 g) can cause severe symptoms in a patient,” said Govind Makaria, professor, Department of Gastroenterology and Human Nutrition at AIIMS, on the sidelines of a seminar on the subject that was held in the capital city last week.
Makharia said in the countrywide study of 2015, it was found that the incidence of celiac disease was one in 160, and the disease was more common in north and northeastern states because of their “diet that included more wheat”. “The challenge for those suffering from the disease is to access gluten-free food outside of their homes, in their workplaces and even restaurants. Also, correct labelling is necessary and tests need to be available to diagnose it,” said Makharia.
Researchers are still unsure about the exact reasons that make people prone to the disease, said Carlo Catassi, professor universita, Politecnicadelle Marche, Ancona, Italy, who has worked on the disease for several years. “Bread has always been an integral part of diet in western countries, so it's hard to say why gluten-related disorders have been on the rise in the last few decades. It was thought that children who were not breast-fed were more prone, but then the disease is no less common among breast-fed kids too. Income disparities also have no effect on the disease incidence,” he added.
However, B.S. Ramakrishna, director, Institute of Gastroenterology, SIMS hospital, Chennai, said research has found that “new world wheat” could be responsible for the rising incidence of celiac disaese. “In the last 100 years, agricultural production has changed, and a new variety of wheat is now grown all over the world. That maybe is causing a greater adverse reaction in the intestine,” he said.
Screening for the disease is not expensive, but doctors at the primary health centres need to be made aware so they could diagnose the disease. “Celiac disease is highly under-diagnosed, and what is clinically detected represents only the tip of the iceberg,” said Ramakrishna.
However, Ramakrishna cautioned that people should steer clear of "diet fads" and not avoid wheat, unless they had been diagnosed of the disease. "Wheat is an important part of a nutritious, balanced diet. The no-wheat prescription is only for those who have this condition,” he added.
