"If you don't have celiac disease, it makes no sense to be on a gluten-free diet," remains a common refrain from physicians and other health care providers who choose to deny the idea that people who don't carry a diagnosis of celiac disease can have health issues from consuming gluten.
Nonetheless, the idea that sensitivity to gluten, a protein found in wheat barley and rye, can indeed relate to medical problems has developed incredible traction in our society, as evidenced by the impressive growth in sales of gluten-free foods. Foods labeled as "gluten-free" have increased in sales an average of 34 percent each year between 2009 and 2014. In fact, last year, global sales of gluten-free food approached an astounding $8.8 billion.
"Overall, the gluten-free food market continues to thrive off those who must maintain a gluten-free diet for medical reasons, as well as those who perceive gluten-free foods to be healthier or more natural ... Gluten-free products appeal to a wide audience; 41 percent of U.S. adults agree they are beneficial for everyone, not only those with a gluten allergy, intolerance, or sensitivity," reports Amanda Topper, food analyst at Mintel, a global market intelligence agency.
So why the trend? If only about 1 percent of our population actually requires a gluten-free diet by virtue of the fact that they suffer from celiac disease, what explains this powerful and widespread shift in public perception and buying habits that are propelling the gluten-free movement?
It seems to me the answer boils down to the debate as to whether people can have health issues related to gluten when they don't have celiac disease. Clearly, if non-celiac individuals have improvements in health-related problems by going gluten-free, that would certainly reinforce their buying habits. Some would say that there's a strong placebo effect underlying the trendy gluten-free movement. To be fair, that is not an unreasonable consideration. To level the playing field why not consider looking at scientific research that actually utilizes study design that takes into account the possibility of a placebo effect to determine whether or not the idea of being sensitive the gluten outside of having celiac disease has merit.
In a recent study appearing in the highly-respected journal Clinical Gastroenterology and Hepatology: The Official Clinical practice journal of the American Gastroenterological Association, researchers evaluated 61 adults who did not have celiac disease but felt that their consumption of gluten-containing foods was related to both intestinal as well as extraintestinal symptoms. The participants received oral capsules containing either gluten, approximately 4 g daily, or a placebo (rice starch) for one week. After one week the diets were switched meaning that the gluten consumers were given the rice starch and vice versa. The results of the study were quite remarkable. Symptoms like abdominal bloating, abdominal pain, foggy mind, and depression, were exceedingly more common when subjects were consuming the gluten as opposed to the placebo.
And this report adds to the growing evidence of the effects of gluten sensitivity outside of celiac disease having manifestations well beyond the gut. In fact, we are now seeing reports in peer-reviewed journals relating non-celiac gluten sensitivity to such issues as autism, schizophrenia, and ataxia (coordination difficulties).
Gluten sensitivity is certainly hip, without question. But the explosive rise in sales of gluten-free foods is not explained simply by the fact that people want to be trendy. The health benefits of going gluten-free have been experienced by large numbers of consumers who finally have had improvements in long-standing issues. In a society where health related problems are generally approached by resorting to taking a medication, we should expect significant dedication to a simple dietary change, without any side effects, and proven efficacy.