The All India India Institute of Medical Sciences (AIIMS) estimates around six to eight million people in India suffer from celiac disease. Indians are likely genetically predisposed to have a problem digesting wheat. Despite this, public awareness of the condition is low.
The estimated figures are based on a study conducted by doctors at AIIMS which assessed 23,000 people. Of these candidates, 0.6 per cent (1 in 160) had celiac disease. It was found to be more common in northern India, with 1.2 percent of candidates affected. In northeastern regions 0.8 percent were found to be affected, with a much lower figure of 0.1 percent found in southern India.
Actual diagnosis figures, however, remain far lower due to many Indians in rural environments lacking access to healthcare infrastructure. Many mistake any symptoms of the disease for other allergies. Due to misdiagnosis or a lack of any hospital intervention, individuals may continue to eat products which aggravate the symptoms of the disease.
Celiac disease is an autoimmune condition which involves an immune reaction to the gluten protein, commonly found in wheat, barley and rye products. This immune reaction results in inflammation of the small intestine, which can result in digestive issues and problems such as diarrhoea and anaemia.
Untreated celiac disease can cause a number of long term health conditions. These mostly stem from continued inflammation of the small intestine inhibiting the body’s ability to absorb nutrients. A prominent health concern in those with untreated celiac disease is osteoporosis. Due to a limited ability to absorb calcium, bone density is adversely affected, leading to a increased risk of bone fractures and breaks. This can cause disability, particularly in later life.
Around one third of Indians may have a genetic susceptibility to the condition claims Dr Govind Makharia, professor of Department of Gastroenterology and Human Nutrition at AIIMS. This would make the disease a major health concern across the country.
Wheat products are a prominent component of the diet of India, particularly in northern states. “Compared to 25 g in Western Europe and about 17 g in countries like Italy, India consumes about 30-40 g of wheat daily,” said Chris J Mulder, Hepatogastroenterologist and Head of Department, VU Medical Center, Amsterdam, speaking at the 17th International Celiac Disease Symposium, held in Delhi. “This could be a possible reason for the higher incidence of celiac disease in India.” The rice-based diet of much of the South may explain lower prevalence there.
Mulder also mentions that if a person with celiac disease consumes around 50g of wheat, it can result in villous atrophy. This is where the villi (elongated outcroppings of the small intestines) in the small intestines are eroded, inhibiting the body’s capacity to absorb nutrients.
Despite such a prominence of the disease in India, gluten free food options are lacking, claims a report conducted by the Institute of Agri-Business Management (IABM). The report found that India has the agricultural capacity to produce 2,347 kilo tonnes of gluten-free products. In 2016 the actual amount produced was a significantly lower 7.55 kilo tonnes.
The report attributes this disparity to a lack of knowledge of both celiac disease and its causative factor, gluten. This lack of awareness is far more prominent in rural regions. It is also these same regions that typically consume vast quantities of gluten containing foods, exacerbating the problem.
In order to address the problem in rural areas, gluten free crops must increase in prevalence. If awareness and diagnosis rates increase, IABM believe that the business opportunities will become available for rural farmers to produce these crops, as the market for the products could increase rapidly.
Currently, the estimated diagnosis rate of celiac disease in India is seven to eight percent. Larger cities are beginning to cater to those who avoid gluten as awareness grows, claims IABM researcher Jolly Masih. Investigations into celiacs in rural populations are needed to find the full extent of the disease’s prevalence in India, with a further need for education to increase awareness of symptoms and encourage medical intervention where necessary.