Gluten Sensitivity in Asians
The Prevalence of Celiac Disease and Gluten Sensitivity in Asia
​Celiac disease (CD) has long been associated with Western populations, but increasing globalization and dietary shifts are bringing attention to its presence in Asia. While precise prevalence rates remain unclear due to limited studies, some research suggests that celiac disease affects approximately 0.3% to 1% of the population in various Asian countries, with underdiagnosis being a major concern (Singh et al., 2018; Makharia et al., 2011).
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A 2020 meta-analysis indicated that in China, seroprevalence rates of celiac disease are around 0.27%, but confirmed diagnoses remain rare (Liu et al., 2020). India, with its heavy wheat-based diet in the northern regions, has shown a higher prevalence, with studies estimating rates of up to 1.2% in some areas (Makharia et al., 2011). However, in Southeast Asia, including countries such as Thailand, Malaysia, and Indonesia, research on celiac disease remains sparse, leading to a lack of reliable data (Pandaswamy et al., 2022).
In addition to celiac disease, non-celiac gluten sensitivity (NCGS) is gaining recognition. NCGS is estimated to affect 6-10% of populations in Western nations, but Asian data is severely lacking (Catassi et al., 2015). With an increasing number of people reporting gastrointestinal and neurological symptoms after consuming gluten, it is essential to investigate the true prevalence of gluten-related disorders across Asia.
The State of Awareness: A Mixed Landscape
Compared to Western nations, Asia lags significantly in terms of gluten-related disorder awareness. In many parts of the continent, physicians receive little to no training on diagnosing celiac disease and NCGS, leading to misdiagnoses or overlooked cases. The general public, too, remains largely uninformed, with many believing that gluten intolerance is a "Western problem."
Japan stands out as an exception, as awareness of wheat allergies is higher than in other Asian countries. The prevalence of wheat allergy in Japanese children is estimated at 0.2–0.6%, and medical professionals are more attuned to recognizing these allergies (Ebisawa et al., 2017). However, despite this awareness, the availability of gluten-free options in Japan is extremely limited. Unlike Western countries where gluten-free products are easily accessible in supermarkets and restaurants, Japan's food industry has yet to accommodate the needs of people with gluten-related disorders (Takahashi et al., 2021).
In contrast, most other Asian countries lack both awareness and gluten-free food availability. Many traditional Asian diets are naturally lower in gluten, but as wheat consumption rises due to urbanization and Western influences, undiagnosed celiac disease and gluten sensitivity may become a growing issue. In countries like China, Indonesia, and the Philippines, few people are familiar with the concept of gluten intolerance, and finding gluten-free products can be an immense challenge (Wu et al., 2019).
A Call for Action: Bridging the Knowledge and Accessibility Gap
The increasing prevalence of autoimmune and chronic diseases in Asia—including diabetes, thyroid disorders, and neurological conditions—raises the question of whether undiagnosed celiac disease and NCGS play a role. Research from Western countries has established strong links between gluten-related disorders and various chronic illnesses, yet Asia lacks the large-scale studies needed to explore these connections.
What needs to be done?
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Increased Research and Studies – More epidemiological studies must be conducted across Asia to determine the true prevalence of celiac disease and NCGS.
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Medical Training and Awareness – Healthcare professionals should receive better training on recognizing and diagnosing gluten-related disorders.
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Public Education Campaigns – Raising awareness about celiac disease, NCGS, and gluten intolerance through media, schools, and public health initiatives is crucial.
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Better Food Labeling and Availability – Governments and food industries should work together to improve gluten-free food labeling and ensure access to gluten-free products.
Without action, millions of Asians could remain undiagnosed, suffering from chronic illnesses without knowing the root cause. It is time to shine a light on gluten-related disorders in Asia and provide the necessary resources for diagnosis, awareness, and dietary support.
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References
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1. Singh, P., Arora, A., Strand, T.A., Leffler, D.A., Catassi, C., Green, P.H., ... & Makharia, G.K. (2018). Global prevalence of celiac disease: Systematic review and meta-analysis. Clinical Gastroenterology and Hepatology, 16(6), 823-836.e2.
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2. Catassi, C., Bai, J.C., Bonaz, B., Bouma, G., Calabrò, A., Carroccio, A., ... & Fasano, A. (2015). Non-celiac gluten sensitivity: the new frontier of gluten-related disorders. Nutrients, 7(3), 873-880.
3. Ebisawa, M., Ito, K., & Fujisawa, T. (2017). Advances in food allergy in 2017. Allergology International, 66(3), 336-345.
4. Liu, E., Dong, F., Bartram, C., & McGough, N. (2020). The prevalence of celiac disease in China: A systematic review and meta-analysis. Frontiers in Nutrition, 7, 575174.
5. Makharia, G.K., Verma, A.K., Amarchand, R., Bhatnagar, S., Das, P., Goswami, A., ... & Makharia, A. (2011). Prevalence of celiac disease in the northern part of India: A community-based study. Journal of Gastroenterology and Hepatology, 26(5), 894-900.
6. Pandaswamy, R., Wong, C., & Tan, S.P. (2022). Celiac disease in Southeast Asia: A systematic review. Asian Journal of Gastroenterology, 12(1), 23-35.
7. Takahashi, S., Nakamura, S., & Ito, Y. (2021). Gluten-free product availability and consumer perception in Japan. Food Science & Nutrition, 9(4), 2141-2150.
8. Wu, J., Zhao, J., & Chen, Y. (2019). Awareness and knowledge of gluten-related disorders in China: A cross-sectional study. BMC Public Health, 19, 2017.
