When shopping for food, 24-year-old media student Leepakshi Nagrath spends many seconds poring over the tiny inscriptions on the back of packets. Any mention of wheat, barley or rye in the ingredients sends the items promptly back to the shelves. Nagrath was five when she was diagnosed with celiac disease and discovered that a few nachos or a slice of pizza could aggravate symptoms including abdominal bloating, irritable bowel syndrome and chronic diarrhoea.

Gluten, the protein component of grain such as wheat, barley and rye, makes bread and cakes spongy and easier to eat. However, for people with the autoimmune celiac disease, its consumption could hurt the small intestine. The buzz around the gluten-free diet spiked after celebrities, including tennis star Novak Djokovic and actress Gwyneth Paltrow, spoke in favour of it, but there is little awareness about celiac disease in India.

"Most people dismiss it as a western concept, but I know of men in Rajasthan and Punjab in their 60s who tested positive for it," says Jeeva George, a celiac patient who started glutenfreeliv.in, an online initiative to support others like her. "Even doctors are not fully aware of the distinction between celiac, gluten-sensitivity and a wheat allergy," she adds. Through social media and her website, the former executive now connects patients with knowledgeable doctors and food outlets.

Children are more prone to the disease and diagnosis is done through specific blood tests and a biopsy of the small bowel. Around 1.2 million Indians suffer from celiac disease, according to the Celiac Society for Delhi and medical practitioners. Left untreated, the disease could lead to complications such as vitamin deficiencies, thyroid and cancer. Those who have symptoms of the condition but test negative for it likely suffer from gluten-sensitivity which is not proven to damage the intestinal lining.

"As a child, it was not easy to just plainly give up some of the best food available," says Nagrath. She briefly strayed from the diet in the 7th grade but stuck with it after suffering bouts of diarrhoea. "It is like saying 'NO' to almost 95 per cent of the food items. But nothing is more important than taking care of your health, is it?" she says. Avoiding gluten keeps symptoms at bay and makes Nagrath feel fresher.

There is no known cure for celiac disease but early detection and a strict diet help keep it under control, says Honey Tandon, executive dietician, Columbia Asia Hospital, Gurgaon. Familiarity with gluten-related problems is growing, adds Tandon, who gets at least two enquiries each week. Every month, restaurants such as Le Cafe and Piccoli Tortini in Mumbai report a steady increase in the number of people coming to them for gluten-free food.

Online grocers, gourmet malls and cafes have recently started offering products without the protein. Gluten-free goodies are the first items to be made daily at Bandra-based Piccoli Tortini. "We don't let ingredients mix because customers with celiac disease cannot risk coming in contact with wheat or maida," says chef Priya Laxman.

Gluten is replaced with ingredients like millet, sorghum, quinoa or arrowroot. These had been a part of age-old Indian traditions and can be adapted to modern recipes too, says Rakhee Vaswani, founder and instructor at Palate Culinary Studio. However, pre-packeted gluten-free products cost more than regular food offerings and are an acquired taste. Bread baked with maize or rice flour, for instance, is denser and heavier.

While some of Vaswani's students are gluten-sensitive, many enquire about going gluten-free because they want to lose flab. Busting the myth about weight benefits, nutritionist Tandon observes, "Well, if you stop eating a major set of foods, there will be some weight loss but gluten as such is not fattening." George says awareness needs to grow to a level where people do not mistakenly offer wheat or maida-laced food to celiac patients. "We never give sugar to a diabetic. Celiacs are a long way away from that point."



Gluten guide



Diarrhoea, headache, skin rash, joint pain, depression, fatigue and anxietyAnti-tissue transglutaminase antibody level, small intestine biopsyRice, ragi, jowar, corn, bajra, amaranth, tapioca, quinoa, potato flour