Celiac Disease

Coeliac disease is an autoimmune condition in which gluten — a protein in wheat, barley, and rye — damages the lining of the small intestine. That damage reduces absorption of nutrients and causes a wide range of symptoms, some obvious and some silent. It is lifelong but fully controllable with a strict gluten-free diet.

Who gets it

• Anyone can develop it; it tends to run in families.
• More common in certain Indian communities, particularly northern India — partly because wheat is the dominant staple.
• Associated with type 1 diabetes, autoimmune thyroid disease, and Down syndrome.

Symptoms — often atypical in India

• Digestive — chronic diarrhoea, bloating, abdominal discomfort, weight loss.
• Non-digestive — often the presenting features in India: iron-deficiency anaemia not responding to iron, short stature or failure to thrive in children, unexplained infertility, recurrent miscarriage, osteoporosis, itchy blistering rash (dermatitis herpetiformis), abnormal liver enzymes, chronic mouth ulcers, fatigue.
• Silent — some people have no symptoms and are picked up by screening.

Diagnosis

• Blood tests (tissue transglutaminase IgA + total IgA).
• Small-bowel biopsy via upper endoscopy usually confirms the diagnosis.
• Do not start a gluten-free diet before testing — it will make the tests unreliable.
• First-degree relatives should be screened.

Treatment — lifelong strict gluten-free diet

• Avoid wheat (gehu), barley (jau), rye and many wheat-derivatives. Breads, rotis, paranthas, naan, most biscuits, most namkeens, many sauces, most Indian street foods, seitan, sooji, maida, dalia, halwa from semolina, common atta.
• Safe grains — rice, millets (ragi, bajra, jowar), corn, buckwheat (kuttu), amaranth (rajgira), quinoa, sabudana (sago), besan (gram flour), urad dal flour.
• Watch for hidden gluten in processed foods, sauces, pickles, spice mixes, some asafoetida preparations, chapati-dusting in restaurants.
• Use dedicated utensils and cooking surfaces to avoid cross-contamination.
• Correct vitamin and mineral deficiencies — iron, B12, folate, calcium, vitamin D, zinc.
• Involve a dietitian experienced in Indian food to plan meals that are both gluten-free and balanced.

Symptoms often improve within weeks of a strict gluten-free diet; full intestinal healing takes months. Cheating on the diet damages the intestine again even without obvious symptoms, raising long-term risks.