Gluten has been running the gamut of modern dietary concerns, provoking an estimated 1.6 million Americans to pass on the rolls and opt for gluten-free regimens — a choice some experts say is based more on knead rather than need.
A study published in the American Journal of Gastroenterology approximates that the number of Americans who have celiac disease is around 1.8 million, with 1.4 million unaware of their ailment. However, the number of people who actually have the condition is almost entirely separate from the aforementioned 1.6 million who are buying into the gluten-free fad.
"So here we've got this kind of irony where those who need to be on [a gluten-free diet] aren't on it, because they don't know they have it. And those who are on it probably don't need to be on it, at least from a medical point of view," researcher Joseph A. Murray, MD, a gastroenterologist at the Mayo Clinic in Rochester, Minn. said. "It's a little frustrating."
Researchers consulted the government survey NHANES, which assesses the health of the U.S. population on a regular basis; they also screened a batch of 8,000 people, ages 6 and up, with blood tests meant to identify any present gluten protein antibodies. Subjects who possessed the antibodies were given an additional test aimed at finding more protein indicators that signify the body attacking itself. At the study’s conclusion, a total of 35 people had confirmed celiac disease — from this, researchers deduced that 1.8 million Americans had the disease, with roughly 80 percent of those cases going undiagnosed. Additionally, of the 55 people who admitted to being on a gluten-free diet, only two were found to have celiac disease, leading researches to posit that 96 percent of people do not need to be on the gluten-free diet to which they adhere.
"This is very much in keeping with what we had known about celiac disease in the U.S. before. There's a lot of it out there, around 1 percent, and it's dramatically undiagnosed," said Daniel A. Leffler, MD, the director of clinical research at the celiac center at Beth Israel Deaconess Medical Center in Boston.
Leffler attributes the lack of awareness and proper diagnoses to supposition — "It still suffers from the stigma of being a rare childhood disease" — while others situate the problem on the padded shoulders of role reversal.
"We have a lot of self-diagnosing going on out there," Melissa Abbott told The Republic. Abbot follows the gluten-free market for the Hartman Group, a Seattle-based market research organization.
This chunky batter of self-diagnosis whisked together with marketing ploys and celebrity plugs is sure to give the food industry a hearty delight, with Americans projected to spend nearly $7 billion this year on gluten-free food products, a Mintel report hypothesizes. A 27 percent increase in prominence for the gluten-free market between 2009 and 2011 shows further the strengthening draw of glutenless appetites.
Celiac disease is known to trigger serious damage in the lining of the small intestines, stalemating the proper absorption of food components that promote healthy living. Considering that potentially 1.4 million people may have the disease unbeknownst, Murray urged physicians to step up their game when girding afflicted patients against gluten.
"If you detect one person for every five or six (who have it), we aren't doing a very good job detecting celiac disease," he said.
The prominence of gluten sensitivity, defined recently and ambiguously by doctors as an allergy to gluten that causes the body to bloat and ache, could also account for the rise in gluten-free diets. It’s something that Sheila Crowe, MD, a San Diego- based physician and board member of the American Gastroenterological Association, believes should be fine-tuned and attended to.
“The definition is nebulous," she said.
Alessio Fasano, MD, a University of Maryland researcher, proposed that 6 percent of adults in the U.S. possess a gluten sensitivity — a number he arrived at based on the patients he’s worked with in his clinic. Like Crowe, Alessio noted the “tremendous amount of confusion out there” regarding gluten sensitivity and its severity. More research is need he argued.
Confusion and self-diagnosis aside, medical experts have yet to cite any damage coming out of gluten-free diets administered to those who don’t have celiac disease or gluten sensitivity. Nevertheless, officials insist that patients must consult their doctors before changing dietary tactics and physcians must be prepared to oblige.
"A newly diagnosed celiac patient can have bone problems. They can be deficient in micronutrients like iron, folate and zinc," Murray added. "This is a chronic inflammatory condition of the intestines. Patients need to be followed."