Gluten-free diets are thriving among Americans who either really think they have an intolerance, even celiac disease, or perhaps just think it’s healthier in general.
But how does a legitimate intolerance turn into a booming health trend?
There are whole aisles in specialty grocery stores dedicated to gluten-free products, which would imply that many people need to eliminate the component of wheat that makes chewy bread oh-so-good. And the market is there. Roughly thirty percent of Americans say they’re trying to reduce or eliminate gluten in their diets.
But the numbers don’t exactly add up – only 1 percent of the population has celiac disease, and only 0.1 percent have wheat allergies (usually kids who grow out of it).
So what’s the deal with the other 29 percent of people who say gluten doesn’t work for them? It could be that when they eat gluten they just don’t feel good, stomach hurts, stuff like that, which is reason enough to cut it out. But could it be that some people are reacting to a placebo effect – based on all the gluten-free hype?
A study from the late 1970s identified “non-celiac gluten sensitivity” (NCGS) as a possible explanation for gastrointestinal reactions to gluten, but without the allergy or celiac disease. Gluten sensitivity kind of fell of the radar for researchers after that, but it has returned.
It’s challenging to really figure out if someone has NCGS (because there is not really test for diagnosis) or if they simply believe gluten is going to make them not feel good and essentially have a placebo-effected response. Some researchers have tried to figure it out with a double-blind randomized controlled trial in which one group eats gluten, another does not, and no one knows which group they are in.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
FiveThirtyEight detailed two recent studies and how they played out:
The first of these, published in 2011, followed 34 people for up to six weeks. The study population was made up of people who complained of gastrointestinal symptoms consistent with NCGS.
Everyone participating in the study was on a gluten-free diet. Half had their diet supplemented with a regular muffin and regular bread; the other half received a gluten-free muffin and gluten-free bread. The authors found that 40 percent of patients on the entirely gluten-free diet reported a continuation of symptoms, compared with 68 percent of those who had consumed gluten. The groups also differed on such measures as “satisfaction with stool consistency,” a phrase that I honestly never thought I would write.
The second study, published in 2013, had a similar set up — 37 people complaining of gastrointestinal problems, randomized into high-gluten, low-gluten and no-gluten groups. This time, rather than using bread and muffins, the authors used gluten and whey protein supplements. They found no difference in symptoms among the groups.
These studies were small, so some might be critical of the results, but the second study seems to pretty solidly show that the gluten-related symptoms might not be gluten-related at all.
In a larger Italian study of people who complain of gastrointestinal problems, the authors concluded that NCGS is just slightly more common than celiac disease, so maybe a little bit above 1 percent of the population.
If avoiding gluten makes people feel better, more power to them. And of course, companies that make gluten-free products won’t try to stop them.
But it does seem that in a lot of cases, it might be way more of a psychological thing. A lot of other things could cause gastrointestinal sensitivity.
[Photo from Flickr user Barron Fujimoto]
