Some people who avoid gluten in the US report being able to eat pasta and bread in Europe without the same issues. What’s going on?

A recent article unpacked some of the reasons why Americans traveling in Europe are able to eat gluten abroad, but not in the US. Experts don’t know for sure, but possibilities include differences in the type of wheat used, a higher presence of chemicals in US foods, and lifestyle factors when you’re travelling.

Between 1-5 percent of Americans have Celiac disease, but it often goes undiagnosed because people do not have obvious symptoms. Celiac disease is an autoimmune disease that causes damage to the small intestines when someone eats gluten. It can lead to several serious health issues. A large study published in the Journal of the American Medical Association found that people with diagnosed, undiagnosed, and “latent” celiac disease or gluten sensitivity had a higher risk of death, mostly from heart disease and cancer.