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Nov 26, 2011 02:16 PM

Gluten sensitivity may now affect as many as 1 in 16 Americans

Based on comparisons of blood samples from the 1950s to the 1990s it seems that antibody markers of gluten sensitivity, and of celiac disease in particular, have become about 5 times more common in recent years.

It is estimated that about 1 of every 133 people has celiac disease, and of those with a relative who has celiac disease, the prevalence is even higher, as much as 1 in 22. Yet just 10 years ago or so, it was still being taught that the prevalence of celiac diasease was only about 1 in 10,000 in the US, much lower than was believed at that time to be the case in Europe.

So even if a lot of the recent awareness among the general public of gluten sensitivity has been driven by fad-chasers, there may actually be a significant increase in the number of people who would benefit for legitimate medical reasons from a gluten-free diet.

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  1. Interesting. But it may also be that gluten sensitivity is over diagnosed, much as low blood sugar was decades ago. Or it might be that gluten sensitivity was under diagnosed for decades.

    3 Replies
    1. re: sueatmo

      My thoughts as well. But if the study (or studies) comparing blood samples from different eras are valid, it's more than just a matter of changes in diagnostic practices.

      1. re: sueatmo

        It's not over diagnosed, I suspect. At least for celiac disease. The blood test is known for being unreliable (erring on the side of a negative) and the "gold standard" test is a gut biopsy, which a ton of people don't/won't/can't do. I think we're dealing with a majorly underdiagnosed phenomenon, and no wonder - the standard American diet is so chock full of wheat - our "normal" may very well be less healthy that we ought to be.

        1. re: Vetter

          3 grains, rice, wheat, and corn dominate nearly all the diets in the world. America is far from unique in its use of wheat. USA per capita consumption of wheat is down from a high in the late 19th c Z(225lb/yr), though up a bit from the 1970s (110)

      2. Are there degrees of sensitivity?

        6 Replies
        1. re: sandylc

          Many. And many forms of issues with gluten. You can have allergies, intolerance and Celiac Disease ( and I am sure that I am leaving out some). People with all of the above have different reactions ( and some, no reaction!) to gluten- meaning that they can be asymptomatic. This is all important because issues with gluten are not one size fits all.

          1. re: carfreeinla

            My mother has had some unusual food intolerances for most of her life. It is strictly gastrointestinal. People don't understand: "A little won't hurt you!" Only if you don't count the visit to the emergency room!!!!

            1. re: carfreeinla

              As Carfreeinla said, there is a wide spectrum of responses to gluten.
              There are even some patients who experience severe rashes (dermatitis herpetiformis) rather than (or in addition to) gastrointestinal symptoms and malnutrition.

              On the other hand, there is the suggestion that some people who don't have bona fide gluten intolerance may feel better on a gluten-restricted diet for reasons other than what they might have anticipated:

              "One thing to consider is that many people feel better on a gluten free diet because they are eating less food overall (due to fewer choices) and cutting out most sources of refined grains, both of which are a good idea even if you don't have gluten issues.

              Your 'sensitivity' to carbs may also relate to blood sugar fluctuations and insulin resistance, both of which can improve by reducing total and particularly refined grain intake."

              1. re: carfreeinla

                However, if you have celiac disease, as I do, there are no varying degrees. If you have celiac you have celiac.

                1. re: chefathome

                  Chefathome, on the contrary, the manifestations of celiac disease itself vary a fair amount.

                  (If there were no variable degrees, wouldn't it be much easier for doctors to recognize the disease?)

                  1. re: racer x

                    The villi blunting can vary and so can the symptoms (wildly!) but the only thing one can do is to strictly follow the gluten-free diet for life. Thta is what I meant. You cannot have celiac just a little bit - if you have it, you have it, unfortunately. Sorry if I was unclear. I know tons of people with celiac and their symptoms are all over the map so yes, the manifestation can be different, but the treat ment is the same.

            2. Over-diagnosing in MHO. If we all stopped eating anything that gave us gas, we have to stop eating lots of veggies and virtually all beans. True celiac disease, ok. but the rest has just gone over the SILs find something new to be intolerant of every year or two so it's now to the point they have to allow something back into their diet that they used to be intolerant of or they'd have nothing to eat.

              3 Replies
              1. re: escondido123

                Celiac and gluten intolerance is not simply about avoiding gas. Your SILs do a disservice to the rest of us. If you saw a photo of me from when I ate wheat and then a photo now, I assure you, you'd be able to literally see the difference. I was malnourished, constantly rashy, had cracked skin around my nose and lips, had ridged/damaged fingernails, and was bloated in the face. But I looked well fed (ahem) and ate my whole grains like a good girl. I was dragged kicking and screaming to give up gluten. Please don't write off the very real numbers and prevalence of this very common disease because some ding dongs have co-opted it for a fad.

                1. re: Vetter

                  "Ding dongs". I love that & use it all the time.

                  1. re: Vetter

                    Please do not distort what I wrote. I did not say celiac is simply about avoiding gas. I understand that it is a very serious disease, so serious that I would not take it upon myself to try and make a meal for someone with the disease--the consequences of failure are too great. But there are many people--you see them on CH, you certainly run into them in real life--who are obsessed with every bite they put in their mouth, whether it's calories, allergies, just don't like it, nutritionist told me to stop dairy, I think I have a problem with mold--that sharing a homemade meal with some folks has become a minefield. Ah for the days of just having to deal with vegetarians.

                2. I've had brutal heartburn for years. Myriad tests, endoscopies, and prescriptions failed to alleviate my symptoms. Tired of feeling like a guinea pig for doctors, I thought I would give a gluten free diet a chance.

                  It took 3 days for me to be heartburn free.

                  From what I gather, I have what is known as "non-celiac gluten sensitivity".

                  I can eat wheat products. I just have to deal with REALLY bad heartburn.

                  Symptoms of gluten sensitivity manifest in a multitude of ways. The reaction is specific to the individual. This is what makes it hard to diagnose.

                  I don't know how or why I developed this. I'm just very, very glad I found something that works to alleviate the symptoms.

                  2 Replies
                  1. re: NotJuliaChild

                    That is amazing NJC! Thanks for the comments. I've been trying to follow a mostly raw vegan diet to look and feel better and what I crave most is not the meat and dairy but the grains. To me the grains seem really addicting. Let food be your medicine!

                    1. re: NotJuliaChild

                      RE: NotJC - THAT is exactly ME! Thank you for posting!! To eat anything wheat-related I have to take so many Pepcids/antacids I'm sure it does not do my body good....

                      Thank you for posting!

                    2. It does seem to be increasing, and I don't think it's just from greater awareness. This article has some interesting theories:


                      6 Replies
                      1. re: hsk

                        The investigators mentioned in that USAToday article are the same as were quoted in the NY Times Magazine linked to in the OP, and those investigators are referring to the same two studies.

                        From skimming one of those studies (the Mayo Clinic study) now I see several huge potential problems with the methods that were used (problems that the authors acknowledged in their discussion of their findings). The study looked for bloodstream antibodies which are markers for gluten intolerance/celiac disease. They compared the prevalence of those antibodies in blood samples that had been collected back in the 1940s and 1950s and stored to the prevalence in samples that were drawn in the 1990s, almost 50 years later. The samples were studied simultaneously, using the same modern methods of analysis. If the prevalence of gluten intolerance has remained stable over the decades, the percentage of blood samples with diagnostic antibody levels should also have remained essentially unchanged (or so the argument goes).

                        They found that the prevalence of diagnostic antibodies was 4 - 5 times higher among participants whose blood was sampled in the 1990s than was found among participants whose blood had been sampled in the 1940s and 1950s. Based on this finding, they concluded that the prevalence of gluten intolerance has been dramatically rising in the US.

                        Unfortunately, the populations that were being compared (circa 1950 vs a half-century later) were not comparable in other regards, so the difference in antibody rates could have been due to other factors that were not studied.

                        First, the participants in the 1950-era study were young, healthy individuals working on an Air Force base (average age only 20) while the 1990s group were much older (by an average age of two decades or more, in fact). If gluten intolerance increases with age, and there is evidence that it does to a certain point, the age difference alone might explain the discrepancy.

                        Second, as military men, the 1950s-era participants were drawn from across the US, while the 1990s participants were all locals living near the medical center, so if the rate of gluten intolerance happened to be higher in the population of people living near the medical center than throughout the rest of the country, comparing the two populations could also create an illusion of an increasing rate. (I suspect that young military workers also probably tend to be healthier than non-military workers -- a young person with bowel difficulties or symptoms of malnutrition would probably have been less likely to have gotten into the Air Force than someone who was pretty healthy, which would have tended to lower the likelihood of finding gluten intolerance antibodies in the military base group compared to the general population.)

                        Third, the proportion of African Americans appears to have been significantly lower in the group of participants from the 1990s than was the case 50 years earlier -- an important observation because gluten intolerance is known to be less common among non-Europeans than among Europeans and European Americans.

                        The second study I can't read because I don't have access to the journal; I can only see the abstract which is available online.

                        In that study they looked for the diagnostic antibodies in blood that had been drawn in 1989 and compared the prevalence to that in blood that had been drawn from the same participants 15 years earlier. They found that the prevalence had doubled in those 15 years, suggesting that some individuals who had not had gluten intolerance when they had first given blood had developed it over time.

                        However, that finding doesn't necessarily mean that the prevalence of the disease more generally was rising during those 15 years -- it just seems to suggest instead that gluten intolerance may be acquired with age.

                        I'd also be interested to see the statistical analysis of the data in the second study -- the doubling they found might not have been statistically significant.
                        (They also said in the abstract that the prevalence of antibodies had risen about 5-fold in the US more generally over the 15 years but they didn't explain in the report abstract their justification for extrapolating numbers measured in a local Maryland population to the rest of the country.)

                        1. re: racer x

                          Still, even with the flaws of those two studies, it's possible that we may be experiencing a real increase in the prevalence of the conditions, not just an increase in awareness among doctors and a lowering of the threshold for making the diagnosis.

                          There is at least one other study (which I haven't read in depth), in which the prevalence of antibodies was compared in groups of blood drawn decades apart, in this case in Finland, with the finding that the prevalence had markedly risen over a 20-year period.

                          1. re: racer x

                            Actually this was the part from the USA Today article I found interesting. I know both articles quoted the same studies.

                            Awareness of celiac disease has grown in recent years, evidenced by the growing number of gluten-free foods on the market. However, medical experts don't believe that the increase in celiac disease incidence can be chalked up simply to folks becoming more aware of the chronic digestive disorder or to improvements in diagnostic techniques.
                            Rather, the most popular potential explanations for the increase in celiac disease rates involve improvements in sanitation and hygiene in civilization overall, said Fasano and Carol McCarthy Shilson, executive director of the University of Chicago Celiac Disease Center.
                            According to the "hygiene hypothesis," Shilson said, people in industrialized countries are more at risk for celiac disease because their bodies have not had to fight off as many diseases.
                            "We're just too clean a society, so our immune systems aren't as developed as they should be," she said.
                            Another version of the hypothesis holds that the cleanliness of industrialized society has caused a fundamental change in the composition of the digestive bacteria contained within the gut, Fasano said.
                            "It's because this increase occurs primarily in industrialized countries, where things are cleaner," Fasano said. "We abuse antibiotics, we wash our hands too often, we are vaccinated more often."
                            Other potential explanations for the rise in celiac disease rates, according to Fasano, include:
                            An increase in the amount of gluten found in grains. "We eat grains that are much more rich in glutens than they were 70 or 80 years ago," he said.
                            Children being exposed to gluten from an early age. "We know for sure if we introduce grains too early, people at risk for developing celiac disease are more likely to contract it," he said.
                            Too few women breast-feeding their children. "There are theories out there that say breast-feeding will protect you, or prevent celiac disease," Fasano said.
                            It's possible, experts say, that each of these theories is correct to a degree and that a combination of factors will ultimately be found to contribute to celiac disease. "It may well be in one person, one plays a stronger role than another," Fasano said.

                            1. re: hsk

                              Thank you, hsk, for highlighting ideas which are not a popular but every bit as valid (maybe more so).

                            2. re: racer x

                              Thank you racer x. I get so frustrated with "conclusions" from "medical" or "scientific" "studies" where they completely isolate the details that they have predetermined to be of interest, while disregarding about a million other factors which probably have an effect on the outcome. Please disregard my lack of technical language here; I think I made some sort of point, however!