Gluten-Free Mania -- If You're Following the Fad, You're a Marketer's Dream and Part of the Confusion

Why has the gluten-free trend taken off like wildfire in the last few years while the FODMAP diet has not really caught on even though it was developed way back in 1999 and shown to have a high success rate for people with IBS and even other gastrointestinal issues?
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My Facebook page blew up quickly amongst my health and fitness friends when I shared a few articles saying that the researchers who initially found evidence that there may be such a thing as "non-celiac gluten sensitivity," or "NCGS," could not reproduce the same results in a larger follow-up study. In other words, a lot of people who think they have gluten sensitivity and have jumped on the gluten-free bandwagon may be wasting their time, or at least their money.

Now, I know that for many people following a lifestyle diet is a lot like following a religion, and they get crazy passionate about it, so it's hard to tell people they may be worshipping a false idol. There's even something scientists call the "nocebo effect," which is a lot like the power of suggestion. Meaning, if you think you're getting sick from eating something, you may make it so.

This makes marketers' happy! The $10.5-billion gluten-free food and beverage industry has grown 44 percent from 2011 to 2013. There's also a "health halo" surrounding these foods, meaning people think they are doing something healthier by eating gluten-free.

Marketers feed on this. According to Mintel, a market research firm, "75 percent of consumers who do not have celiac disease or sensitivity to gluten eat these foods because they believe they are healthier, despite the lack of any scientific research confirming the validity of this theory." Mintel predicts, "the gluten-free food and beverage market will grow 48 percent from 2013-2016, to $15.6 billion, at current prices."

Gluten is a protein found in wheat and related products that helps dough rise, keep its shape, and makes it chewy. The gluten-free trend has demonized this protein, saying it causes all kinds of nasty ailments. Yes, if you have celiac disease, an immune disease in which eating gluten damages the small intestine, it certainly is the enemy. However, only about 1 percent of the population has it. Once you hear what the symptoms are, you may start to wonder if you have what some scientists refer to as "non-celiac gluten sensitivity," or NCGS. If you go on a gluten-free diet as a precaution, you may just be adding to food manufacturers' bottom line while not doing much for your own bottom. Just because it's called a "diet," being gluten-free doesn't guarantee weight loss. These products don't have fewer calories than their gluten containing counterparts, unless the lifestyle change causes you to eat less.

The allure is probably in the reduction of the other side effects people think they are getting from gluten, which include, passing gas, bloating, abdominal discomfort, diarrhea or constipation, headaches, bad acne, fatigue, and bone or joint pain. This is what the gluten-free lifestyle is touting, but unfortunately it may be more about good marketing than scientific proof.

Although gluten-free life has become tres chic in the last few years, the research on it has caused more questions than answers. Jessica Biesiekierski, a Ph.D. who researches food and gastrointestinal symptoms, conducted a trial to test gluten sensitivity in people who don't have celiac disease. Biesiekierski and her team published a study in 2011 that found evidence of the existence of non-celiac gluten sensitivity in a randomized controlled trial of 34 people. This caused excitement in the community as they thought they found the culprit for many gastrointestinal distresses. It was right around then I started noticing a proliferation of food manufacturers marketing gluten-free products. Coincidence? Probably not.

This landmark study was so well received that the team tried to reproduce the results in a larger, more complex and thorough trial of 37 people who were believed to have NCGS and IBS (irritable bowel syndrome). They were randomly assigned to groups given a two-week low-FODMAP diet that is known to benefit people with gastrointestinal disorders and IBS -- a low "FODMAP" diet -- and then placed on high-gluten, low-gluten or control diets for one week. This second study was published in 2013 in the journal Gastroenterology and found that only 8 percent of the participants had gluten-specific effects from the gluten diets. However, all participants had significantly improved symptoms from the low-FODMAP diet. FODMAP stands for fermentable oligo-saccharides, disaccharides, mono-saccharides and polyols. They are a group of carbohydrates, which are often poorly absorbed in the small intestine, and when fermented by gut bacteria produces gas and leads to other gastrointestinal maladies.

The researchers concluded that gluten had no real effect on patients who claimed to be gluten sensitive and do not have celiac disease.

Daniel Leffler, M.D., MS, Director of Research at the Celiac Center at BIDMC and Director of Quality Assurance for the Division of Gastroenterology at Beth Israel Deaconess Medical Center, in an article entitled, "Gluten Sensitivity: Not Celiac and Not Certain," writes, "unfortunately, the current [2013] study raises more questions than it answers." The study, "calls into question the very existence of NCGS," and the research does indeed suggest, "FODMAPs, rather than gluten or other wheat proteins, might be the mediator by which low-gluten diets improve gastrointestinal symptoms."

Some researchers believe that people who say they feel better after being gluten-free may actually be sensitive to fructan, a carbohydrate found in wheat, instead.

This is not to say that NCGS is a total fallacy and no one should bother going gluten-free, but its most likely a fad encouraged by marketers. In an email interview with me Dr. Leffler says, "the gluten-free diet has gained a popularity that likely eclipses its true value, like so many other diet trends in the past." He believes there is a non-celiac gluten sensitivity syndrome, although as of yet, no one is sure what causes it or how prevalent it is. Clearly more extensive research is needed.

So why has the gluten-free trend taken off like wildfire in the last few years while the FODMAP diet has not really caught on even though it was developed way back in 1999 and shown to have a high success rate for people with IBS and even other gastrointestinal issues? There's even a smart phone app for it. Maybe the gluten-free diet is just more marketable. Since the first Biesiekierski study in 2011 suggested that gluten sensitivity may cause a host of uncomfortable and irritating issues and the fact that more people are being diagnosed with celiac disease now that testing is more accurate, the health food industry has found a market they can cash in on. And, its understandable that food companies who have poured millions of dollars into making and advertising gluten-free products, would want to milk the trend until the cow runs dry, especially when market research shows the sector is still growing in lieu of compelling research.

If you think you have NCGS, or suffer from the symptoms mentioned in this article, talk to your doctor. It is estimated that 83 percent of Americans who have celiac disease are undiagnosed or misdiagnosed with other conditions.

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