Last week, a patient lamented: “Oh, how I wish the Maggi controversy had happened several years ago. Not only would I not have felt left out on numerous occasions, people would have also understood the plight of those with severe food restrictions."

My patient has celiac disease, a permanent autoimmune disease where gluten, a protein found in wheat, barley, rye and oats, damages the intestines and results in many diseases and complications, including anaemia, osteoporosis, other autoimmune conditions, and intestinal cancer.

About 1% of the Indian population is suspected to be affected by celiac disease. The diagnosis rates have gone up in recent years due to increased awareness and also increasing incidence of this disease.

The only acceptable treatment today is strict adherence to a gluten-free diet—a diet without wheat, barley, rye and oats—for life. Safe limits of gluten for a celiac population have been defined to be less than 20 parts per million, which translates to less than one-thousandth of a slice of bread.

In a country where the focus has always been on infectious diseases, the added concern of non-infectious diseases like celiac disease and food allergies is daunting. Imagine the concern of parents if an almost ubiquitous item—gluten—itself is a toxin. They are clueless about which food items contain gluten and probably end up giving this “toxin" in some small amounts to their child in some form, possibly in every meal.

It is a challenging scenario in India, where gluten-free substitute items are either not available, or are very expensive, or are not validated owing to the absence of legislation. Whether inadvertently or by choice, the possibility of getting “glutened" is extremely high in our present food safety system, for gluten has so far not been recognized in food laws.

In the last few weeks, the controversy surrounding the instant noodles brand has brought to light concerns regarding food safety systems in India. The discussion is centred around tighter norms for labelling, packaging and testing of all food products, but gluten and other allergens, like milk, egg, soy and nuts, should be debated too.

Early this year, a draft notification issued by the Union ministry of health and family welfare on gluten-free food items sets out the label declaration requirements for gluten and non-gluten foods. A welcome move, but, unfortunately, a gluten-free claim alone will not help. In addition, changes in the way we list ingredients on food items are needed to include gluten and other allergens. Also needed are precautionary statements on food packaging to indicate presence of any allergens, including gluten, due to cross-contamination.

The manufacturing practices, testing protocols and audit procedures for claims on packages should also be specified and implemented stringently. There are successful international examples to draw from, most recently the mandatory changes in labelling regulation in the European Union.

Food growers and manufacturers of processed and unprocessed items have to be sensitized to the needs of those suffering from celiac to help ensure safe products for them.

The celiac children of India were probably not stirred by the Maggi debate because they couldn’t eat it anyway. But they may have reason to be thankful to the Maggi controversy for igniting a debate and giving them hope of a revamped food system which could someday improve their lives.

Pankaj Vohra is a senior consultant, paediatric gastroenterology and hepatology, Max Healthcare, New Delhi, and founder director, Celiac India & Beyond Foundation.

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