Cureton noted that the market for gluten‐free food and beverage products grew at a compound annual growthrate of 28% from 2004-2008. Packaged Facts reported that sales in the U.S. were $1.6 billion in 2008 and projects this to increase to $2.6 billion in 2012 and to over $5 billion by 2015.

A recent MamboTrack survey conducted by Mambo Sprouts Marketing tracked the buying habits of 1,000 health and natural product consumers and asked them about their purchasing intentions for 2012 (1). It found that 69% of this group buy gluten free foods, and 38% intend to increase gluten-free purchases. While many marketers have estimated 15-25% of U.S. consumers are interested in gluten‐free products, the Hartman Groups suggests that the number is 13.2%, or about 40 million people (2).

Mintel’s Global New Products Database (GNPD) found that product launches with a gluten‐free claim nearly tripled in 2011 to about 1700 products as compared to 2007 (3).

Approximately 3 million Americans suffer from celiac disease, and only a fraction of these patients have been diagnosed, which implies that patients suffering from other forms of proven gluten reaction, including gluten sensitivity and wheat allergy, are contributing to market growth. The rest of the market can be attributed to interest in gluten-free diets for maladies presumably affected by gluten exposure, including autism, multiple sclerosis, and irritable bowel syndrome and attention deficit hyperactivity disorder.

The diagnosis of celiac disease has doubled every 15 years in the U.S. since 1974 (4).  There are several reasons accounting for this phenomenon, including an increased awareness; more accurate diagnostic tests; greater screening of at risk groups; changes in the environment and alternations in gut flora. Celiac disease is immune‐mediated triggered by the ingestion of gluten‐containing grains (wheat, rye, barley) in genetically susceptible individuals. The disease is characterized by an inadequate inflammatory response to gluten. Symptoms are variable ranging from severe malabsorption syndrome to “silent” cases.

According to research presented by Cureton, 5-8% of Americans suffer from immune system (IgE) mediated wheat allergy; 0.2-0.4% from auto-immune based celiac disease and 6% from gluten sensitivity. However, the market for gluten-free is much broader than these segments and includes those looking for solutions for weight loss, improved sports performance, for better nutrition and other health benefits. Cureton stressed that there is little to no evidence that the consumption of a gluten-free diet can improve LDLcholesterol particle size, acid reflux and irritable bowel symptoms; reduce aging or result in weight loss -- claims often associated with such diets. Cureton also cautioned that a gluten-free diet can be low in important nutrients such as fiber, iron, B vitamins (folate, niacin, B12), calcium, phosphorous and zinc.

Celiac patients must avoid all types of wheat, such as spelt and kamut, and wheat germ, and barley, including forms such as malt, as well as rye. Only oats and oat products labeled gluten-free should be consumed. There are many frequently overlooked foods that may contain gluten. Cureton provided a list which includes broth, candy, imitation bacon, imitation seafood, marinades, processed meats, sauces, soup base, soy sauce, syrup and thickeners.

Since 2006, the Food Allergen Labeling and Consumer Protection Act (FALCPA) has required that companies identify in “plain English” the eight most prevalent food allergens: egg, fish, milk, peanuts, shell fish, soybean, tree nuts and wheat.  However, FALCPA does not include for identification:

1. Barley (malt), Rye or Oat (but not “hidden” ingredients);

2. Cross contamination, for example if wheat is in a product unintentionally, it does not need to be declared;

3. Meat products covered by USDA. Cureton noted that the majority of food manufactures are voluntarily following the same guidelines as FALCPA;

4. Over the counter or prescription medications; and

5. Alcoholic beverages, with the exception of distilled beverages which are gluten free.

Food manufacturers often use voluntary statements, which indicate the “potential” unintended presence of a food allergen. Products with this warning have been tested to contain less than 5 parts per million (ppm) gluten while other products with no statement, test above 20 ppm, the maximum for a “gluten-free” designation.

The U.S. Food and Drug Administration has proposed an extension of gluten-free labeling which would allow a product to be defined as “Gluten Free” if all of the following conditions are met:

1. Does not contain a prohibited grain, such as wheat, barley, rye, and crosses;

2. Does not contain an ingredient derived from a prohibited grain that has not been processed to remove gluten, such as hydrolyzed wheat protein, and barley malt;

3. If the food contains an ingredient derived from a prohibited grain that has been processed to remove gluten, such as wheat starch or modified food starch, use of that ingredient in the food product may not result in the food product containing 20 ppm or more gluten; and

4. The food product contains less than 20 ppm gluten.

For food manufacturers, several gluten‐free grains and vegetable products are available including brown rice, whole corn, amaranth, buckwheat, flax, quinoa, sorghum, teff, millet, montina, arrowroot, potato, tapioca and flours made from nuts, beans and seeds.

In conclusion, celiac disease is one of the most common immune-mediated diseases, with a worldwide prevalence of around 1%, although a few decades ago the disease was thought to be very rare. The best treatment known to deal with the disease is adherence to a lifelong strict gluten-free diet. And gluten-free diets are certainly on the rise, becoming fashionable as celebrities and professional athletes are dropping gluten from their diets.  A gluten-free diet is often promoted as a way to increase energy, lose weight or deal with certain health problems. However, as dietitians such as Cureton often stress, such diets are not necessarily healthier, as they may lack fiber, vitamins, minerals and antioxidants and may also be higher in carbohydrates and sodium.

For further information, please visit: www.celiacenter.org.

Conferences, presentations and information available from the Food and Marketing Institute can be accessed at: www.fmi.org/.

References

1.         http://www.mambosprouts.com/2012-natural-and-organic-market-trends/

2.         http://www.hartman-group.com/hartbeat/making-sense-of-the-gluten-free-trend

3.         Mintel, 2011. www.mintel.com/press‐centre/press‐releases/822/could‐you‐be‐gluten‐intolerant‐some‐may‐be‐suffering‐in‐silence

4.         Catassi C, Kryszak D, Bhatti B, et al. 2010. Natural history of celiac disease autoimmunity in a USA cohort followed since 1974. Ann Med.42(7):530-8.