General Mills might be described as Big Gluten, but they’ve made the unusual move of pushing gluten-free foods, because there’s a small but dedicated and growing market:
Gluten-free packaged foods — in which wheat has been replaced by alternative ingredients like rice, sorghum and tapioca flours, among others — were almost impossible to find in the 1990s. Most of what did exist was dreadful: think cardboard. It was also hard to find people who understood the disease itself. Doctors believed it wasn’t much of a problem in this country.
“Nobody really was ready to accept the 1 percent prevalence of celiac disease,” says Dr. Stefano Guandalini, founder and medical director of the University of Chicago Celiac Disease Center, who came to the U.S. from Italy in 1996 and found very little awareness of celiac disease. Even experts ignored it, Guandalini says, noting that a prominent medical textbook published as recently as 1999 questioned how widespread it was. “The chapter on celiac disease,” Guandalini says, “quotes a prevalence of 1 in 10,000 in the U.S. and adds that this is mostly a European condition — and the prevalence is decreasing. This is the formal, official teaching in ’99.”
But Guandalini didn’t buy it. And neither did Dr. Alessio Fasano, another Italian who was practicing at the University of Maryland. The genes were here, Fasano recalls thinking, courtesy of our European ancestors, and so was the gluten, a natural component of wheat that provides the elastic qualities that make for delicious baked goods. But the protein is also difficult to digest. And even a healthy intestine does not completely break gluten down. For those with celiac disease, the undigested gluten essentially causes the body’s immune system to lash out at itself, leading to malabsorption, bloating and diarrhea — the classic gastrointestinal symptoms — but also, at times, joint pain, skin rashes and other problems. In Italy, Fasano routinely saw celiac disease. Surely it was in the U.S. too. Hence, in 1996 Fasano published a paper, asking, in the title, a simple question: “Where Have All the American Celiacs Gone?”
The same year that he published the paper, he founded the University of Maryland Center for Celiac Research. He started small; Fasano had only one patient the first year. In a 1998 paper, however, he reported that he had randomly screened 2,000 blood samples for the antibodies that typically indicate a diagnosis of celiac disease and discovered that 1 in 250 tested positive.
Still, doubts lingered. So Fasano set out to do a more comprehensive study — or, as he called it, “the most insane, large epidemiological study” on celiac disease in the U.S. to date. More than 13,000 subjects in 32 states were screened for the antibodies. Those who tested positive underwent further blood tests and, when possible, a small-bowel biopsy to confirm the presence of celiac disease. The results, published in 2003, were stunning: 1 in every 133 people had celiac disease. And among those related to celiac patients, the rates were as high as 1 in 22. People were listening now — and everything about gluten-free living was about to change. “Believe it or not,” he says, “the history of celiac disease as a public health problem in the United States started in 2003.”
As awareness of the disease became more widespread, Fasano expected celiac diagnoses to increase. That, in fact, is what has happened. Since 2009, Quest Diagnostics, a leading testing company, has seen requests for celiac blood tests jump 25 percent. But Fasano didn’t anticipate other developments. He now estimates that 18 million Americans have some degree of gluten sensitivity. And experts have been surprised, in general, by the rising prevalence of celiac disease overall. “It’s not just that we’re better at finding it,” says Dr. Joseph A. Murray, a gastroenterologist at the Mayo Clinic in Rochester, Minn. “It truly has become more common.”
Comparing blood samples from the 1950s to the 1990s, Murray found that young people today are nearly five times as likely to have celiac disease, for reasons he and others researchers cannot explain. And it’s on the rise not only in the U.S. but also in other places where the disease was once considered rare, like Mexico and India. “We don’t know where it’s going to end,” Murray says. “Celiac disease has public health consequences.” And therefore, it has a market.
Gluten-free products aren’t just selling these days; they appear to be recession-proof. According to a recent Nielsen report on consumer trends, the volume of gluten-free products sold in the past year is up 37 percent. Spins, a market-research-and-consulting firm for the natural-products industry, says the gluten-free market is a $6.3 billion industry and growing, up 33 percent since 2009. Niche companies like Amy’s Kitchen, Glutino, Enjoy Life, Bob’s Red Mill and Udi’s Gluten Free Foods are reporting incredible growth.
Major corporations have also been moving into the marketplace: Anheuser-Busch introduced Redbridge, a gluten-free beer, in 2006, and Kellogg rolled out gluten-free Rice Krispies this year. Other companies have begun adding labels that indicate when their products are gluten-free — that is, when they contain fewer than 20 parts per million gluten (the proposed federal standard). Both Frito-Lay and Post Foods have begun such labeling in the past year. It’s the golden age of gluten-free.
Celiacs aren’t the only ones who are grateful. Athletes, in particular, have taken to the diet. Some claim to have more energy when they cut out gluten, a belief that intrigues some experts and riles others. Guandalini dismisses the idea as “totally bogus.” Yet no one can argue with the success of the world’s No. 1 men’s tennis player, Novak Djokovic. Within months of revealing this year that he had a gluten allergy and had altered his diet accordingly, Djokovic posted a remarkable 64-2 record. By September, sportswriters barely let a moment pass without asking about, as one called it, his “off-court eating habits.” After his victory at the U.S. Open final, a reporter wanted to know what he ate for dinner the night before, for breakfast that morning and what he planned to eat that night. “I’ll give you a simple answer,” Djokovic said with a smile. “Last night I didn’t have any gluten, and tonight I will have a bunch of gluten.”
