Answers
What is celiac disease, and how is it diagnosed?
Short answer
Celiac disease is a lifelong condition in which gluten, a protein in wheat, barley and rye, damages the lining of the small intestine. It is common in North India. It can cause diarrhoea, bloating, weight loss and anaemia, or only tiredness or low iron. It is diagnosed with a blood test and an endoscopy, and treated with a strict gluten-free diet.
Symptoms
Some people have no gut symptoms at all, and it is found only on tests.
- Loose motions, bloating, gas or belly pain
- Weight loss, or poor growth in teenagers
- Iron-deficiency anaemia that does not improve with iron tablets
- Tiredness, mouth ulcers, weak bones, or raised liver enzymes
How it is diagnosed
A blood test (tTG-IgA antibody) is the first step. If it is positive, an upper endoscopy with small biopsies from the duodenum confirms the diagnosis.
Important: keep eating wheat until all the tests are done. Stopping gluten before testing can make the results falsely normal.
Treatment: a gluten-free diet
The gut usually heals within months on a strict diet. A dietitian helps a lot in the first few months.
- Avoid wheat (atta, maida, suji, dalia), barley and rye, and foods made from them such as roti, bread, biscuits, noodles and many packaged snacks
- Safe foods: rice, millets (jowar, bajra, ragi), makki, besan and other dals, potatoes, milk and curd, eggs, meat, fish, fruits and vegetables
- Oats are safe only if labelled gluten-free
- Check labels, and watch for shared flour and frying oil at home and in restaurants
Follow-up
Blood tests are repeated to check that antibodies are falling and anaemia is recovering. Family members, especially brothers, sisters and children, should be tested, as celiac disease runs in families.
Hidden gluten in Indian kitchens
Eat more
- Rice, poha, millets (jowar, bajra, ragi), makki, besan and all dals
- Milk, curd, paneer, eggs, fish, meat, fruits and vegetables
- Your own flour ground at a separate, clean chakki
Cut down
- Hing (asafoetida) mixed with wheat flour; buy a gluten-free one
- Suji, dalia, seviyan, biscuits, and wheat used to thicken gravies
- Soy sauce, malt drinks, beer and many packaged namkeens
Good to know
- Even small amounts of gluten keep damaging the gut, even without symptoms.
- Rice and millets eaten instead of wheat still need iron, calcium and fibre from other foods; a dietitian helps.
Common questions
Can I eat wheat once in a while?
No. Even occasional gluten damages the intestine and raises the long-term risk of complications, even if you feel nothing.
Is celiac disease lifelong?
Yes. The gut heals on a strict gluten-free diet, but the sensitivity to gluten does not go away.
Should everyone try a gluten-free diet?
No. It helps only people with celiac disease or a few other conditions. Starting it before testing can hide celiac disease and make diagnosis harder.