If you look at the global statistics for gluten intolerance, you’ll notice something really interesting right away — while as many as 1 in 133 people are suspected to have celiac disease in the U.S. and Europe, there are almost no documented cases in large parts of the world.
Since there’s no hard data from most of Asia, South America and Africa, doctors have assumed for decades that celiac disease is a “European” problem caused by lifestyle, genetics, or even GMOs.
In recent years, new studies have begun to question that assumption. It turns out that the truth may be a whole lot simpler than any of these theories: celiac probably exists everywhere in the world, but doctors in less developed nations are simply less likely to diagnose it.
An Italian study from 2007, for instance, found that the rates of celiac disease in parts of Africa and throughout South America were roughly the same as the rates in the U.S. and Europe. While they weren’t able to obtain hard numbers for most of Asia, celiac disease is beginning to become more widely-recognized in North India where wheat is a dietary staple.
The researchers dismiss the idea that gluten intolerance is “spreading,” instead citing lack of awareness on the part of physicians as the reason for low rates of diagnosis — particularly in patients with atypical or delayed symptoms. A study published in 2004 in Indian Pediatrics echoes this theory, noting that it’s typically only children presenting with severe symptoms like chronic diarrhea that tend to be diagnosed.
The Italian study also found that Japanese and Chinese immigrants to North America were just as likely as people of European ancestry to develop the disease, suggesting that the genetic predisposition to celiac disease does exist in those populations.
That’s confirmed in a 2009 Chinese study, which speculates that celiac may exist at the same rates in China as it does elsewhere in the world — but that a rice-heavy diet with fewer wheat products may result in only mild symptoms that are unlikely to be diagnosed. The major problem with this, the authors note, is that the disease will worsen with continued gluten exposure even if wheat is not a dietary staple. They recommend routine genetic and blood tests for celiac within the general, “healthy” Chinese population to more accurately screen for subclinical and atypical cases of celiac disease.
While there’s still much we don’t know about the global prevalence of gluten intolerance, there’s one point all these studies agree on: as wheat products and an American-style diet become more popular throughout the world, diagnosed cases of celiac disease are going to become more and more common. And with the lack of affordable gluten-free products available in many countries, that’s a huge problem, especially in the developing world.
What happens to a newly-diagnosed celiac patient in rural Africa who lives mostly on wheat or barley to survive? Even in nations with lots of gluten-free options available, the diet is extremely difficult to maintain and often very expensive.
For millions of people, the choice may well be to continuing eating food that they know will make them sick — and put them at a higher risk of certain cancers and severe autoimmune conditions in the long term — or to simply go hungry.
Photo credit: Sushi Ina via Flickr