If it seems like many folks are avoiding gluten lately, that's because it is absolutely true. The food industry is exploding with gluten free alternatives in just about every area from body care to cosmetics to gluten free bread, cereal, and alcoholic drinks. Even the Girl Scouts have joined in with the release of a gluten free chocolate chip shortbread cookies. The global food industry reports that the gluten-free market is projected to balloon from about $17.59 billion in 2018 to over $32.39 billion plus by 2025. In the United States the number was $ 2.7 Billion in 2018 and the market is expected to more than double by 2025.
The exact reason for the increasing numbers of gluten intolerant people is unknown but there are several theories as to why the prevalence has increased so much, including hypotheses like the so-called “old friends” theory where it is believed that the loss of contact with the very bacteria, fungi, parasites, and other microbes that humans evolved with has resulted in intolerance to natural compounds like gluten. Research with celiac patients found that those who were intentionally infected with hookworms could then tolerate digestive exposure to gluten without problems. Other hypotheses include the presence of too much wheat in the diet, overuse of antibiotics, treatment of conventionally grown wheat with pesticides, and of course misdiagnosis of the problem altogether.
To gain more complete understanding of gluten and its potential impact on health, there are a few questions that must be addressed.
What is gluten?
Gluten is a general term for a large family of proteins found in several types of grains like wheat (all types including wheat-berries, durum, semolina, spelt, faro, graham, etc.), rye, and barley. Gluten can also be found in derivatives of grains like malt and brewer’s yeast. It is used by the plant as a source of nourishment during seed germination. Gluten acts as a glue helping foods maintain their shape and elasticity, it also allows bread to rise during the baking process. Gluten is often found in unexpected places like soy sauce, pickles, cosmetics, prescription medications, supplements, and even in naturally gluten free products like rice, oats, and French fries via cross-contamination.
Gluten “sensitive” or “intolerant”?
People that are sensitive or intolerant to gluten are those who develop any number of symptoms when they consume gluten or gluten containing products. Often termed, non-celiac gluten sensitivity, these people may experience many of the same symptoms like brain fog, gas, bloating, constipation, headaches, joint pain, etc. as someone with celiac disease yet they do not test positive for the condition. Such individuals may see benefit including resolution of symptoms from adhering to a diet free of gluten.
What is the difference between a gluten “sensitivity” or “allergy” versus an “intolerance”?
An allergy to particular foods happens when the body produces an immune response upon exposure to that food. The resulting symptoms can be mild like a stuffy or runny nose and/or headache to moderate symptoms like hives, itchy mouth, or a rash, to severe reactions like throat tightening, difficulty breathing and even life-threatening anaphylactic reactions. Researchers estimate that 32 million Americans have food allergies, including 5.6 million children under age 18 – that’s roughly two people in every classroom. Further, the Center for Disease Control reports that the prevalence of food allergies among children increased by 50% between 1997 and 2011.
Another type of food reaction is an intolerance (though people often mistakenly call these allergies). This type of reaction is not initiated by the immune system and does not result in anaphylactic reactions. Food intolerance's are often related to the absence or decreased activity of specific chemicals or enzymes that are required to digest certain substances. A classic example of this is lactose intolerance. People who suffer from lactose intolerance lack sufficient amounts of the enzyme lactase which is needed to digest lactose resulting in digestive disturbance.
In conclusion, the difference between an allergy and an intolerance comes down to the type of biochemical reaction that drives them within the body. The treatment in many cases may be the same (avoidance) regardless of the type of reaction causing the symptoms.
What are some signs and symptoms of gluten sensitivity/intolerance?
The reactions people have to gluten consumption can vary by from person to person. This is a list of some but not all symptoms individuals may experience.:
Irritable Bowel Syndrome (IBS)
Iron deficiency anemia
Delayed puberty (in children)
Slowed growth (in children)
What is celiac disease?
The most well-known and serious type of gluten reactivity is an inflammatory gut disease known as celiac disease. Celiac disease is often thought of as a food allergy, but since celiac is a genetic autoimmune disease caused by activation of certain genes, this is an inaccurate representation. About 33% of people in the Western world, carry the gene for celiac disease.4 But since celiac disease has a prevalence of only about 0.5-1%, the cause is beyond simple genetics and disease manifestation in susceptible individuals likely must also include an environmental trigger.
As in other autoimmune diseases, people with celiac disease may have periods of exacerbation of symptoms or remission, when they are asymptomatic.6 However, celiac disease is chronic. If someone with celiac disease consumes gluten, an abnormal immune response is triggered that causes significant inflammation that damages the villi of the small intestine. The villi are finger-like projections found in the small intestine whose function is to increase the surface area of the small intestine to facilitate absorption of nutrients as food moves through. The damage to the villi and inflammation of the intestinal lining can lead to malabsorption and malnutrition which can lead to osteoporosis, anemia, and delayed growth.
Are celiac disease and gluten intolerance the same thing?
No. Although the symptoms can often be the same, celiac disease and gluten intolerance are driven by different biochemical processes within the body. Celiac disease is an autoimmune condition that results in an immunologic response to gluten in the intestines. An intolerance is not immune mediated and may be related to lack of key enzymes or chemicals required for digestion of gluten. To make a long story short gluten intolerance is not as severe as celiac disease.
How a Gluten Free Diet Can Be Helpful
In the case of celiac disease, a strict gluten free diet is an absolute must for one's survival. A gluten free diet means that the protein gluten is excluded from all foods consumed. Label reading is imperative when taking on a gluten free diet. Some people are exquisitely sensitive to gluten and may not see improvement of symptoms with a gluten-free diet if they are exposed to even small trace amounts of gluten. For this reason, some people may need to be very conscientious of hidden sources of gluten as well cross contamination of typically non-gluten containing foods. Such individuals would need to consume gluten free products from facilities and growers who are strictly dedicated to living a gluten free lifestyle. Another thing one can do is eliminate all process foods and eat foods that have one to 5 ingredients in it. Regardless of what you may have been told or what you understand there is always help available to help you and especially if you need help with comprehending what is on food labels.
Celiac disease: Prevalence, diagnosis, pathogenesis and treatment
Fact & Statistics on Food Allergies
Old Friends Hypothesis
The Gluten Free Food Market
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