How will R&D and Regulations help Celiac disease patients in India and When?

In welcoming you to another edition of the new world of NuFFooDS Spectrum I would like to address a very important agenda of good Nutrition balance that can build a healthy body. We all are aware that by eating good food with staples such as wheat, rice, pulses, lentils, legumes, nuts, etc., and fruits and vegetables, meat, poultry and fish one can be healthy. However a large population who are not able to eat wheat and when they eat so they end up with a huge problem of gluten-allergy which unfortunately is a very serious disease and is called Celiac Disease. Today we have at least 10 million such celiac patients in India to whom spe- ciality foods are not available which is wheat-free for such large numbers.

This manifestation of allergy to wheat forces them to have a 100% wheat-free products life long and in this modern life they are completely deprived of all the wheat products. Imagine for a day that you have to live without wheat products! Such is the situation where these millions of Indians who are suffering to the core according to the Celiac Society Or- ganisation. I had the opportunity to be the Chief Guest on May 3rd, 2014 at New Delhi in this organisation day and it was baffling to see the problem and its magnitude.

What is Celiac disease? Wheat has two main proteins namely Glutenin and Gliadin. They do interact and form what is called Gluten and we also have the properties of Gluten in Rye prolamines (secalines) and Barley prolamines (hordens). Apart from this, Gluten is not found in many other grains but certainly the disease arises from the gluten sensitivity which constitutes an abnormal immune reaction to Gluten. It probably is prevalent in almost all the countries where wheat eating is part of the culture.

Celiac disease till now has no cure but is manageable with a Gluten-free diet, namely wheat-free diet. Therefore there is need for urgent research and handling this autoimmune con- dition through better nutrition (with alternatives to wheat). It is needed to be done by using other sources of cereals and legumes and compensation of Biomolecules by Nutraceuticals to ensure build-up of immune system on the one side and to handle the health of gut lumen.

In the case of Celiac patients the gut lumen becomes much smaller. This reduction in surface area as a result of the disease reduces the length of each villi and hence absorption at the microvilli level is considerably reduced in Celiac patients. This causes weight loss and other related problems of malabsorption. It is very easy to advise what to eat (without wheat!) but in practice it does not work like that. This is where an integrated approach perhaps is the key to such a challenge with traditional knowledge plus modern scientific support plus the rich epidemiological data in our country where many other non- wheat products are available based on traditional, ethnic and social practices and region’s agri-base.

|On the regulatory side regulation is necessary both for Gluten-free products and low Gluten products. There are some cases which are doubtful as Celiac or not and get enhanced with wheat products but there is no serious reaction with low Gluten products. It is this regulation that perhaps is the spin-off from the Codex Standards for Foods for Special Dietary use for Persons (intolerant to Gluten), (Codex-STAN 118-1979) based on which India is already proactive in this area to bring out a legislation. It is heartening to note that this legislation hopefully will make a difference but unless and until we work in the area of better nutrition to Celiac pa- tients and also to increase their immune system by personalised diet the challenge will continue. Perhaps even genetic approach of Celiac disease population and with a new approach of nutrigenomics for relief from the daily suffering of these patients cannot be underestimated. This requires a holistic approach of networking encompassing Bioinformatics, Genomics and reverse Nutraceutics and Nutritionals. This can be done with a clear mandate of fundamental molecular nutrition basis using the knowledge of molecular medicine, biotechnology, pharmacogenomics and nutraceutical chemistry and immochemistry.

It is this holistic approach that perhaps will bring relief to those children and their families who lead a daily suffering life because of the nature of the disease and the social fabric of non-availability of wheat-free products. Therefore my call to the research and development laboratories and the research and development groups in the industries to produce more wheat-free products keeping these 10 million population in view and this is not a small number. We should encourage developing the awareness and make sure that the Celiac awareness as well as the prod- ucts are available at an affordable cost and in plenty in the market with alternates. Perhaps very little knowledge of nutraceuticals is there in combating Celiac disease. Not only India is suffering with this problem with more than 1% of its population, but the whole world is. Perhaps India can lead the world with its traditional knowledge of foods and medicine to come to the rescue of these suffering patients integrating with modern science. This is the compassion part of the NuFFooDS that we must have in our mandate as we move forward.

Dr V Prakash,
FRSC Distinguished Scientist of CSIR-India,
Chairman, Advisory Board,
NuFFooDS Spectrum