These days it seems you can't go to a grocery or a restaurant without seeing a "gluten free" label.
Food company giant General Mills, for one, offers more than 300 gluten-free products. General Mills' brand Pillsbury introduced its first gluten-free products earlier this year -- doughs for chocolate chip cookies, thin-crust pizza and pastries.
Restaurants increasingly feature gluten-free options. Even PNC Park, in 2012, opened Just4U, a concession stand serving gluten-free products from hot dogs to beer.
Interest in gluten-free products has exploded over the past several years, with sales last year reaching $4.2 billion. In fact, from 2008 to 2012, the gluten-free market experienced a compound average growth rate of 28 percent, according to market research firm Packaged Facts. The company expects sales to surpass $6.6 billion by 2017.
Gluten-free foods are a necessity for people who have celiac disease, an autoimmune disorder in which the body attacks gluten, a protein found in wheat, barley and rye. This immune response also destroys the lining of the small intestine, leading to malabsorption of nutrients and abdominal discomfort. Over time, people with celiac disease can experience symptoms in all body systems, from joint pain and osteoporosis to depression and foggy thinking.
It was once thought that celiac disease was rare in the United States, but medical professionals now recognize that about one in 133 Americans may have the disease.
"We now realize it's probably just as common in the U.S. as it has been known to be in Europe for a long time now," said Kofi Clarke, a gastroenterologist and director of the Celiac Center at Allegheny General Hospital. Most cases are undiagnosed, but the number of people diagnosed with celiac disease has been increasing along with the awareness about the disease.
Currently there is no cure for celiac disease. The only treatment for celiac patients is to eat a gluten-free diet.
In recent years, "There's been a lot of interest in gluten sensitivity or gluten intolerance," Dr. Clarke said. People with apparent gluten sensitivity experience the same symptoms as those with celiac disease, only without the intestinal damage. Dr. Clarke noted that current data on gluten sensitivity is limited and the condition is difficult to diagnose. Because food contains many components other than gluten, patients may be reacting to some other ingredient in the grains they are consuming.
More research needed
"We know there's a phenomenon that we don't fully understand yet, and we will get some better information on it as we see more of the studies coming out," Dr. Clarke said.
His sentiment is echoed by Amy Macklin, a registered dietitian nutritionist and owner of Gluten Free Roots, a Robinson-based consulting business. She has worked with people in cases where celiac disease has been ruled out, but the patients felt better after going off gluten. Gluten sensitivity seems to exist, Ms. Macklin said, but more research is needed to provide conclusive evidence of the condition.
The increase in the number of people diagnosed with celiac disease as well as the growing number of people who believe they are gluten intolerant account for a portion of the increased sales of gluten-free products, but those consumers alone do not explain the market's double-digit growth. In fact, according to a survey conducted by Packaged Facts, the main reason consumers purchase gluten-free products is because of their "conviction that gluten-free products are generally healthier." But is that conviction justified?
It depends on what kinds of gluten-free foods you're eating, experts say.
Ms. Macklin warns that processed gluten-free products tend to be higher in calories than the wheat products they are replacing, meaning people can actually gain weight when they go gluten-free. Additionally, unlike typical wheat products, gluten-free alternatives are not enriched with vitamins and minerals like B vitamins and iron. This can lead to nutritional deficiencies in people who don't get those vitamins and minerals from other sources.
Processed gluten-free foods are designed to approximate the taste and texture of the products they are replacing and tend to rely on substitutes such as rice flour, potato starch and tapioca starch. These foods have high glycemic indexes, so when people eat them, their blood sugar spikes. Manufacturers "get the worst foods to replace wheat and gluten," said William Davis, a cardiologist and author of the book, "Wheat Belly." He said that eating such foods over time leads to disorders such as diabetes, hypertension, and heart disease.
'They're made with junk'
"As often happens, the processed food industry has no idea what they're doing," Dr. Davis said. "Or, even worse, they know exactly what they're doing and don't care because they see this wonderful explosion in interest in gluten-free [products], so they step in as opportunists. That's why we have all these breakfast cereals right now being called gluten-free, but they're made with junk. They're sugar and cornstarch or some nonsense like puffed rice. These are awful for you."
Dr. Davis believes that everyone -- not only people with celiac disease or those who may have gluten sensitivity -- should avoid wheat products. The problem with wheat products, he said, is not merely the gluten protein. For instance, modern wheat contains the gliadin protein, which is broken down in the digestive tract into peptides that bind to the opiate receptors of the human brain and stimulate appetite, leading to overeating.
"There is a little bit of truth in the gluten-free notion," Dr. Davis said, "but there's so much more here. It's like saying the problem with cigarettes is tar, so let's make a low-tar cigarette."
Dr. Davis and Ms. Macklin agree that health-conscious consumers should focus on naturally gluten-free foods -- whole foods, rather than processed products. Dr. Davis called it "a return to real foods." He said, "You can have gluten-free cucumbers. You can have gluten-free salmon, and gluten-free eggs and mushrooms."
Ms. Macklin said her family focuses on eating naturally gluten-free. She has two sons, one of whom has celiac disease. "We never have separate meals," she said. Instead, the whole family lives the gluten-free lifestyle.
Unlike Dr. Davis, Ms. Macklin said people without celiac disease or possible gluten sensitivity can include whole wheat as part of a healthy diet. Like whole wheat, gluten-free whole grains like quinoa, millet and sorghum are nutrient-dense and contain fiber. "They are healthy additions to anyone's diet," she said.
Ms. Macklin and Dr. Clarke both say that people who adopt a naturally gluten-free diet may benefit from it because they are being more careful about what they eat, not because they have celiac disease or are gluten sensitive. Dr. Clarke said, "I think it's important for people to realize if you eat a gluten-free diet and you feel well, it doesn't mean you have celiac [disease] at all. It just means you're eating healthier."
For people who believe they may have gluten sensitivity, Ms. Macklin urges them not to adopt a gluten-free diet before visiting a gastroenterologist to rule out celiac disease because you have to be consuming gluten to get an accurate diagnosis. Dr. Clarke, too, encourages people to discuss their symptoms with their physicians.
It's too soon to tell whether individuals without celiac disease or possible gluten sensitivity will continue to buy gluten-free products or if consumers are simply in the midst of a fad. Whether processed products continue to fly off the shelf or not, eating healthy whole foods will likely never go out of style.
Kathryn Sterling: firstname.lastname@example.org