By: Erica Meador MS, RDN, LDN
The gluten free industry has grown from $4.8 billion in 2009 to $6.1 billion in 2011 to $10.5 billion in 2013. Mintel Insights predicts 48% growth from 2013 to 2016, topping out at $15.6 billion. Let’s compare this to another popular food segment: high protein foods and beverages. In 2012, 19% of all United States food and beverage global product launches were categorized as high-protein. Gluten-free product launches represented 11.3% of all new products in 2012 (compared with 3.4% of new products in 2007).
It is obvious that gluten-free has become more than a fad; it seems it is here to stay for a large majority of consumers. Currently, 24% – 30% of consumers report that they have reduced or eliminated gluten in their diets. Per my estimates, combining wheat allergy, celiac disease, and reports of gluten and/or fructan sensitivity, likely only 10% of people MAX require a gluten-free diet. There are four conditions that benefit when gluten-containing foods are cut from the diet.
The first, and arguably most severe, is wheat allergy. Wheat allergy is considered a true allergy; proteins in wheat cause an allergic person’s body to launch an immune response to the proteins resulting in symptoms ranging from mild gastrointestinal distress or rash to severe rash, hives, swelling, anaphylaxis, and death. Allergies can develop at any point in life. Sometimes children’s allergies improve, but both children and adults with even mild allergies can experience a severe reaction at any point. Only wheat and species of wheat such as spelt, durum, semolina, and others need to be eliminated with wheat allergy. Pure barley and rye are NOT wheat and do not need to be eliminated from the diet of someone with a wheat allergy!
Celiac disease is classified as an autoimmune reaction to gluten. This means that upon ingestion of gluten, the body begins to attack itself. The result—small intestinal damage or enteropathy—can lead to malabsorption of many nutrients, including calcium (which can lead to osteoporosis) and iron (which can lead to anemia). However, not everyone has the same symptoms. Dozens of symptoms of celiac disease have been reported from severe fatigue to joint pain to diarrhea to dermatitis herpitiformes, a severe skin rash. Celiac may not always be as acutely severe as wheat allergy, but it can cause permanent damage because the body is attacking itself in the presence of gluten. Gluten is a protein found in wheat, barley, rye, and oats. Oats do not inherently contain gluten; however, they almost always have gluten contamination because the oats were either next to a wheat field or they were milled or processed in a plant that also processes wheat. Those with celiac should note though, that they may be sensitive even to gluten-free oats, because the oat protein avenin is similar in structure to gluten causing a small percentage of people react to both.
Non-celiac gluten sensitivity (NCGS) has been recognized for decades, although knowledge was minimal until the last five years. In 2009, Sapone et al. released a landmark study demonstrating that those reporting NCGS had no elevation of a certain inflammatory marker whereas those with celiac had marked increase in the specific inflammatory marker suggesting a either a very different reaction to gluten in these two conditions OR a non-reaction in NCGS. The scientific community responded with an increased vigor in defining the differences between celiac and NCGS. In 2011, researcher Jessica Biesiekierski and team, led by gastroenterologist, Peter Gibson, confirmed with a double-blind, randomized, controlled trial that those reporting NCGS have resolution of symptoms when gluten-containing products are removed from their diets though the mechanism of NCGS still eluded scientists.
During this time frame, another diet—the FODMAP diet—was gaining popularity. This diet is aimed at ameliorating the symptoms of those with irritable bowel syndrome, based on the premise of removing foods that result in gastrointestinal distress and malabsorption. FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols and includes the following: fructose, lactose, fructans, galactans, and polyols. Remember how wheat, barley, and rye contain gluten? Well, they are also very high in fructans. Peter Gibson’s group again performed a double-blinded randomized controlled trial in 2013, this time looking for differences in responses to fructans versus gluten. They found that patients reporting NCGS were actually sensitive to fructans, NOT gluten. This means that many who report they have NCGS actually have irritable bowel syndrome and are sensitive to fructans not gluten.
Some percentage of people actually aren’t allergic to wheat, don’t have celiac, irritable bowel syndrome, OR non-celiac gluten sensitivity, but are nonetheless on gluten-free or –reduced diets. They have bought into the idea that gluten is bad for them, and they feel better because eating gluten-free forced them to clean up their diet (i.e., less carb-heavy, less processed foods). Then again, when this group without any of the above conditions begins eating gluten-free processed products, they are likely to feel worse again because gluten-free products often contain simple carbohydrates and excess sugar and lack B vitamins, fiber, and protein. The macronutrient and micronutrient profiles, as well as the glycemic index of gluten-free products are often worse than gluten-containing products.
Many doctors and researchers still believe there is a group of people sensitive to gluten without celiac disease, but they agree that this number is significantly lower than once thought thanks to Biesiekierski’s and Gibson’s very important study in 2013. So what do you have? Do you have wheat allergy? Do you have celiac? Non-celiac gluten sensitivity? Irritable bowel syndrome? Tune in next time to get the details of testing, diagnosis, and a detailed list of the foods to avoid in each situation.
Want to see my TV interview on this topic? Click on this link, which aired in Champaign-Urbana Illinois on 8-18-14.
Mintel Insights, http://www.mintel.com/menu-insights
Wood, RA. The natural history of food allergy. Pediatrics, 2003; 111: 1631-1637.
Sicherer, Sampson. Food Allergy. J Allergy Clin Immunology. 2006; Vol 117, number 2: S470-S474.
Sapone, A. et al. Differential mucosal IL-17 expression in two gliadin-induced disorders: gluten sensitivity and the autoimmune enteropathy celiac disease. International Archives of Allergy and Immunology. 2010; Vol 152, Issue 1, pgs 75-80.
Biesiekierski, J.R. et al. Gluten causes gastrointestinal symptoms in subjects without celiac disease: A double-blind randomized placebo-controlled trial. Am J of Gastro. 2011; Vol 106, issue 3: pg 508-514.
Biesiekierski, J.R. et al. No effects of gluten in patients with self-reported non-celiac gluten sensitivity after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates. Gastroenterology. 2013; Vol 145, Issue 2, pgs 320-328.