The basics

It's not an allergy.
It's not a diet trend.

Celiac disease is an autoimmune condition where gluten damages the small intestine. Here's what that actually means — and why it's far more common in India than people think.

The mechanism

What gluten does inside you.

Gluten is a protein found in three grains: wheat, barley, and rye. For most people it's harmless. In celiac disease, eating it triggers the immune system to attack the lining of the small intestine — specifically the villi, the tiny finger-like folds that absorb nutrients from food.1 As the villi flatten, your body slowly stops absorbing what it needs, which is why the damage shows up as things like anaemia, fatigue, and weak bones long before anyone suspects the gut.

This is the key idea: celiac is an autoimmune disease, not a food allergy and not a lifestyle choice. The only treatment is removing gluten completely, for life.1

Three different things

Celiac isn't the same as "gluten intolerance."

These get lumped together, but they're distinct — and the difference changes how seriously you're taken:

  • Celiac disease — an autoimmune reaction that damages the intestine. Diagnosed with blood tests and biopsy. Requires strict, lifelong gluten avoidance.1
  • Wheat allergy — a classic allergic (IgE) reaction to wheat, which can be immediate. A different condition with different testing.1
  • Non-celiac gluten sensitivity — real symptoms from gluten without the autoimmune damage or allergy. A diagnosis of exclusion, once celiac and allergy are ruled out.1

How common — in India

Not rare here. Just under-diagnosed.

Celiac affects roughly 1% of people worldwide.4 For years it was assumed to be a "Western" disease, absent in India — that assumption was wrong. A large community study in the Delhi region by researchers at AIIMS found a prevalence of about 1.04%, or roughly 1 in 96 people2 — essentially the same rate as Europe and the US.

A pan-India study of over 23,000 adults then mapped a striking gradient: celiac antibodies were found in 1.23% of northern India, 0.87% of the northeast, and just 0.10% of the south.3 The genetics behind celiac (the HLA-DQ2/DQ8 genes) were similar across all three regions — around 36–38%.3 What differed was wheat: the north ate an average of 455g a day, the south just 25g.3 In other words, the gene is spread evenly; the wheat is what lights the fuse. If you're from the north Indian wheat belt, this is your disease as much as anyone's.

The hard truth

It's lifelong, and "just a little" isn't fine.

There's no pill and no cure. The only treatment is a strict gluten-free diet, for life.1 And it has to be strict: even trace amounts keep the immune reaction going, which is why food is considered gluten-free only below 20 parts per million of gluten.1 That's why a pinch of the wrong hing or a shared serving spoon matters — more on that in the Indian kitchen. The upside: once gluten is truly gone, the gut heals and most people feel dramatically better.1

References

Sources for this page

Every clinical claim above is numbered and traced to one of these sources. Superscript numbers in the text link here.

  1. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK, NIH) — Celiac Disease: Definition, Symptoms & Causes, Treatment. View source →
  2. Makharia GK et al. Prevalence of celiac disease in the northern part of India: a community based study. J Gastroenterol Hepatol. 2011;26:894–900. (AIIMS; prevalence 1.04%, ~1 in 96.) View source →
  3. Ramakrishna BS, Makharia GK, et al. Prevalence of Adult Celiac Disease in India: Regional Variations and Associations. Am J Gastroenterol. 2016;111:115–123. View source →
  4. Gatti S, Rubio-Tapia A, Makharia G, Catassi C. Patient and Community Health Global Burden in a World With More Celiac Disease. Gastroenterology. 2024. (Global prevalence ~0.7–2.9%.) View source →