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.
Awareness of the disease in India is at critically low levels, with expert panels recently suggesting upwards of ninety percent of the population are unaware of the condition. For this reason, many may be suffering from the disease and causing severe damage to their bodies while assuming they simply have indigestion or other similar conditions.
Wheat products are a prominent component of the diet of India, particularly in northern states. “This could be a possible reason for the higher incidence of celiac disease in India,” said Chris J Mulder, an Amsterdam-based hepatogastroenterologist, speaking at the 17th International Celiac Disease Symposium, held in Delhi in 2018.
Disease incidence was shown to be notably higher in northern India. This correlates with the increased use of wheat products as a key component of the diet. “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 Mulder.
The rice-based diet of many of India’s southern states may explain lower prevalence in this region. A key factor in managing the disease is the removal of all gluten containing products from the diet. Many in south India may be unwittingly following this advice already and could even be living with the condition without provoking any symptoms at all.
As a whole, the prevalence of celiac disease in India has increased fourfold since the 1960s. This suggests either an increase in diagnosis due to heightened awareness, or a shift to higher gluten diets spurring on symptoms – or a combination of both factors.
The symptoms of celiac disease are often only viewed as immediate. These typically revolve around digestive issues. Examples include diarrhoea, vomiting, constipation and stomach cramps. However, it is issues that arise over a longer period that are far more dangerous.
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.
Other issues can include issues like anaemia. More unexpected symptoms may arise such as gluten ataxia. This occurs when antibodies released during gluten digestion begin to cause damage to the cerebellum in the brain. This region is responsible for motor functions such as speech and balance. Damage over the long term can lead to severe neurological impairment.
Prevention and treatment
The only currently utilised treatment for celiac disease is strict adherence to a gluten-free diet. This can often be difficult, particularly in poorer communities where variety in food availability is limited. In some areas products containing gluten form a staple part of diets and so adherence to this diet regime can be difficult. Issues may arise from even small amounts of gluten present in the diet, again making adherence difficult due to some products potentially not listing the ingredients.
If gluten is entirely removed from the diet the disease can be managed well without the intervention of any medications. Symptoms should be all but non-existent if gluten is not digested, as the primary factor causing the issues is specifically the body’s reaction to digested gluten.