Is this the end of the gluten-free fad?

 

Last November, when I first wrote about the gluten-free diet fad, I bemoaned how an everyday protein, a staple in human diets for many millennia, had become demonized by the diet fad crowd. In fact, the gluten-free fad rapidly grew into a multi-million-dollar industry in Canada to accommodate that vulnerable intersection of consumer fears and gullibility.*

Back when I was writing my piece, the National Post had a piece that indicated while nine million Canadians were allegedly on a gluten-free diet or avoided gluten for non-medical reasons, only 1% of us – about 330,000 people – actually have Celiac disease (of whom only 33,000 are actually diagnosed with it).

A whole lot of people have self-diagnosed themselves with gluten-sensitivity, based more on what they’ve seen on TV or read on the internet, rather than on actual medical advice, let alone the results of tests. But that’s a psychosomatic illness, not a real one. And in fact, some people may simply be faking it (i.e. if you claim a gluten allergy and yet you still drink beer…) or because it fits with their other pseudoscience interests or fads.

As one writer says,

Are you into reiki, homeopathy, or the healing power of crystals, magnets or Head of the Class reruns? You might be a phony celiac.

Many self-diagnosed “sufferers” seem likely instead to have “orthorexia nervosa” – “an extreme or excessive preoccupation with avoiding foods perceived to be unhealthy.” An obsession with righteous eating. Psychiatric Times calls it a “disease that masquerades as health.”

Orthorexia is marked by the compulsive and rigid imposition of a set of ideals about what is correct to consume and the distress that ensues when actual eating does not adhere strictly to these ideals. In anorexia, the goal of food restrictions is to lose or to avoid gaining weight, so the focus is directed toward how eating (or exercising or purging) affects the morphology of the body. Orthorexia instead is a preoccupation with ideas of health or other philosophical ideals.

A food blogger lists some of the symptoms of orthorexia:

• Feeling virtuous about what they eat, but not enjoying their food much
• Continually cutting foods from their diet
• Experiencing a reduced quality of life or social isolation (because their diet makes it difficult for them to eat anywhere but at home)
• Feeling critical of, or superior to, others who do not eat as healthily they do
• Skipping foods they once enjoyed in order to eat the “right” foods
• Choosing to eat foods based off of nutritional value, instead of eating what they’re craving
• Feeling guilt or self-loathing when they stray from their diet
• Feeling in total control when they eat the “correct” diet

So maybe that’s the real culprit here.

I was at Costco on the weekend, musing over the huge number of products marked “gluten-free” – and wondering why so many were items that never had gluten in the first place. Finger paints? Stickers? Just riding the bandwagon, clearly. A profitable bandwagon, too, since many of the same type of product – like crackers – are more expensive when marked “gluten-free” than their gluten-rich counterparts.

But mostly I was marvelling at how widespread the madness has grown. Marvel tinged, of course, with a certain sadness at the willingness of industries without a conscience to endorse and encourage fads. And then make a profit from people’s insecurities.**

Is it really just a fad rather than a solution to an age-old problem? Science-Based Medicine thinks the former:

The current fad food “allergy” is gluten, a self-diagnosed condition in which gluten is believed to be some sort of dietary toxin – which must be distinguished from (1) the person with the documented anaphylactic wheat allergy and (2) those with celiac disease, an auto-immune response to gluten that requires absolute avoidance (but does not cause anaphylaxis if ingested). Capitalizing on the confusion about allergies and intolerances are alternative medicine providers, who offer their own definitions of allergies, and (conveniently) their own cures.

Joseph Brean, writing in the National Post this week, said:

…gluten has lately acquired a famously bad reputation among trend-savvy nutritionistas, who blame it for everything from irritable bowels and autoimmune disorders to bloating and lethargy, even diabetes, depression, autism and schizophrenia. A whole industry has risen up to capitalize on its wholesale rejection, in which gluten-free foods are often sold at a massive mark-up over “regular” products.

But cracks are appearing, not so much in the medical science, which for the truly gluten-intolerant has made major strides in lockstep with the trend, but in gluten as the pop cultural food obsession du jour.

Which is good news, I believe, but I doubt it’s because consumers are being wiser, more skeptical of unsupported claims, or more erudite in basic nutrition, chemistry or biology. I suspect it’s simply that, like so many other consumer fads before it, gluten-free is falling prey to simple ennui. People can only care so much and for so long about an issue, then dart off to pursue the next Big Thing. Oh! Shiny!

Nutritionistas. Love that  word. They need their own theme song.

Going gluten-free can actually be dangerous and unhealthy. The University of Wisconsin health site says there is risk in making the switch for non-medical reasons:

Avoiding grains on the gluten-free diet means that you are eating fewer products enriched with nutrients, which may lead to deficiencies in iron, calcium, thiamine, riboflavin, niacin, and folate.
Along with fruits and vegetables, the most common sources of dietary fiber are whole-grain breads and cereals, which contain gluten. Many people on gluten-free diets tend to eat inadequate amounts of fiber, which may lead to constipation.
Following a gluten-free diet may potentially cause a decrease in the amount of beneficial bacteria in the gut (Bifidobacterium and Lactobacillus), which can negatively impact the immune system.
Another negative aspect regarding the gluten-free diet is cost. Gluten-free products tend to be more expensive – (often much more – ed) – than gluten-containing products. Gluten-free products may be lacking in variety or may not be as accessible as gluten-containing products in some grocery stores. Gluten may also be found in cosmetics, lotions, shampoos, and medications.

So how did we get to this stage, where wild, unscientific claims could galvanize millions of people into jumping onto the gluten-free bandwagon? It seems a combination of evangelical-style approach of the fad’s hucksters, a media obsessed with obesity and shape, and consumers looking for a simple, fast no-work solution to the latter.

As if eating gluten-free cookies and brownies will make you svelte. Carbohydrates are carbohydrates regardless of their gluten buddies.

Brean quotes Ottawa doctor, Yoni Freedhoff:

“People treat food like religion, it’s really strange. I can’t think of many other areas of life where there’s so much personal passion. If you believe and buy into one of these particular styles of eating, often you end up becoming very zealous in your description of same, and your preaching of same, and you want everybody else to do what you’re doing. People really want to be right when it comes to the way we eat.”

Dr. Judy Scheel, writing in Psychology Today, called the fad a marketing ploy:

Clever, brilliant perhaps, on the part of American marketing who has found a new way to prey on the psyches of consumers.

She also notes reasons not to go gluten free:

Gluten-free food will likely set you up for deficiencies of important nutrients, including B vitamins, especially, B9 (folic acid) – Whole food breads and cereals are loaded with B vitamins. Eating fiber rich foods are important, especially for breakfast, in order to get and maintain normal intestinal and bowel movement. Removing whole grains will add to digestive problems overall, not correct them. Most Americans do not eat enough fiber. It is possible to get more fiber from brown rice and fruit, which are gluten-free, but a person must be committed to eating enough of these foods on a daily basis to achieve a similar effect of foods rich in fiber like wheat breads and cereals.

Going gluten free may even be dangerous to your health, as journalist Rachel Krantz wrote in The Daily Beast: “…some doctors worry that a growing number of people are diagnosing themselves with a gluten allergy in order to have a socially acceptable method to lose weight. Or even worse, to mask an eating disorder.”

Yes, to be clear, gluten or wheat sensitivity (it could be either or both) and even allergy affects some people – a small number – not just Celiac sufferers. But as Darshak Sanghavi notes in Slate:

To understand the proper role of gluten-free diets requires untangling three separate and unrelated medical problems blamed on gluten: celiac disease, wheat allergy, and gluten intolerance. Here’s the thing: The first problem is almost certainly underdiagnosed, but the latter two are likely to be overdiagnosed…
But the most confusing problems arise with the third problem blamed on gluten: so-called gluten intolerance. This condition is neither an autoimmune disorder, like celiac disease, nor an allergy, like true wheat allergy. There’s not even a mediocre blood test for gluten intolerance. The diagnosis simply relies on someone’s subjective feelings of bloating, bowel changes, or mental fogginess after eating gluten. This is a set-up for all manner of pseudo-scientific self-diagnoses, especially when you consider that 2 percent of people believe they have illnesses caused by magnetic fields.

He concludes that, “Part of the problem is that there is a lot of really bad science out there on gluten intolerance… patients convinced they have gluten intolerance might do well to also accept that their self-diagnosis may be wrong.”

Yeah, that will happen. Never. When people become True Believers, admitting they are wrong compromises their entire world view. Even waving proof in front of them won’t work. Ask any diehard smoker.

It’s not simply bad science, there’s a lot of risky quackery and pseudoscience associated with the GF fad. Gluten is blamed for a wide variety of ailments including “depression, arthritis, social phobias, or epilepsy,” auto-immune diseases, eczema, headaches, autism, constipation, carpal tunnel syndrome, infertility, high cholesterol, neuropathy, rashes, hives and seizures.

Which all sounds suspiciously like the sort of wild claims made by some chiropractors for back problems. Homeopaths – the biggest quacks of them all – have gotten on the bandwagon. Here’s a list one homeopath site says are symptoms related to gluten consumption:

• Weight gain, obesity, apple shape
• Mood and psychiatric disorders such as depression, obsessive compulsive disorder and schizophrenia
• Autism spectrum disorder, ADD, ADHD
• Vertigo and dizziness
• Hereditary gluten intolerance may be passed on to offspring
• Digestive issues such as bloating, gas, diarrhea or constipation
• Bumpy dry skin on the back of the upper arms (also may be related to an essential fatty acid deficiency), keratosis pilaris
• Tiredness and lack of focus after eating gluten
• Migraine headaches
• Joint pains and muscle stiffness
• Female hormonal issues such as fibroids, polycystic ovaries and pms
• Underactive thyroid and hashimoto’s thyroiditis

Which is simply a kitchen-sink list of unrelated ailments for which no evidence is presented. But then, I’m not surprised: it’s from a homeopath, and scientific evidence is highly antithetical to their profession.

The vast majority of claims about cures is merely anecdotal (and generally anonymous): people who state in some online forum or website that going gluten-free made their lives better – but without providing any proof; no medical tests, evidence, or research to back them up (or evidence that they are real people, not some marketing dweeb hired to promote gluten-free products or allegedly helpful enzymes***). They said they stopped eating it and got better from whatever ailed them. T

his is a “post hoc, ergo propter hoc” fallacy. It could simply be coincidence or any of a thousand other factors.

Skeptoid notes that many of the claims of companies selling gluten-free products are simply untrue and not based on any science or empirical evidence:

GlutenFree.com and GlutenFreeMall.com claim their products help people with autism or ADHD, which is completely untrue according to all the science we have. The autism claim in particular is broadly repeated across the autism activist community. The treatment of autism with a gluten free diet has been studied a number of times with varying results, but so far no well designed studies have shown any plausible benefit. A 2006 double blinded study published in the Journal of Autism and Developmental Disorders tested children with and without autism, on gluten-free and placebo controlled diets, and found no significant differences in any group…
Naturopaths routinely list gluten as a potential cause of disease in general. This is a medically bizarre claim. Proteins are essential for nutrition, and there is no evidence that incidence of disease increased worldwide once wheat grain became a staple. It’s true that bread itself is a rich source of carbohydrates, which are not essential and can be safely minimized in the diet, but this is true of gluten-free breads as well. By no logic should the strategy of avoiding carbohydrates be misconstrued as avoiding gluten.

Gluten has lately become part of a conspiracy theory intertwined with GM foods and the company Monsanto. GMO foods are blamed for a lot on their own, usually with the same lack of scientific research to back those claims. I’m waiting for gluten to be linked to UFOs, alien abductions and the Second Gunman.

Another so-called link is between gut (colonic) or candida yeast and illness; suggesting that reducing gluten reduces the carbohydrates yeasts need to survive, thus reducing the population of allegedly harmful yeast in your bowels. Quackwatch debunks that one.

Gluten may not even be the culprit when people have real problems: other proteins, additives or carbohydrates in the food may be causing problems, as an article in Scientific American notes:

…several studies hint that so-called gluten sensitivity might not always be caused by gluten. In some cases, the problem may be entirely different proteins—or even some carbohydrates. “We’re so used to dealing with gluten as the enemy, but it might actually be something else,” says David Sanders, who teaches gastroenterology at the University of Sheffield in England. Joseph Murray, a gastroenterologist at the Mayo Clinic in Rochester, Minn., agrees: “I’m starting to feel more uncomfortable calling it nonceliac gluten sensitivity. I think it might be better to call it nonceliac wheat sensitivity.”

A final group of potential culprits belongs to a diverse family of carbohydrates such as fructans that are notorious for being difficult to digest. A failure to absorb these compounds into the blood may draw excess water into the digestive tract and agitate its resident bacteria. Because these resilient carbohydrates occur in all kinds of food—not just grains—a gluten-free or wheat-free diet will not necessarily solve anything if these molecules truly are to blame.

Gluten is actually just one a group of more than 70 proteins found in wheat and related grains. Gluten itself is one of the “prolamin storage proteins,” and consists of about 100 components, including soluble gliadin protein and insoluble glutenin polymers. Fortunately for me, it causes no adverse symptoms in my body, because it really adds to the texture and flavour of products like bread that I love to make and consume.

If the gluten-free fad is on the wane, I will celebrate (maybe by baking a loaf of bread with extra gluten in it!). Until then, I’ll grit my teeth and suffer when I next hear about the miracle cure someone has had from a gluten-free diet.****
~~~~~
* In the USA, the gluten-free industry is worth about $4.2 billion annually, although several sites suggests it was as high as $12 billion by 2012, up from $10.5 billion in 2011.

** Oh, sorry, does that suggest to you that a corporation has a conscience?  If so, I didn’t mean to. Corporations exist for the sole purpose of making money for their shareholders. Profit isn’t a dirty word, but sometimes the means to achieve that end is.

But how valid are those claims to be “gluten-free” on packaging? Maybe not much. According to this site:

On August 2, 2013 the Federal Drug Administration (FDA) published in the Federal Register and announced a press release saying, “In order to use the term ‘gluten-free’, ‘no gluten’, ‘free of gluten’, and ‘without gluten’ on its label, a food must meet all of the requirements of the definition, including that the food must contain less than 20 parts per million of gluten.” This new rule was directed to the FDA by the Food Allergen Labeling and Consumer Protection Act (FALCPA).
Manufacturers have one year to come into compliance with this new rule.

Which suggests that until August, 2014, those claims might not live up to any standard. Caveat emptor.
*** Another marketing scheme on the GF bandwagon. From Skeptoid:

For $30 US one can buy 60 tablets of GlutenEase from a company called Enzymedica, Inc. The pill is supposed to include a blend of enzymes – including amylase, glucoamylase and dipeptidyl peptidase-4 (DDP-IV) – that are intended to digest both casein (a protein found in milk) and gluten. To be fair, the web site does state “GlutenEase is not formulated to prevent celiac symptoms”. It is designed to “support people suffering with gluten or casein intolerance”. “Support”, to me, is one of those weasel words that doesn’t really say anything but the reader often interprets it as being important…

Gluten Defense, made by Enzymatic Therapy Inc., contains a similar blend of enzymes that includes DDP-IV, lactase and amylase. Their website says the pills are supposed to “defend against hidden gluten”. The site goes on to say that “the right digestive enzymes can make a difference when trying to support a gluten free and casein free lifestyle”. There is that word “support” again. In fine print at the bottom of the page is the standard FDA statement that says statements on the page have not been evaluated by that organization. Users are instructed to “take two capsules with each meal or as directed by your healthcare practitioner.” A bottle of 120 capsules, available online and at many health food stores, costs about $30.

“Over-the-counter enzymes may be able to break down a few molecules of gluten here and there, but it would be downright dangerous for anyone with celiac disease to think that a supplement would make it possible for them to eat gluten again”, says Dr. Stefano Guandalini, a professor of pediatrics and director of the University of Chicago Celiac Disease Center. “The amount of gluten that these would be able to digest is ridiculously low,” he says. “For people with celiac disease, these are something to completely avoid.”

**** An an alternative view, the New York Times recently published an article suggesting the gluten-free industry was growing and would top $15 billion in US sales by 2016. It suggests that the trend will continue because it has different dynamics than other food and diet fads, and the sheer profit margins make manufacturers eager to perpetuate it:

Nonetheless, Ms. Morris says she does not think people will be “over” gluten-free foods as quickly as they have dumped the cupcake craze.
“The reason I do believe this has legs is that it ties into this whole naked and ‘free from’ trend,” she said. “I think we as a country and as a globe will continue to be concerned about what’s going into our food supply.”

…Gluten-free customers are valuable, ringing up roughly $100 in sales with their average grocery basket compared with $33 for the overall average basket, according to Catalina Marketing.

I hope they’re wrong.