Over the past decade, the frequency of conversations about gluten intolerance (GI) and celiac disease (CD) in the United States has gone from almost unheard of to commonplace. Chances are your local supermarket sells dozens of items labeled “gluten free” where none existed five years ago. Restaurants and school lunch programs frequently offer gluten-free alternatives. What happened?
Before I dive into that discussion, I want to clarify some terms to minimize confusion. “Gluten” is the general term for a mixture of tiny protein fragments (called polypeptides), which are found in cereal grains such as wheat, rye, barley, spelt, faro, and kamut. Gluten is classified in two groups: prolamines and glutelins. The most troublesome component of gluten is the prolamine gliadin. Gliadin is the cause of the painful inflammation in gluten intolerance and instigates the immune response and intestinal damage found in celiac disease. Although both conditions have similar symptoms (pain, gas, bloating, diarrhea), or sometimes no gastrointestinal symptoms at all, celiac disease is an autoimmune reaction to gluten that can cause severe degradation of the small intestine; whereas, gluten intolerance/sensitivity is an inability to digest gliadin with no damage to the intestines.
The medical community’s use of improved diagnostic tools (saliva, blood, and stool tests; and bowel biopsies) as well as self-diagnosis by aware individuals has certainly contributed to the swelling ranks of people afflicted with these maladies; however, that’s not the whole story. A combination of hybridized grains, America’s growing appetite for snacks and fast food, and the genetics of gluten intolerance and celiac disease have brought discussions of these once uncommon conditions front and center.
Again, what happened?
New evidence indicates that the hybrid versions of grains we eat today contain significantly more gluten than traditional varieties of the same grains. Experts such as Dr. Alessio Fasano, medical director of the Center for Celiac Research at the University of Maryland School of Medicine, believe this recent increase in the amount of gluten in our diet has given rise to the number of people suffering from gluten intolerance and celiac disease.
According to Fasano, “The prevalence of celiac disease in this country is soaring partly because changes in agricultural practices have increased gluten levels in crops.” He further states, “We are in the midst of an epidemic.”
For example, the ancient wheat that Moses ate was probably very different from our wheat today. Moses lived about 3,500 years ago, when wheat, spelt, and barley were all popular grains. Modern wheat varieties, however, have been bred to grow faster, produce bigger yields, harvest more efficiently, and bake better bread. The downside to today’s hybridized cereal grains is that they contain more gluten.
Celiac disease was once considered a rare malady and was estimated to have afflicted approximately 1 in 2,000 people in the United States. According to research done by the Mayo Clinic, CD is four times more common today that it was five decades ago. This increase is due to increased awareness and diagnostics, and the estimate today is that 1 out of every 133 people in the United States has celiac disease.
Here are estimates for other parts of the world:
• 3 in 100: United Kingdom
• 1 in 370: Italy
• 1 in 122: Northern Ireland
• 1 in 99: Finland
• 1 in 133: United States
• Once thought rare for African-, Hispanic- and Asian-Americans, current estimates in these populations: 1 in 236
• 1 in 30 are estimated to have gluten intolerance in the United States.
For additional facts and figures about celiac disease, please visit The University of Chicago Celiac Disease Center .
More than 6,000 years before Moses was born, an agricultural revolution took place in the Middle East that allowed humans to embrace farming (sowing and harvesting wild seeds), herding, and other forms of agriculture and move away from our hunter-fisher-gatherer ancestors. This was the first major introduction of gluten into the human diet.
According to Dr. Loren Cordain, PhD, author of The Paleo Diet, “The foods that agriculture brought us—cereals, dairy products, fatty meats, salted foods, and refined sugars and oils- proved disastrous for our Paleolithic bodies…. studies of the bones and teeth early farmers revealed that they had more infectious diseases, more childhood mortality, shorter life spans, more osteoporosis, rickets, and other bone mineral density disorders than their ancestors thanks to the cereal-based diet. They were plagued with vitamin and mineral deficiencies and developed cavities in their teeth.”
In other words, people traded their health for sustainable food sources and a less nomadic way of life.
Two hundred years ago, the global diet received another big injection of gluten with the birth of the Industrial Revolution and steam-powered mills that were able to produce refined-grain flours that had significantly longer shelf lives, making flour (aka: gluten) more accessible and available to an almost global market. “We were able to mill and process grains for consumption and eat them in larger quantities than we had ever done in the past,” writes Cordain.
Jack Challem, “The Nutrition Reporter,” offers a different long view of human consumption of gluten: “Look at in another way, 100,000 generations of people were hunter-gatherers, 500 generations have depended on agriculture, and only 10 generations have lived since the start of the industrial age, and only two generations have grown up with highly processed fast foods. This short period of time in the course of man’s existence that grains have been around has proven that many of us are not physiologically able to tolerate gluten.”
Historical evidence of people having trouble digesting gluten was first documented in the 2nd century A.D. when the Greek physician Aretaeus of Cappadocia, diagnosed patients with celiac disease. The symptoms included “wasting and characteristic stools.” Since Aretaeus’ time, the disease has gone by a variety of names, including “non-tropical sprue,” “celiac sprue,” “non-celiac gluten intolerance,” “gluten intolerance enteropathy,” and “gluten sensitive enteropathy.”
Fast forward to 1950, when the Dutch pediatrician Willem-Karel Dicke proposed wheat gluten was the cause of the disease. His theory was based on observations that celiac children improved during World War II when wheat was scarce in Holland.
As Challem points out, today, thanks in large part to the fast food and snack food industries, gluten is in just about every kind of food imaginable.
So Why Can’t Everyone Handle Gluten?
People who that carry any of the genes for CD and GI (expressed or not) are more susceptible to developing either condition. You can carry two dominate genes for celiac disease and perhaps end up developing CD or you can carry one dominant gene and one recessive gene and develop only GI. Your genes determine the body’s immune response in the presence of gluten, and many different health problems may result from that response. Some people may have their brain affected and develop cognitive problems such as depression or impaired brain function, while others suffer pancreatic problems and develop diabetes. Research still needs to be done to answer the question as to why these maladies affect different parts of the body in different people.
When populations that are genetically predisposed to CD and GI are exposed to cereal grains with higher gluten content, there’s little wonder why more people are having these genes “turned on” and develop gluten insensitivity on a much larger scale—especially now that the flour made from these grains are part of the “hidden ingredients” in foods from ice cream to lunch meats.
OK, Now What?
So, gluten has changed, and we have changed, and it appears not for the better. Fortunately or unfortunately, depending on how you look at it, identifying and eliminating the foods and ingredients from your life that do not work for your body is the only answer. There is no magic pill to take to make it all go away.
If you, or someone you know, is experiencing major health issues that aren’t getting better, enlisting a knowledgeable physician who understands the complexities of CD and GI testing is an excellent idea; however, on average, it takes the medical community 10 years to diagnose people who are suffering with severe health problems from undiagnosed CD and GI.
The Bottom Line
Gluten intolerance is not a fad diet. I have seen countless cases display miraculous improvements in long standing ailments—simply by adapting this lifestyle. Even if you have a test for CD and it comes back negative and medical community clears you to continue eating gluten, but you feel better without it, listen to your body. You know yourself far better than anyone else and you deserve good health. If you have doubts about your diet, try going gluten-free for two weeks and see how you feel. Those with more advanced illnesses (autoimmune diseases and such) will usually not experience changes until they have been gluten-free for six months to a year.
About the author: Julie McGinnis, MS, RD, has been involved in the field of nutrition for twenty years and started work in a conservative hospital setting as a registered dietitian. Her company, The Gluten Free Bistro, is the culmination of years of nutrition experience and living gluten-free combined with a genuine desire to provide a nutritious product for the celiac and gluten intolerant communities. Visit Julie McGinnis at www.theglutenfreebistro.com