Emerging Health Epidemic in India: Celiac Disease

The celiac disease affects approximately six to eight million people in India.It is more common than is recognized and remains under-reported in the country. A study conducted by All India Institute of Medical Science, on more than 2500 participants, revealed that 1% of the participants suffer from the disease. Later based on a wider research it was revealed that the occurrence of the disease is more common in north India compared to south India. This difference may be attributed to variation in their diets (south Indians consume more of rice) or their genetic make-up. Studies show that the prevalence of celiac disease has been doubling in every 20 years.  The reason for this increase in a number of cases of the celiac disease could be many including but not limited to increase in the consumption of wheat, usage of a new strain of wheat, increased use of antibiotics etc.

What is Celiac Disease?

Celiac disease is an autoimmune disorder which is caused by an allergy to gluten whose intake led to damage of intestinal lining. Gluten is a protein found in wheat, barley, and related cereals. Earlier it was thought to be a disease affecting the children and presenting with diarrhea and malabsorption. However, with the increasing understanding of the disease, it has been realized that it affects the adults as well and may present with other symptoms like anemia, osteoporosis, and growth retardation. The damage to the small intestines causes malabsorption of food and deficiency of multiple nutrients.

The diagnosis of celiac disease involves serological tests which can isolate the patients having the disease and those at risk of disease occurrence. The presence of disease is indicated based on the serologic tests for the presence of antibody to the tissue transglutaminase (anti-tTG). The biopsy of the small intestine is essential for the confirmation of the presence of disease.

Symptoms of Celiac Disease:

The disease is generally presented with some classical symptoms of chronic diarrhea, constipation in few cases, recurrent diarrhea, vomiting, foul-smelling stool, abdominal pain, weight loss etc. Other typical symptoms of the disease include short stature, iron deficiency anemia, inability to concentrate, mouth ulcers, chronic liver disease, osteopenia, osteoporosis, migraine, tingling or numbness of the hands and feet, delayed puberty, infertility, alopecia, arthritis, and many more.

Management of Celiac Disease:

There is currently no treatment available for this disease which means the disease cannot be treated/reverted with medicines. Only the nutrition supplements for treating nutrient deficiency are given for 6 to 12 months. Celiac disease patients require a gluten-free diet for the lifetime.  The intestine starts healing immediately after giving up gluten, and it may take up to 2 years to heal up completely. The symptoms also start improving after starting a gluten-free diet. Accidental or frequent ingestion of even small amount of gluten can cause short-term symptoms and long-term damage. Thus, compliance to a strict gluten-free diet is critical in the management of the disease.

The biggest challenge in the management of this emerging epidemic is the lack of awareness about the disease and its causes. Hence, both creating awareness and improving research for the prevention and treatment of the disease are the needs of the hour.

Safe and Unsafe Food in Celiac Disease:

It is very critical to know for a celiac disease patient what should be consumed and what should not be. The good aspect is that 3 out of 4 basic food products are completely safe, while the bad aspect is that wheat is very common food ingredient in India and it finds its way in many food items, specially packaged food. Following is a list of safe food items for celiac patients: grains which are inherently gluten-free (rice, corn, bajra, jowar, ragi, cholai, kuttu, etc.), fresh vegetables and fruits, plain milk and meat, fish, egg, pulses, salt, sugar, tea, coffee, vegetable oil, honey, etc. Unsafe items include food items that contain gluten in any form.Grains that contain gluten include wheat, barley, and rye or oats. Thus, any food item containing any quantity of these grains in any form is considered unsafe for celiac patients. Celiac patients are advised to consume only those packaged food products that are indicated as gluten-free.

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