A Deeper Dive into Food Sensitivities
/Given my personal experience, I was very interested in researching NCGS. Around the world, it seems as though the amount of people getting diagnosed with Celiac Disease or NCGS is increasing quickly. About 10 years ago, there were no gluten free options on menus or many brands of gluten free products. Not many people knew someone with a gluten sensitivity or allergy. Nowadays, there are at least 5 different brands of gluten free bread on shelves, and some stores even have entire isles dedicated to gluten free products. However, this rise in “popularity” has many different components. Research suggests that the amount of people with Celiac Disease has not increased, but instead its diagnosis. Celiac Disease is extremely underdiagnosed all around the world due to the similarity of its symptoms to other conditions such as IBS and Crohn’s Disease. As for gluten sensitivities, the underdiagnosis is immeasurable. Most people in the health care and scientific communities did not acknowledge non celiac gluten sensitivity’s existence until a double blind study and psychological study was conducted by researchers in 2012. Additionally, a gluten free diet was adopted by the “fad diet” community and gave the topic a stigma that people with sensitivities like myself are still trying to shake.
Now, the cause of gluten sensitivities is still up for debate. The only agreement of the scientific community on the topic is the mere existence of gluten sensitivities as no one can agree on much else. The plausible theories of its cause seem to be a group of proteins in wheat, rye, and barley called amylase trypsin inhibitors, FODMAPs, or some other unknown biological markers. Research began by comparing non-celiac patients to patients with the disease and measuring their responses. It is known that Celiac is caused by a genetic mutation of a gene, however the inheritance pattern is still unknown. Many people believed that a gluten sensitivity would work in the same manner, however no evidence of that has been concretely defined. In terms of the proteins, people with gluten sensitivities have significantly higher levels of a certain class of antibodies against gluten that suggest a short-lived, systemic immune response. These antibodies suggest that the barrier of the intestines might be defective, allowing partially digested gluten to get out of the gut and interact with immune cells in the blood. Elevated levels of two proteins that indicate an inflammatory response to bacteria were identified, which eventually subsided after six months on a gluten free diet. On the other hand, FODMAPs are compounds that ferment in the gut to cause symptoms of irritable bowel syndrome, such as abdominal pain, bloating, and gas. These compounds are found in many foods like onions, garlic, legumes, milk, yogurt, apples, cherries, and mangoes and wheat. Researchers are unsure of the exact working of both of these systems, and which one causes gluten sensitivities, but at least we are learning something.
Beyond the workings within the body, many researchers are looking into wheat itself. Many people fear that modern wheat varieties contain more immunoreactive proteins than in the past and that this is the cause of the increased incidence of wheat-related disorders, according to Darina Pronin from the Leibniz-Institute for Food Systems Biology. In order to test this, the researchers selected five leading wheat varieties for each decade of the 120 years examined. In order to generate comparable samples, they cultivated the different varieties in 2015, 2016 and 2017 under the same geographical and climatic conditions. Analyses by the team of scientists showed that, overall, modern wheat varieties contain slightly less protein than old ones. In contrast, the gluten content has remained constant over the last 120 years, although the composition of the gluten has changed slightly. While the proportion of critically viewed gliadins fell by around 18 percent, the proportion of glutenins rose by around 25 percent. In addition, the researchers observed that higher precipitation in the year of the harvest was accompanied by a higher gluten content in the samples. In conclusion, they did not find any dramatic increase in various irritating components, however the changes are still present.
The wheat debate continues with the comparison of US to European wheat. Many people with gluten sensitivities report the ability to eat wheat freely when traveling in Europe. This has sparked much investigation into the differences between the two. In comparison, wheat grown in the US and wheat grown in Europe of the same class or type have about the same gluten content. Studies have revealed that the gluten content does not change based on growing conditions, and is the same within each variety. However, the red wheat grown majorly in the US does have a higher gluten content compared to other classes of wheat which are more commonly grown in Europe. So, it appears that the factor is not where the wheat is grown per say, but the class of wheat itself. However, this debate on regions is further complicated with the added factor of pesticides. Though heavily debated, some experts propose that glyphosate — AKA Roundup — plays a role in the development of celiac disease and NCGS. A 2020 study published in Frontiers in Microbiology suggests that exposure to glyphosate alone or through food treated with the herbicide promotes gut dysbiosis by reducing good gut bacteria and increasing the number of opportunistic pathogens. This glyphosate-induced dysbiosis may be linked to inflammation, reflux disease, obesity, and colon cancer. Interestingly, glyphosate and many other chemicals of the same nature are prohibited from use in many European countries. Despite the focus on wheat, high glyphosate residues were also found on other crops such as corn and legumes. However, wheat products contain higher residues post-processing and comprise a significant portion of the average North American's dietary glyphosate exposure. The glyphosate problem continues to worsen as some farms who do not use the pesticide have now found it has contaminated their water and therefore their crops. Although no studies have found a direct link between Celiac disease or NCGS and glyphosate, it is a factor that cannot be dismissed completely.
In conjunction with the increase in gluten sensitivities, there has been a response from the government here in the US and in countries around the world. Here in the US, “If you or one of your dependents has celiac disease and you itemize your deductions, the extra costs due to gluten-free dietary restrictions may be taken as a medical expense.” In Argentina, the “National Program for the Detection and Control of Celiac Disease” promotes awareness and knowledge regarding celiac disease, has implemented an impressive array of labeling restrictions, and created a national logo for all certified-GF packaged foods. For residents, Argentinian health care providers must cover the cost of alternative flours and gluten-free mixes. In Australia and New Zealand, they have the toughest labeling laws in the world. Set by the Australia New Zealand Food Standards Code, they apply to all food sold or prepared for sale, including imported food.
The Australia New Zealand Food Standards Code requires the following: Foods labeled as “gluten free” must not contain any detectable gluten; and no oats or their products; or cereals containing gluten that have used malt or their products. Ingredients derived from gluten containing grains must be declared on the food label, however small the amount. Foods labeled as “low gluten” must contain less than 200 parts per million of gluten. In Canada, labeling restrictions are placed on all packaged gluten-free foods. All foods considered certified gluten-free by Health Canada must contain under 20 parts per million of gluten. Any intentionally added gluten-containing ingredient must be listed on a product. In addition, Canadian residents receive tax deductions for the extra cost of gluten free foods versus their non-gluten free counterparts. Based on the enhanced labeling regulations for allergens and gluten sources, any intentionally added gluten sources, even at low levels (e.g. wheat flour as a component in a seasoning mixture which makes up a small proportion of the final food), must be declared either in the list or ingredients or in a “Contains” statement. This limitation is extremely rare, as here in the US, it can be simply listed as “spices” with no additional disclosure. In Ireland, Irish citizens may claim tax deductions for the extra cost of gluten free foods versus their non-gluten free counterparts. In Italy, it is a myth that routine screening is performed. However, children and adults are tested for celiac disease when they have specific symptoms. Diagnosed celiacs receive vouchers to buy specifically produced gluten free foods, up to 140 euros per month. The Italian Celiac Association and government have done an excellent job educating restaurants on how to deal with celiac disease. There are even gluten-free meals in schools, hospitals, and all other public eating establishments. Finally, Over 90% of British celiac patients receive gluten-free food as part of their prescription for the gluten-free diet. Essentially these patients receive gluten free food and mixes at a heavily discounted price (the cost of the prescription).
I hope my personal experience and research have shed some light on the daunting and complex topic of food sensitivities. There is still a lot to be learned and researched in both the medical and scientific space, something I hope to contribute to in my professional career. Additionally, as seen above, the US does have quite a ways to come in terms of public policy and labeling laws to help protect and inform people about their food products. This is a topic that I am personally very passionate about as it is incredibly difficult to find full ingredients lists for items at fast food restaurants, online products, and even products in store. This poses a great inconvenience for me as I have to spend a lot of time trying to figure out if I can eat the product, and whether it is worth the risk.