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When, and Why, Did Everyone Stop Eating Gluten?

The views expressed are those of the author and are not necessarily those of Scientific American.


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Celiac disease is an autoimmune disease in which the ingestion of gluten induces enteropathy, or inflammation of the gut, in genetically susceptible individuals. This destruction of the gut means that nutrients cannot be absorbed, leading to a variety of clinical symptoms: anemia due to the lack of iron, atherosclerosis due to the lack of calcium, failure to thrive in children, and GI stress, among others.  

Gluten is the primary protein component of wheat – it is what gives breads their delicious chewy texture. The only known cure for celiac disease is complete elimination of gluten from the diet – so no pizza, bagels, pasta, pancakes, waffles, doughnuts, cookies, soy sauce (it has wheat in it), licorice (ditto) … you get the idea. Even communion wafers are verboten.  

Although this is obviously extremely onerous on many levels, unlike any drug regimen it is 100 percent effective and free of side effects. Ingestion of gluten puts celiacs at risk for developing other autoimmune diseases and lymphomas.

Celiac disease was first described in A.D. 100 by the Greek doctor Aretaeus. When his extant works were first published in Latin in 1552 the Greek word for abdominal, koiliaki, was transcribed to celiac.1

But it was not until the Dutch famine of 1944 that wheat was positively identified as the factor instigating the enteropathy. An observant pediatrician, Willem Dicke, noticed that the celiac patients on his ward improved with the strict rationing of flour.   When the first supplies of precious bread were generously given to these sick children they relapsed, proving that wheat was in fact the culprit2.  

The scarcity of celiac diagnoses in this country had been a self fulfilling prophecy for many years: medical students were taught that celiac was so rare they would probably never encounter it, so they never bothered looking. The variable clinical presentations compounded this idea. When doctors started looking for it, they found it in roughly the same rates as it is found in Europe: 1 in 133 people3.     

Although many autoimmune diseases are thought to result from an interplay of genetic and environmental components, celiac is the only one for which the environmental trigger is actually known. It is gluten, as well as hordein and secalin, the homologous protein components of barley and rye.   So no beer or malt vinegar for celiacs either. For the sake of convenience, foods labeled “gluten free” are free of these proteins as well.   But foods labeled “wheat free” may still contain them, so these foods are not necessarily gluten free.  

Celiac disease is hardly the beginning and end of this story. Dermatitis herpetiformis is a rash that results when gluten induces an autoimmune response in the skin rather than the gut, and there is evidence that gluten can provoke a similar autoimmune response in the brain as well1.  

Gluten sensitivity or intolerance – a somewhat vague claim by people who definitely do not have celiac that they feel better when they eliminate gluten – was belittled by the scientific and medical establishment for a long time because it had no discernable cause or explanation, but now they are starting to come around and believe that it might be real4. It might be mediated by the innate, rather than the adaptive, immune system, meaning that T and B cells are not involved5.  

All this is completely separate from wheat allergies, which are mediated by a completely separate adaptive immune response (allergies are mediated by IgE class antibodies, and celiac antibodies are IgA).   People with wheat allergies can safely eat spelt as well as barley and rye, while those with celiac cannot.   And allergies can be outgrown, whereas celiac is forever.

So whether it is due to an actual increase in occurrence or merely an increase in diagnosis, there are certainly more celiacs around than there used to be. Wheat has been cultivated by humans for some 10,000 years, but as is the case with so many popular crops, the number of varieties we used to grow and consume has been reduced to those few that are commercially viable.6  

The soft white winter wheat that was traditionally grown in the mid-Atlantic states is low in gluten, so it is great for pastry and cake flour but not so much for bread. Now, most wheat used in this country is hard wheat grown in the Midwest, and it is bred to yield flour that is consistent in taste and texture. Hard wheat contains twice as much gluten as soft wheat does, so it produces chewy loaves of bread with crunchy crusts rather than flaky pie crusts.

As of now, FDA labeling laws do not require that the presence of gluten in foods be disclosed. These laws require only that the presence of eight major allergens be declared on food labels. Wheat is one of these allergens, but gluten is not. Manufacturers may label foods as gluten free, but such labeling is voluntary. For the millions of Americans with celiac disease, dermatitis herpetiformis, and gluten intolerance who must ensure that they are not consuming any gluten, this translates to A LOT of time spent reading labels in supermarket aisles.

References:

1. Hadjivassiliou M, Sanders DS, Grünewald RA, Woodroofe N, Boscolo S, and Aeschlimann D. Gluten sensitivity: from gut to brain. Lancet Neurol 2010; 9: 318–30

2. van Berge-Henegouwen GP, and Mulder CJ. Pioneer in the gluten free diet: Willem-Karel Dicke 1905-1962, over 50 years of gluten free diet. Gut. 1993 34(11): 1473–1475.

3. Roberts AG. Gluten Free Baking Classics. Surry Books, Chicago, 2006.

4. Biesiekierski JR, Newnham ED, Irving PM, Barrett JS, Haines M, Doecke JD, Shepherd SJ, Muir JG, and Gibson PR. Gluten causes gastrointestinal symptoms in subjects without celiac disease: a double-blind randomized placebo-controlled trial. Am J Gastroenterol. 2011 106(3):508-14.

5. Sapone A, Lammers KM, Casolaro V, Cammarota M, Giuliano MT, De Rosa M, Stefanile R, Mazzarella G, Tolone C, Russo MI, Esposito P, Ferraraccio F, Cartenì M, Riegler G, de Magistris L, and Fasano A. Divergence of gut permeability and mucosal immune gene expression in two gluten-associated conditions: celiac disease and gluten sensitivity. BMC Med. 2011; 9: 23.

6. Indrani Sen. Flour that has the flavor of home. The New York Times Sept. 10, 2008.

About The Author: Diana Gitig received her Ph.D. in Cell Biology and Genetics from Cornell University’s Graduate School of Medical Sciences in 2001. Since then she is a freelance science writer. Diana is based in New York.

The views expressed are those of the author and are not necessarily those of Scientific American.






Comments 28 Comments

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  1. 1. jbairddo 10:17 am 05/10/2011

    It is tough to get people to give up gluten, but it is a great imitator and many symptoms which one would not think related can improve with this diet. My golden retriever had an inflammatory eye problem which caused dry eyes and he needed optimune eye ointment daily. This problem resolve when gluten was removed from his diet. Likewise my two labs have asthma symptoms from gluten (at first i thought it wheat, but even oats set them off). I you or a child has unexplained rashes, allergies, sinus issues or asthma, a gluten free diet is a safe and rational thing to try for 3 weeks.

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  2. 2. mich71 10:29 am 05/10/2011

    I also think lactose intolerance is another big problem. I was diagnosed with celiac and about 2 weeks after giving it up a lot of problems cleared up. I still had a couple of issues and My Dr. recommended giving up dairy. So far the rest of my issues cleared up and I have never felt better.

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  3. 3. sanoran 11:39 am 05/10/2011

    It should be pointed out that, while true allergies exist, the ‘claim’ of being allergic to something also gets people more attention. In our social interactions, the ‘allergic’ individual can end up being in control of events, as the rest of us try to accommodate them (which makes us feel good too). This could be one reason why there are more people who claim to need special diets. Even children learn very quickly, that if they claim to be allergic to something, then they get special attention.

    Evolution (or mother nature) would always favor those with fewer allergies. If wheat is plentiful and some individuals cannot handle wheat, they will simply be surpassed by the process of natural selection. But if we are seeing more ‘allergic’ people, then something else is at work.

    Most likely, as we give more attention to the ‘allergic’ individuals, we are probably promoting more ‘allergies’.

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  4. 4. Robb Wolf 11:40 am 05/10/2011

    Folks should certainly follow the work of Alessio Fasano if they want to be at the cutting edge of gut permeability, gluten intolerance and autoimmunity.

    SA carried a piece by Prof. Fasaon not long ago:
    http://www.scientificamerican.com/author.cfm?id=2098

    In 2004 there were fewer than 400 papers in pubmed with the tag "gut permeability" as of today it is ~10,000. All grains, grain like substances such as quinoa, legumes, casein and fructose can influence elements of GI permeability and diseases as seemingly disparate as hyperinsulinsim and autoimmunity.

    Slowly, an Evolutionary Biology framework is being applied to nutrition and medicine at large. why this perspective has been neglected in medicine and nutriton is a head-scratcher.

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  5. 5. lowndesw 11:43 am 05/10/2011

    I gave up milk too several years ago and my skin problems went away. Now I cal tell if I add a dash of dairy milk to my coffee. When I think about all the money I’ve spent on dermatologists through the years and nothing was ever said about milk, it reminds me of The Dermatologist’s Code: "Never kill ‘em, never cure ‘em."

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  6. 6. lowndesw 11:47 am 05/10/2011

    See SCIAM 2009 article for more info on this:
    http://www.scientificamerican.com/article.cfm?id=celiac-disease-insights

    Genetic trait, leaky gut, and immune response are all required for celiac.

    Link to this
  7. 7. Robb Wolf 11:57 am 05/10/2011

    Yes, and celiac is only a small part of the picture. That is the point folks, especially the medical community are missing.

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  8. 8. rshoff 12:27 pm 05/10/2011

    Well, agreed. When I give up gluten my mild abdominal complaints disappear. When I give up dairy, a few more fade away. However, when eating food we are ingesting a substance that will be absorbed into our cells, tissues, systems. We are not hermetically sealed vessels. We are part of our environment, and we must eat. Everything we ingest has side effects. Medicine, pollution, food. The question is one of balance.

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  9. 9. Jules Gluten Free 1:40 pm 05/10/2011

    Thanks so much for spreading the word on celiac disease and other medically-necessitated (and valid) reasons to avoid gluten.
    The information you offer on high and low gluten wheat is particularly interesting for many who might wonder why many gluten-free flours produce less than satisfactory breads, but make fine cakes, for example.
    Although you do point out the difficulties in locating gluten-free products by reading food labels, there is another, somewhat less obvious wrinkle posed by these labels in the US. As you mention, we must avoid gluten-containing foods entirely. Forever. Cross-contamination is a serious concern.
    The FDA was to have established a federal definition for “gluten-free” in food labeling by 2008, but they have not done so to date. We launched 1in133.org to bring attention to this serious oversight.
    Last week in Washington, DC we built the World’s Tallest Gluten-Free Cake and hosted the 2011 Gluten-Free Labeling Summit. In conjunction with this event, we obtained nearly 9,000 petition signatures in only 6 weeks, emploring the FDA to finish the task of setting a definition for “gluten-free.”
    To learn more, sign the petition, view photos of the over 11 ft tall cake, or read articles covering the event from such media as USA Today, The Washington Post and the Huffington Post, please go to http://1in133.org/index.php.

    ~jules shepard
    co-founder, 1in133.org
    founder, JulesGlutenFree.com

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  10. 10. Cookievore 2:09 pm 05/10/2011

    Well done. Celiac disease is more common world wide than is recognized. The prevalence of celiac disease is actually greater than 1 in 100.

    In a recent study in India, celiac disease was found to affect 1 in 96. Here’s a pdf of the journal article <a href="http://www.coeliac.gr/library/downloads/Docs/Documents/Makharia_Celiac%20prev.pdf">http://www.coeliac.gr/library/downloads/Docs/Documents/Makharia_Celiac%20prev.pdf</a&gt;

    Here’s hoping that medical professionals who are still unaware of the disease or not current in their knowledge will get a clue by reading this article.

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  11. 11. jeramy 2:15 pm 05/10/2011

    As a celiac, living on a gluten free diet for the past 13 years, I take offense to your blog saying that celiacs are verboten from eating bread, pizza, bagels, communion wafers. This is absolutely NOT true. I eat all of the foods you mention, including communion wafers…all made with non-gluten flours and grains. For that matter I am getting more protein in my GF flours and more natural ingredients than gluten eating folks.

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  12. 12. jeramy 2:17 pm 05/10/2011

    You fail to realize that the "wheat" consumed in america has been modified so much that it is far, far from it’s original form from Europe. This is a huge reason why people have such a hard time with the wheat used these days.

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  13. 13. dmgitig 3:03 pm 05/10/2011

    Hi Jules,

    I so appreciate the work you are doing – of course I signed your petition, and hope the FDA will get their act together soon!

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  14. 14. dmgitig 3:08 pm 05/10/2011

    Hi Jeramy,

    I KNEW I was courting trouble with this one, that someone was going to object. I too make all of these items gf. I was intentionally being dramatic, trying to make a point to readers about the panic many people feel about their initial diagnosis. Also, although celiacs can and do safely eat these things, it often takes a bit more forethought and planning than simply popping into the bagel store on the corner whenever you feel like it, or being able to grab a slice of pizza when you get hungry and are on the road. But your point is well taken, and I apologize for offending you.

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  15. 15. Wayne Williamson 5:21 pm 05/10/2011

    Jeramy…I agree…and not just for wheat…there are many food basics that are not near the "real" thing due to changes made by "man"…great for production in the short term….not so good for the long term…

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  16. 16. ashtonish 9:26 pm 05/10/2011

    Just a thought – why isnt gluten being genetically modified either completely out of wheat or so it isnt a problem (change to molecular shape or?)? Hope this isnt too naive a question!

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  17. 17. 2121xxx 12:22 am 05/11/2011

    C’mon, Jeremy, don’t take offense because the author was saying gluten-intolerant people must avoid certain foods. Of course the author was referring to *ordinarily encountered* edibles, such as communion wafers, bagels, and so forth. Obviously, specially-made versions of these things can be arranged; but, practically speaking, yes, it is true that gluten-intolerant people cannot eat these items. I am speaking from experience, as one who is quite hard-of-hearing. For all intents and purposes, I cannot go to movie theaters to take in a motion picture – though if I am really motivated to see a movie, I have workarounds, such as thoroughly reading a plot synopsis before the movie, and bringing along a printed script to follow along with at the movie theater. But I am not offended if one says of me, "He can no longer watch movies in the theater." That is a fair and very useful generalization.

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  18. 18. winddancer 2:21 am 05/11/2011

    "Evolution (or mother nature) would always favor those with fewer allergies."

    Evolution? You can’t apply the concept to the currant human population. We pervert evolution. It used to be that the strongest and smartest were the ones who best survived and had the strongest chance of passing on their genes to the next generation.

    We have finally evolved to the point that we have out wit "mother nature". We protect the weakest and least intelligent and even promote their increase in our population. Look around. The most intelligent among us are the most likely to limit the number of offspring they have.

    Natural selection stops the passing on of weaker genes by lowering the survival rate of that population so that they don’t procreate. Our own ability to recognize and deal with those that have fragile systems protects them from anything Natural happening to them so that those genes do get passed on!

    Link to this
  19. 19. everettehix 11:08 am 05/11/2011

    I must disagree. Your assumption that claiming to have an allergy is done as a means of control and for sympathy is sad. I am allergic to gluten and would never try to dictate where my friends and I eat and even mentioning my allergy feels awkward. I do not want anyone’s sympathy. In regards to your evolution theory, gluten allergies exist, mostly in those of Northern European descent, due to the lack of wheat production in colder climates for many years. Grain production in the world has outpaced evolutionary selection introducing foods into our diets that some are not capable of consuming. It is incredibly arrogant to assume those with allergies are faking it.

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  20. 20. doehring 4:22 pm 05/11/2011

    An intriguing issue is the impact of the change in baking practice from sourdough to brewer’s yeast monoculture. Up to the mid nineteenth century, the only method used to leaven bread dough was sourdough – a complex mix of bacteria and yeasts. This meant that wheat gluten was exposed in a prolonged fermentation to proteolytic enzymes which significantly altered its structure. There is literature suggesting that at least some people with gluten sensitivity can tolerate sourdough bread.
    Beware, however, much of the supposed "sourdough" bread made commercially is just Saccharomyces cerevisiae leavened bread with flavour enhancers!

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  21. 21. justsaying 1:07 am 05/12/2011

    In the spirit of the comment by sanoran, one can only hope that evolution will also take care of people who don’t understand the difference between an auto-immune reaction to gluten (not just wheat!) and a wheat allergy even after just reading an article explaining it!

    Link to this
  22. 22. bucketofsquid 11:04 am 05/13/2011

    Your bizarre perspective on birth rates and intelligence is not founded on fact at all. Had you tied it to education levels then perhaps you would be correct. The simple fact is that many low income families with many children are very intelligent but have limited access to better education systems. Don’t confuse snobbery with science.

    You are correct about undesirable traits getting passed on with lower child mortality rates however; many of the children that would have died are not somehow less perfect. They are far more likely to have simply been in the wrong place at the wrong time. Observe any animal population group in a natural setting and you will see that some are clearly defective and naturally die young. The majority that die before breeding are not particularly defective and simply encounter something they don’t understand or know how to deal with. You seem to suffer from the "mandated by God" syndrome where sufferers of this syndrome view everything bad that happens as "justified and correct".

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  23. 23. bucketofsquid 11:11 am 05/13/2011

    I find it tiresome that so many people don’t get the concept of adaptation to environment. Most of the human population doesn’t digest cow milk very well because for thousands of years their ancestors didn’t consume it. The same is true for large portions of the species in regards to various grains, fruits and vegetables and also meats. Is it really so hard to wrap our minds around the basic fact that if our ancestors didn’t consume it, our bodies may lack the bacteria to properly digest it? This isn’t quantum physics here. This is grade school science.

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  24. 24. rhoggan 5:34 pm 05/15/2011

    Dear Dr. Gitig,
    Thank you for your most informative, even-handed article. I would like to point out one minor problem.
    Please refer to Dr. Dicke’s doctoral thesis (http://members.shaw.ca/Dicke/)in which he reports treating patients with a gluten free diet as early as 1936, long before World War 2 and the 1944 food shortages in The Netherlands. You will also discover, through reading his thesis, that Dr. Dicke gives indirect credit to a concerned mother for the original insight that gluten might be a pathogenic factor in celiac disease.

    I realize that there are many repetitions of the "Dutch Famine" story in the medical literature. I repeated the same mistaken claim in one of my own reports. (Hoggan, R., “Absolutism’s Hidden Message for Medical Scientism” Interchange, 28(2-3): 183-189, 1997) Nonetheless, it is clear that Dr. Dicke’s insight was not associated with World War 2 food shortages.

    best wishes,
    Ron Hoggan, Ed. D.

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  25. 25. rhoggan 5:54 pm 05/15/2011

    Hi Mr. Wolf,
    True, but what you are asking for is a rather large paradigm shift. The recognition of the importance of dietary mediators of intestinal permeability, along with the harm caused by refined sugars are only now gaining wider acceptance. It is difficult to imagine that the "staff of life" causes illness. Another important contributor to the slow acceptance of these new ideas is the vilification of dietary fats. When dietary fats are frowned upon as a primary source of energy, carbohydrates are the only other option.

    best wishes,
    Ron Hoggan, Ed. D.

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  26. 26. rhoggan 6:03 pm 05/15/2011

    Hi Sanoran,
    It is my experience that those who have not complied with a strict diet are also those who imagine that the psychological rewards could offset the inconvenience of the diet. I’m sure there are isolated cases such as you suggest, but most such individuals would quickly be dissuaded by the many inconveniences associated with dietary avoidance.
    best wishes,
    Ron Hoggan, Ed. D.

    Link to this
  27. 27. dmgitig 12:12 pm 05/16/2011

    rhoggan,

    Thank you so much for pointing this out; I apologize for promoting this error.

    Link to this
  28. 28. YotamAviv 8:06 pm 09/18/2012

    While useful, this article does not at all attempt to answer “When, and Why, Did Everyone Stop Eating Gluten?”
    I’ve witnessed a rising trend to view wheat and gluten as unhealthy foods period, regardless of allergies or celiac disease. Is this view warranted? What lead to it?

    Link to this

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