[Overheard at dinner parties, buffet tables, and salad bars across America]
"Keen-wah. I don't really know what it is either, but it's supposed to be healthy, and it's gluten-free. Here, try it."
"Oh, cool. My sister-in-law is gluten-free. I'm thinking maybe I should do that—you know, to help with my IBS."
For a substance largely unheard of until recent years, gluten—a protein found in wheat, barley, rye and other products—seems to be on everyone's lips these days. And why wouldn't it be? A gluten-free diet has been touted as a cure for everything from obesity and rashes to autism and migraines. Gluten-free products now command their own keys on menus and sections in grocery stores. Previously exotic grains that lack gluten, like quinoa and amarinth, have become more mainstream. And manufacturers are promoting their gluten-free products. GlutenFreely.com, a "community and e-commerce site" owned by General Mills, provides tools for gluten-free living such as recipes and products, including its own Chex cereal, now in five gluten-free versions. Just last week, Frito-Lay entered the fray, announcing it would begin putting the gluten-free label on many of its already gluten-free products, including varieties of Doritos, Cheetos, Fritos, and Lay's.
It's all relative, of course. Gluten-free Cheetos may be a safe bet for someone with a gluten allergy, but you'd be hard-pressed to find a dietician who would recommend that anyone opt for a packaged-food snack over a piece of fruit, regardless of his or her response to gluten. In other words, branding a product "gluten-free" does not necessarily confer on it a gold star of health. Meanwhile, as Americans hunger for ways to eat right and live well, the gluten-free frenzy has raised more questions than answers.
For starters, a gluten-free diet is recommended for people with adverse medical or clinical reactions to gluten. They include those with celiac disease, a serious autoimmune disorder in which the ingestion of gluten prompts antibodies to attack the small intestine. About 1 percent of the U.S. population has this disease, says Dr. Alessio Fasano, pediatric gastroenterologist and founder and director of the University of Maryland Center for Celiac Research. An even smaller group—between .01 and .03 percent of the population—has a wheat allergy, he says. But an estimated 6 percent of the country, or 16 to 18 million people, are considered “gluten sensitive,” a new category defined by Fasano and others in a paper published this year in the journal, BMC Medicine.
While tests can check for celiac disease and wheat allergies, there is no test yet to screen for gluten sensitivity, an inflammatory response with symptoms such as gastrointestinal distress, fatigue, joint pain, and depression. A matter of days on a gluten-free diet can help people make that determination. So if, for example, your terrible bloating and mad dashes to the bathroom after eating pizza subside on a gluten-free diet, then you may be onto something. Of course, it could also be the dairy destroying you, but that's for another article.
If it seems like the gluten-free craze has surfaced suddenly, that's because it has. "During the past 50 years we have witnessed an 'epidemic' of [celiac disease] and the surging of new gluten-related disorders, including the most recently described [gluten sensitivity]," according to the recent BMC Medicine article.
Why now? Put simply, food has evolved faster than we have. "Apparently the human organism is still largely vulnerable to the toxic effects of this protein complex, particularly due to a lack of adequate adaptation of the gastrointestinal and immunological responses," the article states.
Today's genetically-engineered wheat contains far more gluten than what our great-grandparents ate— in that time, the amount of gluten in wheat has climbed from 4 to 14 percent, Fasano says. Plus, it's used everywhere, as fillers and additives in everything from sausage to ice cream, he says. "You eat more gluten than you can imagine."
So should we all go gluten-free?
Well, for one, most people don't have any trouble with gluten. And there's the risk that in eliminating gluten, we will eliminate important nutrients that may not be replenished by other foods.
"We want people to get fiber. We want them to get whole grains, so it is a contradictory message," says Joanne Slavin, a professor with the University of Minnesota's Food Science and Nutrition department, who calls gluten the "villain of the month." The substitute for gluten could provide the average consumer with far inferior nutrients, she argues. "A lot of those [gluten-free] products are absolutely full of fat, full of calories, full of sugar," Slavin says. "A lot of low-gluten products are not low in calories."
At the same time, a lot of high-gluten products, such as processed foods, are high in calories. Forsaking those products—which are popular staples of the American diet—for a more diversified diet, with fruits and vegetables, may explain the advantages many have reported by eliminating gluten, says Dee Sandquist, spokesperson for the Academy of Nutrition and Dietetics. If someone chooses to go gluten-free, Sandquist recommends a varied diet based on the federal government's "My Plate" guidelines, in which a plate is quartered among fruit, vegetables, protein and grain, and a cup representing dairy.
Meanwhile, the gluten-free market continues to balloon as industries tap into a population eager to check out the potential benefits of life free of gluten.
According to the market research group Packaged Facts, the sales of gluten-free foods and beverages reached $2.64 billion in 2010, a 30 percent increase since 2006, and are projected to approach $5.5 billion by 2015. At Whole Foods, for example, "the number of products within our gluten-free category has increased dramatically over the past decade and has really come into its own," says Errol Schweizer, Whole Foods' global executive grocery coordinator. "Thirty percent of our baking items are now gluten-free. It's no longer just breads and basic staples, though—the range of offerings is much larger. The flavor profile has also improved dramatically. There was a time when those products were not very appealing, but that's really changed."
That's good news for the many people exploring these diets, as researchers continue to investigate the effects of gluten on the population and its purported linkage to various ailments. But before jumping on the gluten-free bandwagon, health professionals urge those who think they may react adversely to gluten to first get tested for celiac disease, which is widely misdiagnosed.
Until then, Fasano advises that Americans eat foods our bodies have evolved to digest by buying locally-grown, seasonal foods. In other words, stick to those common-sense guidelines of eating natural, unprocessed foods and heaps of fruits and vegetables—a program that, incidentally, looks fairly close to a gluten-free diet.
Corrected on 6/1/2012: An earlier version of this story misstated the number of people considered gluten sensitive in translating the percentage of Americans affected. The estimated 6 percent of the country that are considered gluten sensitive, translates to 16 to 18 million people, not 60 to 80 million people.