Grains make up more than half the total daily calories in the average diet of people globally and represent more than one-third of all food crops grown. And yet, a protein contained in various grains called ‘gluten’ contributes to illness in millions of people. While nutrition experts recommend that most of our calories come from cereal grains, it is precisely some of these that lead to the life-threatening Celiac disease or gluten-sensitivity.

What is Celiac disease?
Celiac disease is an auto-immune condition where an individual is intolerant to gluten for life. The disease occurs globally, has no socio-economic boundaries and can occur at any age: from 9 months to 90 years. Eating foods with gluten causes an immune reaction in the small intestine that can damage the lining of the intestines and lower the absorption levels of essential nutrients leading to mal-absorption and nutritional deficiencies.

Symptoms to watch out for
Classic symptoms of Celiac disease include diarrhoea, gastrointestinal disturbances like abdominal distension, flatulence, pain, constipation, nausea, vomiting, growth problems, stunting, anaemia. Other symptoms include weight loss, lethargy, tiredness, bone problems like osteoporosis and cramps. Skin problems, infertility, mouth ulcers, numbness and behaviour problems like depression, anxiety, schizophrenia, irritability and poor school performance are some other symptoms. The absence of typical symptoms makes the diagnosis difficult and often leads to ill health and life threatening
maladies.
While the earlier text-book description of Celiac disease was of a childhood diarrhoeal illness associated with malnutrition and growth failure, this is no longer the case. Celiac patients can stay asymptomatic or silent for years and therefore, may be diagnosed as late as 80-90 years of age. In fact, the average age of diagnosis of Celiac disease these days is in those between the ages of 45-50.
There may be no marked digestive symptoms, no growth failure and there could be exceptionally tall Celiac patients. There may be no malnutrition and in fact, several Celiacs are overweight or obese and may have good haemoglobin levels. It is estimated that for each symptomatic case there are approximately 6 silent or atypical ones and it is these that are the hardest to pick up.

Increasing the risk
People with silent or hidden Celiac disease are more in danger as they are at a higher risk of developing severe forms of malnutrition, non-specific ill health and if these remain unnoticed, they can prove fatal. Celiac disease can increase the risk to disorders like Type-1 diabetes mellitus, autoimmune diseases, sarcoidosis, multiple sclerosis, fibromyalgia, arthritis, liver diseases, thyroid disorders, pulmonary diseases such as asthma, ulcerative colitis, Crohn’s disease as well as cancer.
Diagnosis can often be overlooked and many patients have been through rounds of hospital admissions only for their condition to worsen.
Despite the growing awareness, diagnosis can still take long. Diagnosis is done using serological markers (blood tests) and endoscopy. Certain tests are important indicators in the diagnosis of the disease:
Serological markers (blood tests)
IgA endomysial antibodies (EMA)
IgA tissue transglutaminase (tTg)
Endoscopy
Although blood tests are fairly sensitive, an endo-scopy is still the gold standard for diagnosis. And an early diagnosis is imperative. Celiac disease is certainly more common than previously appreciated. Data in India is still not available, but according to a recent survey in Punjab, it is estimated to affect 1 in 100 people. However, a whopping 97 per cent of the cases are estimated to be undiagnosed and untreated!

disease for life
Celiac disease is a permanent condition and requires life long strict restriction to gluten along with nutritional supplements to correct deficiencies. A gluten free diet usually helps restore normal health. Living with Celiac disease in developed countries is easier as food labelling is better, conveniently packed food is available and restaurants and fast foods provide gluten free choices. The same however is not true for India, so far.
However, Celiac disease has become more common over the years, one of the reasons cited is the rise of gluten levels in wheat, due to mutation. However, there are several Celiac societies across the world that are working towards creating awareness. In India, the Celiac Society for Delhi is the first such initiative.

The writer is a Clinical Nutritionist; Director, Whole Foods India and Founder President Celiac Society
for Delhi