Celiac disease is a serious autoimmune disease that occurs in genetically inclined people where the ingestion of gluten (Found in Wheat & Wheat products and is a protein of wheat) leads to damage in the small intestine. It is estimated to affect 1 in 100 people worldwide. In India nearly 6 to 8 million people are affected due to celiac disease and many more are undiagnosed and are at risk for long-term health complications.

When people with celiac disease eat gluten (a protein found in wheat), their body mounts an immune response that attacks the small intestine. These attacks lead to damage on the villi, small fingerlike projections that line the small intestine, that promote nutrient absorption. When the villi get damaged, nutrients cannot be absorbed properly into the body.
Celiac disease is hereditary, meaning that it runs in families. People with a first-degree relative with celiac disease (parent, child, sibling) have a 1 in 10 risk of developing celiac disease.
Celiac disease can develop at any age after people start eating foods or medicines that contain gluten. Left untreated, celiac disease can lead to additional serious health problems.

Gluten is a general name for the proteins found in wheat. Gluten helps foods maintain their shape, acting as a glue that holds food together. Gluten can be found in many types of foods, even ones that would not be expected.

There are many food items that may contain gluten, often in hidden or unexpected ways. Always read the label of any food product you buy if “gluten-free” is not specified on the label.

• Pastas
• Noodles
• Samosa & Kachori’s
• Jalebi
• Snacks and namkeen’s 
• Food containing or made of Maida (Fine wheat flour)
• Food containing Suji (Samolina)
• Breads, Cakes, Muffins and Pastries:
• Crackers
• Baked Goods: cakes, cookies, pie crusts, brownies
• Cereal & Granola:
  • corn flakes and rice puffs often contain malt extract/flavoring
• Breakfast Foods:
  • pancakes, waffles, french toast, and biscuits.
• Breading & Coating Mixes
• Sauces & Gravies (many use wheat flour as a thickener)
  • traditional soy sauce, cream sauces 
• Flour tortillas
• Beer (unless explicitly gluten-free) and any malt beverages 
• Brewer’s Yeast
• Anything else that uses “wheat flour” as an ingredient

Foods That May Contain Gluten

These foods must be verified by reading the label or checking with the manufacturer/kitchen staff.

• Energy bars/granola bars – some bars may contain wheat as an ingredient, and most use oats that are not gluten-free
• French fries – be careful of batter containing wheat flour or cross-contact from fryers
• Potato chips – some potato chip seasonings may contain malt vinegar or wheat starch
• Processed lunch meats
• Candy and candy bars
• Soup – pay special attention to cream-based soups, which have flour as a thickener. Many soups also contain barley
• Multi-grain or “artisan” tortilla chips or tortillas that are not entirely corn-based may contain a wheat-based ingredient
• Salad dressings and marinades – may contain malt vinegar, soy sauce, flour
• Starch or dextrin if found on a meat or poultry product could be from any grain, including wheat
• Brown rice syrup – may be made with barley enzymes
• Soy sauce (though tamari made without wheat is gluten-free)
• Pre-seasoned meats
• Cheesecake filling – some recipes include wheat flour

Celiac disease can be difficult to diagnose because it affects people differently. There are more than 200 known celiac disease symptoms which may occur in the digestive system or other parts of the body. Some people develop celiac disease as a child, others as an adult. The reason for this is still unknown.

Some people with celiac disease have no symptoms at all, but still test positive on the celiac disease blood test. A few others may have a negative blood test, but have a positive intestinal biopsy. However, all people with celiac disease are at risk for long-term complications, whether or not they display any symptoms.

The very common first assessment and Diagnosis of celiac disease is based on the presence of serologic tests (ELISA) confirming the presence of antibody to tissue transglutaminase (anti-tTG). The IgA anti-tTG provides the best specificity and is widely used.
The only way to confirm a celiac disease diagnosis is to have an intestinal biopsy.

An intestinal biopsy is considered the worldwide standard for diagnosis because it will tell you if you have celiac disease, or you have a different gastrointestinal disorder or sensitivity which responds to change in your diet.
If the results of the antibody or genetic screening tests are positive, your doctor may suggest an endoscopic biopsy of your small intestine. An endoscopy is a procedure that allows your physician to see what is going on inside your GI tract. A tube with camera mounted on is inserted through the mouth and down the esophagus, stomach and small intestine, giving the physician a clear view and the option of taking a sample of the tissue.
This is usually an outpatient procedure. Samples of the lining of the small intestine will be studied under a microscope to look for damage and inflammation due to celiac disease.

Infants and toddlers tend to have more obvious symptoms which usually evident in the gastrointestinal tract. Symptoms include, but are not limited to:

• Vomiting
• Bloating
• Irritability
• Poor growth
• Abdominal distention
• Diarrhea with very foul stools
• Malnutrition

Vomiting is less common in school-age children than in infants and toddlers. Symptoms include, but are not limited to:

• Stomach aches or abdominal pain
• Abdominal distention
• Diarrhea
• Constipation
• Trouble gaining weight or weight loss

Older children and teenagers may have symptoms or concerning signs that are not obviously related to the intestinal tract, which are called “extra intestinal” or “atypical” symptoms.

These symptoms are what may convince a physician to test for celiac disease. Some of these manifestations include:

• underdeveloped growth
• Weight loss
• Delayed puberty
• Achy pain in the bones or joints
• Chronic fatigue
• Recurrent headaches or migraines

Adolescents with celiac disease may also have mood disorders, including anxiety and depression, as well as panic attacks.

Although symptoms (particularly gastrointestinal) are often similar to those of celiac disease, the overall clinical picture is less severe. Recent research at the Center for Celiac Research shows that gluten sensitivity is a different clinical entity that does not result in the intestinal inflammation that leads to a flattening of the villi of the small intestine that characterizes celiac disease. The development of tissue transglutaminase (tTG) autoantibodies, used to diagnose celiac disease, is not present in gluten sensitivity.

A different immune mechanism, the innate immune response, comes into play in reactions of gluten sensitivity, as opposed to the long-term adaptive immune response that arises in celiac disease. Researchers believe that gluten sensitive reactions do not engender the same long-term damage to the intestine that untreated celiac disease can cause.

Just as in celiac disease, gluten sensitivity can affect all body systems and generate a wide variety of symptoms. Gastrointestinal symptoms can include diarrhea, bloating, cramping, abdominal pain and constipation. Behavioral symptoms can include “foggy mind,” depression and ADHD-like behavior. Other symptoms include anemia, joint pain, osteoporosis, and leg numbness.

How many people does gluten sensitivity affect? Research from the Center for Celiac Research indicates that it affects approximately 18 million people, or six percent of the population.

Do I still need to be tested for celiac disease if I think I’m gluten sensitive?

Yes. You need to be tested for celiac disease to rule out the possibility of long-term complications. Accordingly, do not go on a gluten-free diet until the possibility of celiac disease has been eliminated through testing. If you go on a gluten-free diet and are then tested for celiac disease, the tests could be falsely negative due to the lack of auto antibodies in your blood serum.

“Lifelong Adherence to the Gluten-Free Diet”

Celiac disease is a chronic autoimmune disease, which means that you cannot “grow out” of it. The treatment for both celiac disease and non-celiac gluten/wheat sensitivity is lifelong adherence to a strict gluten-free diet. Only food and beverage with a gluten content less than 20 parts per million (ppm) is allowed.

The gluten-free diet heals the villous atrophy in the small intestine, causing symptoms to resolve. Following the gluten-free diet also helps prevent future complications, including malignancies.

Commonly, people with celiac disease are deficient in fiber, iron, calcium, magnesium, zinc, folate, niacin, riboflavin, vitamin B12, and vitamin D, as well as in calories and protein. Deficiencies in copper and vitamin B6 are also possible, but less common. Supplementation of B12 and folate may help individuals with celiac disease recover from anxiety and depression caused by vitamin deficiencies.

However, patients may continue to be vitamin B deficient as the gluten-free diet may not provide sufficient supplementation. This can be remedied with a daily, gluten-free multivitamin. The multivitamin should not exceed 100% of the daily value (DV) for vitamins and minerals. Calcium and vitamin D supplementation may also be prescribed by your physician if your intake is not sufficient.