2 Immunoglobulin (Ig) E–mediated wheat allergy is another relatively rare gluten-related disease that requires restriction of wheat from the diet. A lifelong GFD is well recognized as the standard of care for patients with gluten-related diseases such as celiac disease and gluten ataxia, in which immunemediated inflammatory responses to gluten proteins are directed primarily against the small intestinal mucosa and cerebellar Purkinje fibers, respectively.
1 The rapid rise in the popularity of a gluten-free diet (GFD) and gluten-free foods has been driven by multiple factors, including social and traditional media coverage, aggressive consumer-directed marketing by manufacturers and retail outlets, and reports in the medical literature and mainstream press of the clinical benefits related to gluten avoidance. More than $15.5 billion were spent on retail sales of gluten-free foods in 2016, which is more than double the amount spent in 2011. The consumption of gluten-free foods has significantly increased over the last 30 years. This article provides insight regarding gluten avoidance patterns and effects on patients without gluten-related diseases, and highlights concerns surrounding gluten avoidance in the absence of a gluten-mediated immunologic disease.Įpidemiology and Economics of a Gluten-Free Diet In fact, gluten avoidance may be associated with adverse effects in patients without proven gluten-related diseases.
However, high-quality evidence supporting gluten avoidance for physical symptoms or diseases other than those specifically known to be caused by immune-mediated responses to gluten is neither robust nor convincing. Emerging evidence shows that gluten avoidance may be beneficial for some patients with gastrointestinal symptoms, such as those commonly encountered with irritable bowel syndrome. Individuals may restrict gluten from their diets for a variety of reasons, such as improvement of gastrointestinal and nongastrointestinal symptoms, as well as a perception that gluten is potentially harmful and, thus, restriction represents a healthy lifestyle. The gluten-free diet is driven by multiple factors, including social and traditional media coverage, aggressive consumer-directed marketing by manufacturers and retail outlets, and reports in the medical literature and mainstream press of the clinical benefits of gluten avoidance. More than $15.5 billion were spent on retail sales of gluten-free foods in 2016. Despite the rarity of these diseases, there have been significant increases in the adoption of a gluten-free lifestyle and the consumption of gluten-free foods in the United States over the last 3 decades. Gluten-related diseases such as celiac disease and gluten ataxia are rare conditions, affecting less than 1% of the population in the United States.
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