Gluten Intolerance in 2010:Looking Back and Looking Forward

by Melissa Diane Smith

(Opinion) The decade of 2000 to 2009 was a breakthrough decade in our awareness and understanding of gluten intolerance.

In 2000, celiac disease was considered very rare and non-celiac gluten sensitivity was hardly on anyone’s radar screen (except for a few researchers’ and doctors’ – and mine as well. I published Going Against the Grain in 2002.)

Several developments occurred to increase awareness and interest. A groundbreaking study in 2003 established that celiac disease is as common in the United States as in Europe. That study and other studies proved that status-quo beliefs about celiac disease – that it primarily developed in children, that it just affected Caucasians, and that it was just a gastrointestinal condition – were all incorrect. We now know that celiac disease can develop in both adults and children – and Caucasians and people of all races – and that it presents itself with non-intestinal symptoms quite often. “In fact, anemia and chronic fatigue are the two main presenting symptoms of celiac disease,” says Alessio Fasano, M.D., director of the University of Maryland Center for Celiac Research who led the 2003 study.

Because of these developments, “celiac disease came out of the shadow and really became an issue,” according to Dr. Fasano. The Centers for Disease Control declared celiac disease a public health problem and screening for celiac disease became more commonplace (at least by more gastroenterologists).

In the past few years research into non-celiac gluten sensitivity has intensified showing that gluten sensitivity is absolutely a bona fide medical condition and it affects far more people than celiac disease – points I raised in my Going Against the Grain book in 2002. It is estimated that for every person who has celiac disease, there are at least six or seven (and some researchers say ten) people who have gluten sensitivity. Consequently, the number of people who eat gluten free has steadily increased, and the food industry has responded by creating more gluten-free foods (although not always healthy gluten-free foods). Sales of gluten-free foods went from $300 million in 2003 to $1.3 billion in 2008 and are projected to continue to grow dramatically over the next few years.

However, the real breakthrough was how much public awareness grew, especially in the United States. People who didn’t fit a celiac disease diagnosis but who didn’t feel well eating gluten delved into new books, articles and studies and spoke about their experiences to more doctors and to more people in Internet chat rooms. The word spread grassroots style and the Internet allowed that to happen much more quickly.

“The increase in awareness came from both sides – both from more doctors and from more everyday people. But I think the increase in awareness really was pushed by the public,” says Stephen Wangen, N.D., author of Healthier Without Wheat. and founder of the Center for Food Allergies and the Irritable Bowel Syndrome Treatment Center in Seattle, Washington.

An Increased Incidence of Gluten Intolerance

Awareness of gluten intolerance isn’t the only thing that has increased. The incidence of gluten intolerance has increased, too. The number of people who have celiac disease has doubled every 15 to 17 years in the past 50 years, and “there is no doubt” that the incidence of gluten sensitivity has risen as well, Dr. Fasano says.

A lack of good intestinal bacteria may be setting the stage for more and more people developing gluten intolerance, Dr. Fasano believes. Lack of good intestinal bacteria can develop from abuse of antibiotics, too much stress, too much sugar, and other dietary factors.

Dr. Wangen thinks increased consumption of gluten in the foods we eat and increased intake of other foods humans didn’t evolve on, such as dairy products, also may be an important factor. “I rarely see people reacting to meats, fish and vegetables, the types of foods eaten by people who didn’t get the diseases we do. We’ve gotten further and further away from our natural environment, especially with our diet,” Dr. Wangen says.

“Even in the alternative health care community, people think that something has gone wrong with your immune system to develop conditions such as gluten intolerance. I believe that people are eating the wrong diet and that brings on the condition, and more studies in immunology should be designed along these lines.”

Predictions for the New Decade

So, what’s coming in the new decade? Much more research into gluten sensitivity. “I really believe in the next five years research will be done to screen people with various conditions – conditions such as migraines, irritable bowel syndrome, schizophrenia, autism, Attention Deficit Hyperactivity Disease and others – and see how many of them have gluten sensitivity,” says Dr. Fasano who is a leading researcher in the field. “It’s a very exciting time and all these conditions that people anecdotally say have improved by going on a gluten-free diet are tantalizing to explore. I think they deserve more attention.”

Research also is being conducted into possibly developing a drug to help block the leakiness of the gut and a drug of oral enzymes that help digest gluten more completely so it doesn’t activate an immune response. But don’t look to either as potential cures to go back to the typical wheat-based diet. “If they are successful, I would see them more as adjuncts to a gluten-free diet, not as a complete treatment,” Dr. Fasano says. “They might help provide a safety net for people with celiac disease and gluten sensitivity so they do not have terrible reactions to small amounts of gluten ingested accidentally.”

Dr. Wangen warns: “It’s easy to get caught up in the hype of these drugs, and they are sure to be money makers, as most drugs are. But the drugs in the pipeline will not cure celiac disease, and the enzyme-based drugs that are being developed will be similar to the gluten-digestive enzymes that are now available,” says Dr. Wangen. “The most perfect treatment will continue to be not to eat gluten.”

So, if diet is the best treatment, will gluten intolerance be widely recognized and diagnosed by doctors including general practitioners in 2020? Dr. Fasano is hopeful and optimistic. With continued research and education, “we’re slowly but surely getting there,” Dr. Fasano says. “We were crawling in this area, now we’re walking, and soon I hope we’ll be running.”

Dr. Wangen is not so sure. “Despite all the research into celiac disease, it is still a problem for people to get diagnosed with celiac disease today. The medical system is extremely slow to change,” he says.

But he still thinks it’s possible. “Changing the medical system so it is less pill-oriented and more diet-focused is going to have to be pushed by the public,” he adds. “I really believe the people have the power to make the difference in what medical care will be like in 2020.”

Overall, we’ve come a long way, baby. But the information we have learned about gluten intolerance can and should take us much further.

Melissa’s Comments:

I am very happy to have played a part in starting the ball rolling toward increased awareness of gluten-related (and grain-related) illness with the publication of my Going Against the Grain book in 2002. What I wrote then holds true today, but now there is even more research to confirm it, and more and more people are becoming aware of it.

Given that I wrote that book eight years ago, I wanted to give an update and retrospective of what has happened between then and now, and a look into the future. I want to thank Dr. Fasano and Dr. Wangen for graciously taking the time to talk with me and give their perspectives. What I hope you learn from this article is that gluten intolerance, which includes celiac disease and non-celiac gluten sensitivity, is an undeniable medical condition and it is only treated with diet. If your doctors don’t know that yet, at least you do.

I have repeatedly said in my work that food is our best medicine. Hippocrates knew that two-and-a-half thousand years ago when he said, “Let food be thy medicine and medicine be thy food.” We know through research that that’s true for gluten intolerance, and true for countless other conditions including diabetes, prediabetes and heart disease (as I and my coauthors explained in Syndrome X and I explained again in Going Against the Grain). But we shouldn’t need research to tell us that. It’s common sense that food, which gives us the nutrients that our bodies are made of and that are involved in the biochemical processes that make our bodies run, is our most important medicine. The biggest factors that get in the way of believing that are our thoughts, emotions and habits (and of course these are heavily influenced by socialization, advertising and just plain propaganda). Just like the medical system, our thoughts, emotions and habits are difficult to change, but we can change them by getting new information, sharing information and resources, and banding together. That’s exactly how awareness of gluten intolerance and the development of gluten-free foods have grown as far as they have in the past eight to ten years. All we have to do is keep the process going.

I will continue to share the most important against-the-grain research and information (and some opinion pieces to offer perspective) on this blog and in my books. I hope you’ll continue to do your part by letting others know about Going Against the Grain, my other books, my Going Against the Grain Group, and this newsletter and blog. By spreading the word together, we can chip away at misinformation so more people can learn about the benefits of Against the Grain Nutrition and regain and revitalize their health. Who knows? In the process, we might help play a part in changing a flawed drug-oriented medical system!

Copyright © 2010 Melissa Diane Smith

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