Gluten-Free: Only the Tip of the Iceberg?

Gluten-free food value sales hit US$2.6 billion globally in 2014. Some within the industry claim that the market has peaked and that a decline in demand is imminent. However, considering that coeliac disease remains woefully underdiagnosed, combined with the fact that half the world’s population could potentially develop the condition if exposed to – as yet still unknown! – environmental triggers, it becomes clear that we might only be at the beginning of the gluten-free product tsunami.

More people diagnosed, but many more still in the dark

Coeliac disease, a condition where the body’s immune system reacts to dietary gluten intake, resulting in damage to the intestinal lining, seems to be on the rise. For example, in Australia, where one in 100 people was previously believed to be affected, more recent research has led to the realisation that one in 60 females and one in 80 males have the condition. Last year, Nottingham University in the UK published a study that showed that there had been a fourfold increase in the diagnosis of coeliac disease in the UK since the 1990s, and the researchers are convinced that three quarters of cases remain undiagnosed.

A recent study, published online ahead of print in February 2015 in Archives of Disease in Childhood, has revealed yet another, and rather unsettling, reality impacting on the diagnosis of coeliac disease: socioeconomic background. The study, carried out by a team of researchers from the Universities of Nottingham (UK) and Salerno (Italy) and funded by Coeliac UK, a not-for-profit charity championing the interests of coeliac disease sufferers in the UK, found that children living in socioeconomically deprived areas were 80% less likely be diagnosed as coeliac disease sufferers than their counterparts residing in more affluent parts.

It’s in the genes

Diagnosing coeliac disease remains a tricky issue. Symptoms can vary hugely from person to person and are often quite non-specific. Tiredness and persistent anaemia, for example, are common, but these could also be caused by an infinite number of other conditions. To be absolutely certain that the patient really is suffering from coeliac disease, a gut biopsy is required, and people tend to shy away from invasive procedures such as this.

If the present diagnostics shortfall seems alarming, the discovery that 50% of people could potentially develop coeliac disease at some point in their lives is far more worrying still.

Coeliac disease is a heritable condition and those who lack the genetic markers that predispose an individual to the condition will not develop it. These genetic markers, however, seem to be surprisingly common, although it varies somewhat across global populations. An Australian study carried out a couple of years ago revealed that over half of Australians possessed the genetic make-up that made them potentially susceptible, while around one third of the US population has a genetic predisposition.

Environmental triggers a mystery

There are, as yet, no firmly established conclusions as to what causes some genetically predisposed individuals to develop the condition while others do not. There is clearly some environmental trigger, perhaps even several. This constitutes the most gaping of holes in our knowledge about coeliac disease.

Researchers in the field have their theories, of course, but none of these have so far been conclusively proven. Stipulated triggers include being bottle fed, having been born via caesarean section, too-early exposure to gluten during weaning, the introduction of dietary gluten too late during childhood, and exposure to antibiotics.

Many gastroenterology experts believe that the microbiota, ie the composition of the bacterial flora present in the human gut, is a determining factor, because these organisms are known to have a profound impact on the human immune system. The microbiota can be influenced by many factors, including the route of birth, diet and medication.

The onset of coeliac disease may occur at any age, which makes the need to finally identify the environmental triggers even more pressing.

Consumers need education and encouragement

In the meantime, besides actively supporting scientific research into the condition, what can the industry do to help sufferers?

First and foremost, since most coeliac sufferers are still in the dark about having the condition, there is much need for stepping up educational efforts. Even if an afflicted individual has dabbled with gluten-free foods, the likelihood is high that they may not have been strict enough to achieve palpable results.

For someone with coeliac disease, even minute amounts of gluten are detrimental to their digestive system. It takes time for a damaged gut lining to recover, plus a total avoidance of gluten. Gluten is found in a myriad of foods, many of which are far from obvious. A large number of wannabe gluten-free avoiders are not aware that there is much more involved than avoiding baguettes and takeaway pizza. A “one-off treat” slice of birthday cake, or even the gravy on Mum’s Sunday roast, can provoke a major setback.

Therefore, the industry should get involved in encouraging consumers to go for diagnosis rather than half-hearted experimentation. The long-term effects of untreated coeliac disease may lead to serious health issues, such as osteoporosis, infertility, and thyroid conditions. A special focus should be placed on socioeconomically less well-off segments of the consumer base, especially parents whose children may be facing a lifetime of malaise.

Focus on economy ranges and expanding the offering

Product developers and ingredients firms have been working very hard in recent years, allowing gluten-free foods to take strides in terms of palatability and presentation. As a result, there is plenty of fancy gluten-free fare on supermarket shelves, such as cakes and biscuits, which are indulgent enough to be purchased even by those not trying to avoid gluten. With the premium end of the market already well covered, the focus needs to shift to the economy realm, enabling those on a small budget to buy what they need for a healthy and varied gluten-free diet.

Being able to choose from mass-market brands is helpful for shoppers, especially where parents of young children are concerned. Youngsters may insist obstinately on eating the same foods as their peers for fear of being seen as “different”. Major players have already tuned into this and they are launching gluten-free extensions of blockbuster brands. General Mills, for example, recently announced that it was to debut gluten-free versions of Cheerios, including Original, Honey Nut, Multi-Grain, Apple Cinnamon and Frosted, in July 2015 in the US.

Our data show that gluten-free bakery products, which includes breakfast cereals, registered the most dynamic value growth over the 2009-2014 review period: 73% globally, based on constant 2014 prices and a fixed US dollar exchange rate. Notably, gluten-free bakery’s dynamism remains buoyant, with the highest value growth rate (17%) achieved in 2014, compared to the preceding years of the review period. The category is also the biggest, accounting for two thirds of global gluten-free food value sales in 2014.

And yet, shoppers can’t always find what they are looking for, or at least not all in one place. In 2014, Coeliac UK conducted a survey among its members in 2014 and found that around three quarters had to visit more than one supermarket to complete their gluten-free shopping. Evidently, retailers could still do more to provide the growing number of shoppers affected by coeliac disease with a more satisfying shopping experience.