Rise of celiac diseases and gluten insensitivity in India

Celiac disease and gluten insensitivity have been on a significant rise in India. They have emerged as huge health concerns in India, reflecting a global trend. Celiac disease is an organic autoimmune disorder which is characterized by an abnormal immune response to gluten, a protein found in wheat, barley, and rye. The impact of the disease can be measured by structural abnormalities. The immune response to these foods triggers inflammation in the small intestine, causing damage to the intestinal lining and interfering with the absorption of nutrients from food. On the other hand, gluten insensitivity, also known as non-celiac gluten sensitivity, refers to a condition where individuals experience adverse symptoms after consuming gluten, despite not having celiac disease or a wheat allergy. Symptoms such as abdominal discomfort, bloating, and diarrhea are quite common in this case. Unlike celiac disease, gluten insensitivity does not involve an autoimmune reaction or intestinal damage. While the symptoms of both conditions can be similar, it is essential to diagnose properly and devise treatment accordingly. 

Key Differences

• In celiac disease, there is an autoimmune disorder triggered by gluten ingestion, causing inflammation and damage to the small intestine. In gluten insensitivity adverse symptoms occur after consuming gluten, without autoimmune or intestinal damage.
• Celiac disease involves an immune response and intestinal damage, whereas gluten insensitivity does not have damages the intestines
• Celiac disease is diagnosed through specific blood tests and a biopsy, whereas gluten insensitivity lacks specific diagnostic markers.

Diagnosis

Diagnosing celiac disease is a two-step process. Firstly, blood tests are conducted to measure specific antibodies associated with celiac diseases, such as anti-tissue transglutaminase (anti-tTG) and anti-endomysial antibodies (EMA). If the blood tests indicate a possible celiac disease, a small intestine biopsy is performed to confirm the diagnosis. On the other hand, gluten insensitivity does not have any specific diagnostic tests. The diagnosis is done after the celiac disease is ruled out and wheat allergy is found.

Prevalence of Celiac Disease and Gluten Insensitivity

Rise in Celiac Disease Cases in India in the Last 20 Years

• Celiac disease has shown a notable increase in prevalence in India over the past two decades.
• A study was conducted to estimate the prevalence of celiac disease in urban and rural populations in the National Capital Region, Delhi, India. A door-to-door study with a questionnaire to identify patients with symptoms arising from celiac diseases like diarrhea. All respondents who were screen positive (any one of the above) and 10% of screen-negative individuals were called for serological testing, which is an anti-tissue transglutaminase antibody. All serologically positive respondents were invited to undergo further evaluation including endoscopic biopsy. Celiac disease was diagnosed on the basis of positive serology, the presence of villous atrophy and/or response to a gluten-free diet. 
• Among 12,573 contacted, 10,488 (83.4%) (50.6% male) agreed to participate. Based on screening, 5622 (53.6%) participants were screened positive. Of all those who screened positive, 2167 (38.5%) agreed to serological testing; additionally, 712 (14%) negatives were also tested. The overall prevalence of celiac disease was 1.04% 
• In another study conducted across 23000 individuals, the prevalence of celiac disease was around 1.23% in north India, 0.87% in northeast India and 0.1% in South India. There is also a significant difference in wheat consumption. While in north India the consumption is at 455g, in South India it is barely around 30g

Rise in Gluten Insensitivity Cases in India in the Last 20 Years

• The prevalence of non-celiac gluten insensitivity is also on the rise in India. According to NIMHANS and ICMR, 10% of Indians are presently suffering from gluten insensitivity. The number was much lower a decade ago
• Both celiac disease and gluten insensitivity are on the rise in India. It is important to diagnose the problem and seek the right treatment for it. 

Treatment Options for Celiac Disease

• The only effective treatment is the exclusion of products with gluten such as wheat or barley. There are many products which contain gluten in some form or the other and it is important to know in detail about the product that is being consumed. Gluten can be found in sauces, dressings, packed foods and certain medicines. Hence checking the label is really important. 
• Cross-contamination during food preparation should be avoided. Separate utensils, cutting boards, and cooking surfaces should be used for gluten-free foods.
• It is essential to consult with a registered dietitian or nutritionist experienced in celiac disease to develop a well-balanced and nutritious gluten-free meal plan.
• Individuals with celiac disease may need to supplement their diet with vitamins, minerals, or other nutrients to correct deficiencies caused by malabsorption.