Coeliac Disease: When Gluten Becomes the Enemy 

Would you be surprised if someone told you that they are allergic to pizza or pasta? Imagine having to avoid some of the most delicious and convenient foods because your body can't tolerate them. You've likely seen the term 'gluten-free' on food labels, social media, and heard it often, but it’s much more than a trendy phrase. 'Gluten-free' is a crucial aspect of life for many people who suffer from coeliac disease. If you're seeking information for yourself or a loved one, read on to learn what coeliac disease is and what can be done to manage it.

To understand coeliac disease, it is important to learn about gluten first. Gluten is a type of protein present in wheat, barley, and rye. This means foods like pasta, cakes, breakfast cereals, most types of bread, certain sauces, and some ready-to-eat meals contain gluten.

In people with coeliac disease - a genetic autoimmune disorder, the body starts attacking itself when gluten is consumed. Think of it as your body's self-goal. When gluten enters the digestive system, the immune system responds aggressively by releasing antibodies that attack and damage the  inner layer of the small intestine. This damage reduces the intestine's ability to absorb nutrients properly, leading to a lack of essential nutrients in the body.

If you're from the South Asian subcontinent, coeliac disease might seem far-fetched, but it's actually quite common and often goes undiagnosed in its milder forms. People with a family history of coeliac disease are more likely to develop it, though not everyone with the gene gets the disease, and not all who have it possess the known genes. Significant physical stress (like surgery, illness, or pregnancy) or severe emotional events can cause coeliac disease. Certain gut microorganisms may also play a role in triggering it. Having type 1 diabetes, rheumatoid arthritis or Down syndrome puts you at a greater risk of coeliac disease.

Symptoms of coeliac disease can appear in young infants starting solid foods or adults between 40-60 years. It’s often hard to recognise because of its varied symptoms. Damage to the intestine occurs slowly, leading to unnoticed symptoms until significant nutritional deficiencies and anaemia arise. Some experience stomach pain, bloating, fatty stool, and other digestive issues after eating gluten. While not usually life-threatening, unmanaged coeliac disease can cause serious health issues. Even silent coeliac disease can lead to long-term complications.

Some people may be sensitive to gluten or wheat products in their diet. Gluten intolerance can cause uncomfortable digestive symptoms after eating but doesn't damage your intestines like coeliac disease does. Those who are allergic to wheat may experience itchy or watery eyes or difficulty breathing after consuming foods containing gluten.

Your doctor will ask you about your existing symptoms and medical history. Make sure that you do not miss out on anything. They may conduct a physical exam and suggest tests and an upper gastrointestinal endoscopy if coeliac disease is suspected. If diagnosed, you'll receive advice on managing the condition.

Coeliac disease requires a strict gluten-free diet, which will help the small intestine heal and improve symptoms within days. Full healing may take 3-6 months or longer, especially for older adults. Regular check-ups are crucial to monitor your health. Don’t stop gluten consumption before undergoing diagnostic procedures for coeliac disease as it may affect your test results.

A dietitian will assist you with a gluten-free diet compatible with coeliac disease. Focus on what you can eat and view these changes as a positive lifestyle adjustment.

Naturally gluten-free foods include:

• Fruits
• Vegetables
• Meat and poultry
• Fish and seafood
• Dairy
• Beans, legumes, and nuts

Safe grains and starchy foods:

• Rice
• Rajgira
• Ararot
• Faliyan
• Kasha
• Cassava
• Corn
• Bajra
• Jowar
• Soy
• Sabudana

Some naturally gluten-free grains might get contaminated with gluten during harvesting and processing. To avoid contamination, choose gluten-tested grains with less than 20 ppm gluten. Read labels carefully, as “wheat-free” doesn’t mean “gluten-free,” and watch out for hidden gluten in items like soy sauce, malt vinegar, bouillon cubes, blue cheese, pudding mixes, and some medications and toothpastes.

1. Plan easy, go-to recipes and keep the ingredients stocked.
2. Have some gluten-free snacks in your car, bag, or desk.
3. Choose places with reliable gluten-free options and check menus online.
4. Use gluten test strips to check the gluten content of unfamiliar foods.
5. Keep cookware, utensils, and condiments separate for gluten and non-gluten use.

Here are some staple Indian recipes that typically contain gluten but can be adapted to be gluten-free:

• Chapati (Roti) - Use gluten-free flours like millet flour (bajra) or rice flour.
• Paratha - Substitute wheat flour with gluten-free alternatives like chickpea flour (besan) or a blend of gluten-free flours from the above-mentioned options.
• Dosa- Traditional dosas use rice and urad dal, which are gluten-free. Ensure no gluten-containing additives are used.
• Idli - Made from rice and urad dal, which are naturally gluten-free. Ensure no cross-contamination with gluten.
• Samosa - Use gluten-free flour instead of wheat flour for the samosa patti.
• Pakora (Bhaji) - Use chickpea flour (besan) instead of wheat flour for the batter.
• Pulao - Typically gluten-free, just ensure no gluten-containing stock or sauces are used.
• Khichdi - Made from rice and lentils, naturally gluten-free, but check for any added gluten-containing ingredients.

If you have coeliac disease, avoiding gluten isn’t optional—it’s crucial. With over 200 potential symptoms, some of which might not show up at all, even silent coeliac disease can cause long-term health issues. Be cautious with “gluten-free” labels, as some products may still contain traces of gluten. Always check labels thoroughly, and remember that “wheat-free” doesn’t mean “gluten-free.” Traditional Indian dishes like chapati and samosas can be adapted with gluten-free flours, so you can still enjoy your favourites. Keep a supply of gluten-free staples, carry snacks, and keep gluten test strips handy. Planning ahead and knowing where to find safe meals can help you manage coeliac disease effectively.

In coeliac disease, eating gluten-containing foods can cause a variety of symptoms, such as:

• Stomach ache
• Bloating and farting (flatulence)
• Constipation
• Diarrhoea, which may smell particularly unpleasant
• Heartburn

Coeliac disease can appear at any age but is most common during two distinct periods: early childhood (8-12 months) when solids are introduced, and mid-life (40-60 years). It may be inherited, showing symptoms in childhood, or triggered later by significant physical stress like surgery, illness, pregnancy, or severe emotional events.

Symptoms of coeliac disease are often mistaken for irritable bowel syndrome, wheat sensitivity, stress, or simply ageing. Common symptoms in adults include bloating and flatulence, nausea and vomiting, stomach ache, diarrhoea or constipation, fatigue, weakness, and lethargy.

Children may experience delayed growth or puberty and adult-like symptoms such as abdominal pain, bloating and flatulence, bulky, foul-smelling stools, diarrhoea or constipation, nausea, vomiting, weight loss or poor weight gain and irritability.

Coeliac disease can develop at any age, especially if you have a family history of the condition. It may be triggered by ageing, stress, illness, emotional upheaval, or even pregnancy and childbirth. Changes in the bacterial composition of your gut can also contribute to the onset of coeliac disease.

Medical professionals classify coeliac disease into one of the below stages:

Stage 0: Healthy with no sign of coeliac disease.

Stage 1: Higher levels of antibodies to gluten (lymphocytes) in your intestinal lining may indicate coeliac disease, even on a gluten-free diet. However, it could also be due to other conditions like food intolerance or inflammatory bowel disease.

Stage 2: You have more gluten antibodies than normal and a condition called crypt hyperplasia. Crypts are grooves between the villi in your intestines, and hyperplasia means these grooves are longer than usual. This stage is rare and you may also have a rash related to coeliac disease (dermatitis herpetiformis).

Stage 3: You have more lymphocytes and longer crypts than normal, with your intestinal villi appearing flattened and shrunken (villous atrophy). This stage typically confirms coeliac disease. Stage 3 is sub-divided into 3a, 3b, and 3c, according to the extent of damage to the villi.