At a prevalence of ~1% of the population, Celiac disease, making specific T cell immune responses to gluten components, still remains relatively rare though even its rates have been increasing since the 1950s. However, in recent years starting from at least 1978 (1), a far larger proportion began to report non-celiac gluten/wheat sensitivity , reaching ~10% in countries ranging from Australia to Italy, Mexico, and the US and UK ().
Celiac disease can be diagnosed using precise tests. However, with no clear diagnostic, non-celiac gluten/wheat sensitivity is largely self-diagnosed and thus accurate numbers are hard to come by.
That preamble out of the way, a difference in reaction to (wheat) grains when in the US versus when in Europe could be attributed to
- Differences in gluten content of wheats grown in US versus some European countries, or
- Differences in the total gluten present in US versus some European diets, or other diet components (additives, emulsifiers, ) difficult to identify separately as the trigger(s).
Differences in gluten content of wheats grown in US versus Europe
Grain gluten differences likely don’t explain recent increases in non-celiac gluten/wheat sensitivity in the US since reports of such sensitivity are increasing the world over including in several European countries (Italy and the UK for example). Though such differences have become a favored explanation in the burgeoning popular media narratives about this increase (), actual research neither corroborates nor substantiates it (see below from , emphasis mine)
‘There are few pertinent papers that address the question of whether or not the protein content of the U.S. wheat crop has increased over time in the 20th century…The hard spring wheats, grown mostly in the Northern Plains, are considered to be highly desirable for bread baking and tend to have protein contents that in general exceed the usual protein contents of winter wheats by about 2 percentage points… The North Dakota Wheat Commission reported13 that, in 2009, the hard red spring wheat crop “ …yielded an average of 13.1 percent (which) was well below the traditional level of more than 14%,” and these protein contents are fairly typical of late 20th century crops for the hard spring wheat region. Various studies have compared the protein contents of wheat varieties from the early part of the 20th century with those of recent varieties.14,15 When grown under comparable conditions, there was no difference in the protein contents. Although nitrogen fertilization can have strong effects on protein content for some wheat varieties,16 the data do not seem to be in accord with the likelihood that recent fertilization protocols have had a strong effect on the protein contents of wheat grown in the United States…
Interpretation of protein data is complicated by occasional major deviations from the more usual range. In 1938, the protein content of spring wheat was exceptionally high (Table 1), averaging close to 19%; these years of exceptionally high protein (or low protein) occur occasionally and are likely to result mainly from environmental factors, rather than nitrogen fertilization or wheat breeding. To maintain a uniformity of quality characteristics from year to year, flour mills usually blend wheat flour that is intended for commercial use by specific customers, for example, bakeries. Very high protein content would usually be unsuitable for direct use, and so high protein wheat flours would usually be blended with lower protein grain to achieve a more normal protein level before reaching the consumer.‘
Differences in total gluten and/or other diet components present in US versus some European diets
Diets have changed dramatically over the course of the 20th century as industrialized mechanization processes were brought to bear in scaling up and streamlining food production. These days, home bread making from scratch is largely a niche hobby and many if not most people purchase commercial breads and other wheat-containing baked goods as a matter of course, not to mention that a great deal of home bread making itself relies on commercially blended products.
Industrial baking and the ingredients it uses are streets removed from home baking, speed and efficiency their hallmarks. Where traditional bread baking uses traditional leavening agents, requires long, slow fermentation, and takes ~16 hours, a cocktail of synthetic ingredients including extra yeast, additives and emulsifiers enables industrial bread making to turn out finished loaves in ~2 hours ().
- Vital Gluten is a vital part of this sped up process. Usually labeled ‘wheat protein’ (see below from ),
‘Gluten fractionated from wheat flour by washing starch granules from a dough (sometimes called vital gluten) is often added to food products to achieve improved product characteristics.’
- Given its capacity to emulsify and to increase cohesiveness, viscosity, elasticity, gelation and foaming ( ), vital gluten is today an essential ingredient in industrial baking.
- Research estimates total US gluten consumption has tripled from ~136 grams per person per year in 1977 to ~408 grams per person per year in 2013 (see below from ),
‘…it appears that vital gluten consumption has tripled since 1977…Changes in the per capita intake of wheat and gluten might play a role; both increased during the period in question…’
- Ironically, some consumption pattern changes such as switching to whole wheat products for perceived health reasons may not help but could instead add to this problem of increased hidden gluten consumption (see below from ),
‘It may be noted that whole wheat products, which are increasing in consumption for health reasons (especially the higher fiber content), often have vital gluten added to them to compensate for the negative effects of the ground whole grain on quality factors, such as loaf volume in breadmaking.’
- Careful, rigorous, double-blind, placebo-controlled crossover trials suggest gluten accounts for only ~17% of non-celiac gluten/wheat sensitivity while the rest can be attributed to fructans, part of FODMAPs, or to nocebo (6, 7). This may be why individuals with self-diagnosed non-celiac gluten/wheat sensitivity switching willy-nilly to a gluten-free diet usually end up hit-or-miss (6, 7).
- Going gluten-free absent proper tests and diagnosis can also back fire (see below from ),
‘But relying on gluten-free alternatives could be counterproductive. The vast majority of gluten-free creations touted as “tummy friendly” contain the same questionable enzymes and additives that food technologists use in the standard, gluten containing industrial equivalent. In addition, they also rely on hi-tech food manufacturing ingredients to provide their architecture. These include xanthan gum, a strong, glue-like substance also used in the oil industry to thicken drilling mud, hydroxypropyl methyl cellulose, also used in the construction industry for its water-retaining properties in cement, and tapioca starch, a nutritionally depleted, chemically modified starch from the cassava root.’
In sum, differences in total gluten and/or other diet components between US and some European diets could explain why some people react to (wheat) grains when in the US but not when in certain European countries.
1. Ellis, A., and B. D. Linaker. “Non-coeliac gluten sensitivity?.” The Lancet 311.8078 (1978): 1358-1359.
2. Aziz, Imran. “The Global Phenomenon of Self-Reported Wheat Sensitivity.” (2018): 1.
4. Kasarda, Donald D. “Can an increase in celiac disease be attributed to an increase in the gluten content of wheat as a consequence of wheat breeding?.” Journal of agricultural and food chemistry 61.6 (2013): 1155-1159.
5. Cabrera-Chávez, F., and AM Calderón de la Barca. “Trends in wheat technology and modification of gluten proteins for dietary treatment of coeliac disease patients.” Journal of cereal science 52.3 (2010): 337-341.
6. Molina-Infante, Javier, and Antonio Carroccio. “Suspected nonceliac gluten sensitivity confirmed in few patients after gluten challenge in double-blind, placebo-controlled trials.” Clinical Gastroenterology and Hepatology 15.3 (2017): 339-348.
7. Skodje, Gry I., et al. “Fructan, rather than gluten, induces symptoms in patients with self-reported non-celiac gluten sensitivity.” Gastroenterology 154.3 (2018): 529-539.