•Chronic diarrhoea, loose stools, or alternating bowel habits
•Abdominal bloating, cramps, and excess gas
•Unexplained weight loss or failure to gain weight in children
•Fatigue, weakness, and persistent low energy (from malabsorption of iron and B12)
•Iron-deficiency anaemia not responding to oral iron supplementation
•Bone pain or low bone density (osteoporosis/osteopenia) from calcium and Vitamin D malabsorption
•Dermatitis herpetiformis - intensely itchy, blistering rash on elbows, knees, and buttocks
•Delayed puberty, infertility, or recurrent miscarriages in adults
Causes & Triggers
Coeliac disease is an autoimmune condition in genetically predisposed individuals (HLA-DQ2/DQ8 haplotypes, present in ~30% of the Indian population) triggered by dietary gluten - a protein found in wheat (gehun), barley (jau), and rye. In Mumbai and across India, wheat is a dietary staple consumed daily as chapati, roti, bread, semolina (suji/rava), and in countless processed foods; even a small amount of gluten is sufficient to trigger intestinal damage in coeliac patients. India is estimated to have the second-largest number of coeliac patients globally - around 6–8 million - yet the condition is vastly underdiagnosed due to low awareness, atypical presentations, and confusion with IBS and lactose intolerance.
How We Test
Serological screening uses IgA tissue transglutaminase antibody (anti-tTG IgA) as the primary test, with anti-endomysial antibody (EMA IgA) as a confirmatory test; total serum IgA is measured simultaneously as IgA deficiency can cause false negatives. Positive serology must be confirmed by small intestinal biopsy (at least 4 samples from the second part of the duodenum, plus 2 from the duodenal bulb) showing villous atrophy (Marsh grade 3). It is essential that the patient continues eating gluten until testing is complete, as a gluten-free diet normalises serology and biopsy within weeks.
The only effective treatment is a strict, lifelong gluten-free diet - complete elimination of all wheat, barley, rye, and cross-contaminated oats. Rice, jowar, bajra, nachni (ragi), and rice flour can safely replace wheat in Mumbai's cuisine. Nutritional supplements (iron, folic acid, calcium, Vitamin D, Vitamin B12) are needed until gut healing restores normal absorption. A registered dietitian experienced in Indian gluten-free cooking is invaluable. The majority of patients achieve complete mucosal healing and reversal of symptoms within 6–12 months on a strict gluten-free diet.
Consult a gastroenterologist or allergist if you have chronic digestive symptoms, unexplained iron-deficiency anaemia, or a first-degree relative with diagnosed coeliac disease - especially before starting a gluten-free diet, as testing requires gluten consumption.
Frequently Asked Questions
No. Wheat allergy is a rapid IgE-mediated immune response to wheat proteins that can cause hives, swelling, or anaphylaxis. Coeliac disease is a specific autoimmune disorder where gluten triggers intestinal damage - not an immediate allergic reaction. The two conditions are distinct and require different diagnostic tests and management.
India is estimated to have one of the highest absolute numbers of coeliac patients in the world - approximately 1 in 100 people carry the condition, with North and West India (including Maharashtra) showing high prevalence due to wheat-dominant diets and HLA-DQ2 gene frequency. Despite this, most cases remain undiagnosed for years as the symptoms overlap with common conditions like IBS and lactose intolerance.
Absolutely - many traditional Indian foods are naturally gluten-free: rice, dal, sabzi, idli, dosa, poha, sabudana, and dishes made with jowar, bajra, or ragi are all safe. The main risks are hidden gluten in wheat starch in some spice mixes, hing (asafoetida) preparations containing wheat flour, and cross-contamination at Mumbai's restaurants and street food stalls. A coeliac-experienced dietitian can provide a detailed Indian gluten-free food guide.
Untreated coeliac disease causes progressive small intestinal damage leading to malabsorption of iron, calcium, fat-soluble vitamins, and B12. Long-term consequences include severe anaemia, osteoporosis, infertility, peripheral neuropathy, and - in rare cases - intestinal lymphoma (EATL). Early diagnosis and strict dietary adherence prevent all these complications.
A negative anti-tTG IgA test is reliable only if you have been eating gluten regularly for at least 6 weeks before testing. If you had already reduced gluten before the test, results can be falsely negative. Some people also have non-coeliac wheat sensitivity or FODMAP intolerance to fructans in wheat - distinct from coeliac - which also improves on a wheat-free diet but carries no autoimmune risk.
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Living with coeliac disease? Let’s find your trigger.
