Olivia Diaz Gilbert
Abstract: Recently, there has been a worldwide movement increasing awareness of gluten related illnesses and the number of people that consume a gluten free diet. This trend has been caused by an increase in the diagnoses of celiac disease and non-celiac gluten intolerance and by the promotion of the gluten-free diet as a weight loss strategy. The gluten-free movement has had an effect on the food culture surrounding foods traditionally made from wheat such as pasta, in many regions around the world. The effects have been unique in several heavy noodle-consuming countries, specifically China, Italy, and the United States.
In the last decade, the gluten free diet has gained popularity due to its medical and perceived dietary benefits.[1] This trend has much to do with the growing number of diagnoses of celiac disease and non-celiac gluten intolerance world-wide.[2] Because gluten is used in so much of food production, the gluten free movement has fundamentally changed the food industry and food culture in the Western World. Noodles are one of the foods upon which the gluten-free movement has had the biggest impact, due to the fact that its main ingredient is wheat flour. However, this impact varies greatly geographically, and between Western and non-Western countries. The following paper will explain the causes of the gluten free movement, and the effects it has on pasta in the U.S., China, and Italy.
One of the most well-researched reasons to avoid gluten is celiac disease. Celiac disease is an autoimmune disorder that causes damage to the villi lining the small intestine when gluten is ingested.[1] This reaction can not only cause digestive discomfort, but also a multitude of nutrient deficiencies as it impairs the small intestine’s nutrient absorbing capabilities. If left untreated, celiac disease is also associated with many more severe life-altering diseases such as osteoporosis, thyroid diseases, and even certain types of cancer.[2] Additionally, the only known treatment for celiac disease is to exclude gluten altogether from one’s diet.[3] This reality has led many suffering from celiac to search for gluten-free products to replace certain diet staples such as bread and pasta. In the past several years, the number of people diagnosed with celiac disease and thus awareness of the disease has increased significantly.[4] Still, according to the celiac foundation, out of the estimated 3 million Americans suffering from celiac disease (1% of the U.S. population), there are currently only 400,000 diagnosed cases.[5]
In addition to celiac disease, there are two other main medical causes for eliminating gluten from the diet. The first is a wheat allergy, which is one of the eight most common food allergies and affects approximately 0.3% of the U.S. population.[6] The second is non-celiac gluten sensitivity. Experts have estimated that as many as 18,00,000 or 6% of Americans suffer from non-celiac gluten intolerance.[7] However, there still has not yet been conclusive evidence showing that non-celiac gluten sensitivity is a diagnosable problem or if the positive results that people report from eliminating gluten from their diets are due to sensitivity, a reduction on the amount of junk food eaten, or the placebo effect.[8] Further research remains to be done that could conclusively link non-celiac gluten sensitivity to specific genetic or physiological factors. Regardless, reports and diagnoses of both celiac and non-celiac gluten sensitivity have been on the rise sine the mid 2000’s, which has caused the demand for gluten free products to increase significantly.
Lastly, as celiac disease and non-celiac gluten sensitivity have gained awareness in the U.S., the gluten-free lifestyle has also been promoted as a diet strategy to promote weight loss.[9] This diet has become so popular, that as of 2014 one study showed that 30% of Americans self-reported they “avoid gluten.”[10] Contrary to the gluten-free doctrine that some celebrities and public figures promote, evidence suggests that going gluten-free is not actually the best strategy for weight loss.[11] People may experience weight loss as they eliminate highly processed, refined, or sugary foods from their diets, however, if these foods are replaced with equally unhealthy gluten-free foods, the benefits of a gluten free diet will be lost.[12] However, so long as the public perceives that a gluten-free diet is good for weight loss, they will continue to demand gluten-free products. This ultimately has a positive effect for those with legitimate disorders, sensitivities, or allergies that prevent them from consuming gluten by increasing the availability of gluten free foods.
The increase in desire for gluten-free products for the reasons explained above has resulted in the development of gluten-free alternatives to products traditionally made from wheat flour, or other ingredients containing gluten. Along with breads, and almost all other baked goods, alternatives to wheat flour pasta and noodles are also in demand. According to Food Business News, pasta sales grew almost 3% world-wide between 2015 and 2018.[13] If it was not already, in recent years pasta has become a staple food for Americans, with the average American eating 20 pounds of pasta each year.[14] This trend in the U.S. has led to even greater need for gluten-free alternatives to noodles and producers have reacted accordingly. Between 2014 and 2018, gluten-free food production went from being a 5.9 billion dollar industry to a 17.6 billion dollar industry.[15] This means that more gluten free products including pasta and noodles, are getting on the shelves at supermarkets, and more people than ever are buying them.
This exponential growth in the gluten free food industry, and the rising popularity of pasta in general has led to many innovations in gluten-free pasta. Multiple different kinds of cereals, psuedocereals, and legumes have been used to make gluten-free pasta and noodles including, quinoa, millet, rice, amaranth, sweet potato, corn, lentils, and chickpeas to name a few.[16] Research shows that pastas made with some grains are preferred to others. For example, one study by the U.S. Department of Agriculture (USDA) found that 83% of participants in the study found pasta made from corn acceptable, while only 50% of the same pool of participants found pasta made form millet acceptable taste-wise.[17] Another study published in the Journal of the Science of Food and Agriculture found that people without celiac disease had lower acceptability scores for pasta made from Andean corn than people with celiac.[18] These studies imply that producers of gluten-free pastas and noodles have desires to improve the standard of their products, and broaden the types of ingredients that are used in them. Additionally, some of the more recent additions to the variety of gluten-free pastas available include those made of legumes such as chickpeas or lentils.[19] These types of noodles have been introduced to the market as high protein alternatives to other gluten-free pastas. These pastas appeal to more than just gluten-free consumers, but also consumers with different kinds of dietary restrictions that make it more difficult to eat enough protein such vegetarians and vegans.[20] The research and innovation in alternatives to wheat flour pasta has led to the increase in variety of gluten-free pastas currently available and vast improvements in the quality of gluten-free pastas.
Based on the trends and research explored above, the gluten-free movement has greatly influenced the food culture specifically having to do with pasta, in America. Pasta and noodles made from ingredients other than wheat flour have increased significantly in popularity, not just with those who cannot eat gluten for medical reasons, but also for people who are not gluten-free.[21] The gluten-free food industry in American is predicted to continue to grow in the coming years, and with this, the impact of gluten-free foods such as pasta on food culture will also continue grow.[22]
However, the awareness for medical problems or lifestyle choices that require a gluten-free diet is much greater in some parts of the world than others. This lack of awareness has implications for the availability of gluten-free products as well as the culture surrounding the gluten-free movement and products. Because of the significance of the noodle in these countries, the following portion of this paper will compare and contrast gluten-free culture in China and Italy with each other and with what has already been established about gluten-free culture in the United States.
In China, the culture surrounding gluten-free food is vastly different than that of the United States. Firstly, awareness about celiac disease or gluten intolerance remains relatively low among the general population.[23] Even among those who are aware of the of the medical issues associated with gluten consider these “Western problem[s]”.[24] According to Dr. Zou Lin, a Physician at the Southern Hospital of Integrated Chinese and Western Medicine in Guangzhou, many believe that the medical issues associated with gluten are psychological rather than physiological, or that these issues can be cured by slowly reintroducing gluten back into the diet.[25] However, this is most often not the case.
Additionally, in China, there exists the concept that gluten related illnesses do not affect the Chinese as much as they do Americans and Europeans.[26] However, one study conducted in 2018 shows that the percentage of the population suffering from disease in Africa, Asia, Europe and Oceania, North America, and South America are very similar and even concluded that the prevalence of celiac disease in Asia (0.6%) was higher than the higher than the prevalence in North America (0.5%).[27] From a public health standpoint, this misinformation needs to be rectified so that Chinese people with celiac disease can get the health advice and treatment they need.
However, raising awareness and changing attitudes surrounding gluten-free diets of people in China is a lot easier said than done. Wheat is an extremely culturally important staple food in China and is used in a multitude of ways outside of just noodles.[28] Wheat flour is used as a thickening agent in much of Chinese cuisine and is an ingredient in soy sauce which is used to flavor many Chinese dishes.[29] Between these two uses of gluten in Chinese cuisine, gluten can be found in dishes that do not include noodles or other foods made from doughs. In China, eating or making gluten free food means completely changing the process of how food in general is made. Because of this, it will likely take longer for the gluten-free movement to gain traction in China and thus for gluten-free foods like noodles to be used where wheat is a traditional staple.[30] Thus far, the gluten-free movement in China has had little to no effect on food culture and it is yet to be seen if it will in the future.
In Italy, a culture surrounding the gluten-free lifestyle has emerged that is different from both the culture in the United States and China. Similar to the United States, awareness of celiac disease and other gluten related illnesses is high among the general public. In fact, celiac disease has been recognized by health experts as a public health issue in Italy for longer than ns United States or other European nations.[31] Its leading celiac association, the Associazione Italiana Celiachia, was founded 30 years ago in 1979.[32] Because of the high level of awareness of gluten-free diets in Italy, there is also a high level of availability of gluten-free products.
Pasta is one of the most culturally important foods in Italian Cuisine. Where the average American eats 20 pounds of pasta every year, the average Italian eats 52 pounds of pasta every year.[33] For Italians with celiac disease or gluten intolerance, finding a gluten-free alternative to pasta means that they can continue to enjoy culturally significant dishes, and thus there is a high demand for gluten free pasta. Dry pasta producers like the Italian multinational pasta producer, Barilla, have responded accordingly in providing a diverse line of high-quality gluten-free alternatives to traditional wheat-flour pastas.[34] Small pasta producers such as restaurants have also responded either by purchasing gluten-free pasta to provide their gluten-free customers, or by formulating their own recipes and making gluten-free pasta in house.[35] Italian pasta producers large and small have embraced and provide for the dietary needs of their celiac and gluten-sensitive fellow pasta lovers.
However, their lies a key difference in gluten-free food culture in Italy and the United states. In Italy, sufferers of celiac disease and gluten intolerance are looked upon with pity by non-sufferers. Unlike in the U.S., in Italy, the gluten-free diet has gained little traction as a diet specifically for weight loss or a “healthy lifestyle”.[36] Pasta is considered a delicious and healthy food, and thus there is no reason that a person without a gluten related illness would eat a gluten free diet and deprive themselves of it.[37] Rather than “adopting” a gluten-free diet as people do in America, Italians are often literally prescribed one.[38] Italians diagnosed with celiac disease are given a monthly allowance by the government to spend on gluten-free alternatives to staple foods which can be found at pharmacies rather than supermarkets.[39] The gluten-free diet is considered treatment for a disease and is almost never a choice.
Another major part of Italian Culture that has been affected by the gluten-free movement is the tradition of making pasta at home. People with gluten related illnesses cannot make and eat pasta in the same way that Italians have for hundreds of years. Because of this dilemma, new products have been developed to mimic the properties of gluten in the baking process.[40] There are now gluten free flour formulations that are designed to completely replace wheat flour. With the addition of xantham gum, a newly available gluten-free binding agent, these flours can be used to make pasta in the traditional Italian way.[41] Although purists may protest the deviation from tradition, gluten-free Italians and Italian-Americans can now experience the joys of homemade pasta and participate in this culturally significant Italian practice.[42]
The gluten-free movement has had different manifestations in food culture in different regions around the world such as the United States, China, and Italy. The rising awareness of celiac disease and gluten intolerance has led to the development of gluten-free replacements for gluten-containing staple foods such as pasta and noodles. However, this awareness for gluten-related illnesses and availability has yet to spread very far outside of the historically Western world. Celiac disease poses a public health issue world-wide, especially in countries such as China where the idea of going gluten free has not gained any cultural traction. There are still many cultural effects to be observed and researched related to the gluten-free movement as this public health issue gains more awareness in countries where there is currently very little awareness.
[1] “What is Celiac Disease?” Celiac Disease Foundation.
[2] “What is Celiac Disease?” Celiac Disease Foundation.
[3] Bijlefeld, Marjolijn, and Zoumbaris, Sharon K.. Encyclopedia of Diet Fads: Understanding Science and Society.
[4] “What is Celiac Disease?” Celiac Disease Foundation.
[5] “What is Celiac Disease?” Celiac Disease Foundation.
[6] Fasano, Alessio. “Five Myths about Gluten.” The Washington Post (Decmber 2018).
[7] Bijlefeld, Marjolijn, and Zoumbaris, Sharon K.. Encyclopedia of Diet Fads: Understanding Science and Society.
[8] Bijlefeld, Marjolijn, and Zoumbaris, Sharon K.. Encyclopedia of Diet Fads: Understanding Science and Society.
[9] Bijlefeld, Marjolijn, and Zoumbaris, Sharon K.. Encyclopedia of Diet Fads: Understanding Science and Society.
[10] Fasano, Alessio. “Five Myths about Gluten.” The Washington Post (Decmber 2018).
[11] Bijlefeld, Marjolijn, and Zoumbaris, Sharon K.. Encyclopedia of Diet Fads: Understanding Science and Society.
[12] Bijlefeld, Marjolijn, and Zoumbaris, Sharon K.. Encyclopedia of Diet Fads: Understanding Science and Society.
[13] Donley, Arvin. “Worldwide Pasta Consumption on the Rise.” Food Business News.
[14] Donley, Arvin. “Worldwide Pasta Consumption on the Rise.” Food Business News.
[15] “Gluten-Free Products Market Size, Share & Trends Analysis Report By Product (Bakery Products, Dairy/Dairy Alternatives, Meat/Meat Alternatives), By Distribution (Grocery Stores, Mass Merchandiser), And Segment Forecasts, 2019 – 2025.” Grand View Research.
[16]. Chiu, Meichen, Talwinder Kahlin, and Rebecca Milczarik. “Whole Grain Gluten-free Egg-free Pasta.” Cereal Foods World.
[17]. Chiu, Meichen, Talwinder Kahlin, and Rebecca Milczarik. “Whole Grain Gluten-free Egg-free Pasta.” Cereal Foods World.
[18] Giménez, M. A., Gámbaro, A. , Miraballes, M. , Roascio, A. , Amarillo, M. , Sammán, N. and Lobo, M. (2015), “Sensory evaluation and acceptability of gluten‐free Andean corn spaghetti.”. Journal of the Science of Food and Agriculture.
[19] Cronin, Alyssa. “Why is America Embracing the Widening World of Non-wheat Pastas?” Washington Post.
[20] Cronin, Alyssa. “Why is America Embracing the Widening World of Non-wheat Pastas?” Washington Post.
[21] Cronin, Alyssa. “Why is America Embracing the Widening World of Non-wheat Pastas?” Washington Post.
[22] “Gluten-Free Products Market Size, Share & Trends Analysis Report By Product (Bakery Products, Dairy/Dairy Alternatives, Meat/Meat Alternatives), By Distribution (Grocery Stores, Mass Merchandiser), And Segment Forecasts, 2019 – 2025.” Grand View Research.
[23] Harding, Hazza. “Across China: Gluten-free Foods Yet to Impress Despite Bakery Boom.” Xinhuanet.
[24] Harding, Hazza. “Across China: Gluten-free Foods Yet to Impress Despite Bakery Boom.” Xinhuanet.
[25] Harding, Hazza. “Across China: Gluten-free Foods Yet to Impress Despite Bakery Boom.” Xinhuanet.
[26] Harding, Hazza. “Across China: Gluten-free Foods Yet to Impress Despite Bakery Boom.” Xinhuanet.
[27] Singh, P., Arora, A., Strand, T.A., Leffler, D.A., Catassi, C., Green, P.H., Kelly, C.P., Ahuja, V., Makharia, G.K. “Global Prevalence of Celiac Disease: Systematic Review and Meta- analysis.” National Center forBiotechnology Information.
[28] Haimovitch, Carie H., “Getting Gluten-free Food in China.” Celiac Travel.
[29] Haimovitch, Carie H., “Getting Gluten-free Food in China.” Celiac Travel.
[30] Haimovitch, Carie H., “Getting Gluten-free Food in China.” Celiac Travel.
[31] Curry, Andrew. “Gluten-Free Dining in Italy.” The New York Times.
[32] Curry, Andrew. “Gluten-Free Dining in Italy.” The New York Times
[33] Donley, Arvin. “Worldwide Pasta Consumption on the Rise.” Food Business News.
[34] Cronin, Alyssa. “Why is America Embracing the Widening World of Non-wheat Pastas?” Washington Post.
[35] Curry, Andrew. “Gluten-Free Dining in Italy.” The New York Times.
[36] Curry, Andrew. “Gluten-Free Dining in Italy.” The New York Times.
[37] Curry, Andrew. “Gluten-Free Dining in Italy.” The New York Times.
[38] Curry, Andrew. “Gluten-Free Dining in Italy.” The New York Times.
[39] Curry, Andrew. “Gluten-Free Dining in Italy.” The New York Times.
[40] Abraham, Lena. “Best-Ever Gluten-Free Pasta.” Delish.
[41] Abraham, Lena. “Best-Ever Gluten-Free Pasta.” Delish.
[42] Heath, Elizabeth. “How to Make Pasta Like a Badass Italian Nonna.” The Hiffington Post.
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