The Gluten‐Free Diet:
What Does It Mean for Your Customers and Your Bottom Line?
Pam Cureton, RD, LDN
Center for Celiac Research
University of Maryland School of Medicine
22 S. Penn Street
Baltimore, MD 21201
Phone: 410‐706‐4140
pcureton@peds.umaryland.edu
www.celiaccenter.org Google Trends
Gluten Free Market
For the American general population adopting a gluten‐free diet is becoming an increasingly popular solution. The market for gluten‐free food and beverage products grew at a compound annual growth rate of 28 percent from 2004 to 2008, to finish with almost $1.6 billion in retail sales last year. By 2012 the market is expected to reach about $2.6 billion in sales.
The fact that approximately 3 million Americans suffer from celiac disease and only a fraction of these patients have been diagnosed implies that patients suffering of other forms of proven gluten reaction, including gluten sensitivity and wheat allergy, contribute to this market growth. The rest of the market is filled by people affected by maladies claimed to be affected by gluten exposure, including autism, ADHD, multiple sclerosis, IBS, and ADHD.
‘Free‐From’ Foods
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. It found that:
69% buy gluten free foods.
38% plan to increase gluten free purchases.
•
Alexandra Smith, Mintel’s director of consumer trends:
Demand for ‘free‐from’ foods is on the rise as consumers become better educated (and more fearful) about allergies and additives. This has certainly increased awareness of the potential dangers in things like trans fats, high fructose corn syrup, and now gluten.
•
•
http://www.mambosprouts.com/2012‐natural‐and‐organic‐market‐trends/
Winter Fancy Food Show :
12 Food Trends for 2012 #6. Gluten‐free gets respect
The 1,300 booths at the Winter Fancy Food Show in San Francisco offered insights into food trends. Gluten‐free foods, including new flour blends, pastas and cereals, were among the show's big stories. •
http://yourlife.usatoday.com/fitness‐food/story/2012‐01‐17/From‐fancy‐salt‐to‐
gourmet‐trucks‐an‐appetizing‐look‐2012/52621708/1
There is little question that consumer interest in gluten‐free eating habits—as well as gluten‐
free products—is on the rise. While many marketers have estimated 15% to 25% of U.S. consumers are interested in gluten‐free products, our own research concludes that the number is 13.2%, or about 40 million people1
•
http://www.hartman‐group.com/hartbeat/making‐sense‐of‐the‐gluten‐free‐trend
Trend Watch 2012
Since 1995, SPINS has provided information on sales across retail channels, and on the consumer and market dynamics underlying the industry's rapid growth. According to Kerry Watson, SPINS natural and specialty product expert, “more doctors are testing for these conditions and more people are experimenting with a gluten‐free diet. It’s our responsibility as an industry to answer the needs of this growing population.”
Product Attribute Related Trends
• Gluten Free Body Care
– A recent study from George Washington University reported topical beauty and body care products that contain gluten could have a negative reaction for those with celiac disease
• Hot Ingredients – Garbanzo Beans
– Quinoa
– Chia
http://www.spins.com/assets/pdf/Trendwatch_new_opt.pdf
Packaged Facts
Packaged Facts, a food market research group, reported that United States sales of gluten‐
free products totaled $1.6 billion in 2008; the group projects $2.6 billion in sales this year and exceed $5 billion by 2015
http://www.post‐gazette.com/pg/12026/1205878‐34.stm#ixzz1kb1olgmT
,
• Could you be gluten intolerant? Some may be suffering in silence, reports Mintel Chicago (February 22, 2012)—The gluten‐free industry is booming, growing 27% since 2009 and exceeding $6 billion in 2011, and fueled by an abundance of new products in 2010 and 2011 that bear a gluten‐free claim. However, despite an increase in popularity and product development, celiac disease and gluten intolerance could be widely undiagnosed, as according to recent Mintel research, just 1% of consumers say they’ve been diagnosed with celiac disease and only 8% overall say they are gluten intolerant/sensitive. However, Mintel research suggests that number should be closer to 15%. •
“The prevailing problem is that many Americans simply may not realize they are gluten intolerant/sensitive, or they may be ignoring signs and symptoms,” says David Browne, senior analyst at Mintel. “While food companies may be overdoing it unnecessarily with gluten‐free label claims that are appearing on everything from tomato sauce to scallops, the message is getting out and it’s likely that many more consumers will engage in the sector, both for foods eaten at home and at restaurants.”
•
Mintel’s Global New Products Database (GNPD) found that product launches with a gluten‐free claim nearly tripled in 2011 to roughly 1700 products as compared to 2007
www.mintel.com/press‐centre/press‐releases/822/could‐you‐be‐gluten‐intolerant‐some‐may‐be‐suffering‐in‐silence
G Gluten Free Aisle Rite
• A whole aisle is dedicated to the needs of people on a gluten free diet at Shop Rite • Additional programs at –
–
–
–
•
Safeway: SimpleNutrition
Wegman’s: Natures’ Market Place
Hy‐Vee: Knowledgeable staff dietitian Whole Foods: Certified GF products only
Read more: http://www.timesunion.com/business/article/Healthy‐choices‐profits‐3341409.php#ixzz1mwBum12Q
The Gluten Free Diet:
GFD Consumers:
Not Only Celiac Disease!
5-8 % of Americans
Medical Necessity:
Wheat Allergy
(IgE-mediated)
0.2-0.4%
Celiac Disease
(Autoimmune-based)
1% of US population
No
Medical Necessity:
Gluten Sensitivity
6% of Americans
Reasons for the Occasional Consumer: not medically necessary
• Weight loss (?)
• Better sports performance (?)
• Celebrity Endorsements • Better nutrition & other health benefits (?)
Weight loss (?) Really?
Learn how you can shed up to 20,
30, 50 lbs or more…
How eating wheat shrinks your LDL cholesterol particle so they stick to artery walls and help trigger hearts
and strokes
Acid reflux and irritable bowel symptoms DISAPPEAR!
You can turn back the aging clock by
Eliminating wheat from your diet
No exercise. No counting calories. Eat the foods you love.
No evidence that a GFD will produce weight loss
Better sports performance (?)
Tennis pro Novak Djokovic
Golf Pro Michelle Wie
Chicago Bulls player Kyle Korver Men’s cycling team goes gluten free for Tour de France
• (Your name here) with book on
gaining an edge in life and in sports by going gluten‐free
•
•
•
•
No evidence that a GFD will increase sport performance Celebrity Endorsements •
•
•
•
•
Elisabeth Hasselbeck Ophra Victoria Beckham
Lady Gaga Chelsea Clinton
Better nutrition & other health benefits (?)
The GFD can be missing important nutrients needed for optimal health and wellness
•
•
•
•
•
•
Lacks fiber
Lacks iron
Lacks B vitamins‐ folate, niacin, B12
Lacks calcium
Phosphorous
Zinc
www.adaevidencelibrary.com Who Benefits From the Use of the GFD?
– Medically Necessary use of the GFD
• Celiac disease • Non‐Celiac gluten sensitivity • Wheat/gluten allergies Definition
Celiac disease is an immune‐mediated disease triggered by the ingestion of gluten‐containing grains (wheat, rye, barley) in genetically susceptible individuals.
Diagnosis Increasing • 2003‐now
• diagnosis of CD has doubled every 3 years
• Over past 35 years • Study from the CFCR: Natural History of Celiac Disease Autoimmunity in a US Cohort followed Since 1974 showed the prevalence in the US has doubled every 15 years Why the Increase?
• Increased Awareness
• More Accurate Diagnostic tests
• More Screening
• At risk groups • Changes in Environment
• Grains ( quality & quantity of gluten)
• Eating patterns
• Hygiene Theory
• Gut Flora/Infections
• Rotavirus
Normal small bowel
Celiac disease
Gluten
Gluten-free diet
Getting the Right Diagnosis
• Clinical symptoms
• Serological testing
While on a regular diet
• Intestinal biopsy “Gold Standard”
While on a regular diet
• Improvement of symptoms
While on a GFD
Symptoms of Celiac Disease
Used with permission from Bell Institute of Health and Nutrition
Serological Screening
Due to high sensitivity and specificity, the best available tests are:
– Tissue Transglutaminase (tTG)
– Total IgA
– HLA haplotypes DQ2 and DQ8
General population of the US
Individuals with Celiac Disease
HLA‐DQ2
or
HLA‐DQ8
Gold Standard: EGD
Normal
Partial atrophy I
Partial atrophy II
Partial atrophy III
Subtotal atrophy Total atrophy
Serology back to normal
Follow up lab testing
• 4‐6 months after starting the GFD
• If positive repeat in 3 months after review of the GFD
• If negative repeat annually Gluten Sensitivity: Definition
Cases of gluten reaction in which both allergic and autoimmune mechanisms have been ruled out (diagnosis by exclusion criteria)
• Negative immuno‐allergy tests to wheat
• Negative CD serology (EMA and/or tTG) and in which IgA deficiency has
been ruled out
• Negative duodenal biopsy
• Presence of clinical symptoms that can overlap with CD or wheat allergy
• Resolution of the symptoms following implementation of a GFD (double blind)
• To date, there is no test for gluten sensitivity! Treatment:
The Gluten Free Diet
Never start the GFD before proper testing is completed! • After 4‐6 months of a GFD, serology levels may return to normal.
• 1 month on the GFD can change the result of the biopsy.
Gluten‐Containing Ingredients
to Avoid
• Wheat – Includes all types, such as spelt and kamut
– Includes forms such as wheat germ
• Barley
– Includes forms such as malt
• Rye
Oats
• Eat only oats and oat products labeled gluten free
• Use with the advise from dietitian/physician
• Limit to ½ cup dry oats per day
Frequently Overlooked Foods That May Contain Gluten
•
•
•
•
•
•
•
Broth
Candy
Communion wafers
Imitation bacon
Imitation seafood
Marinades Processed meats
•
•
•
•
•
•
•
Roux
Sauces
Self‐basting turkey
Soup base
Soy sauce
Syrup Thickeners
Questionable Ingredients?
•
•
•
•
•
Flavorings ?
Caramel Color ?
Seasonings and spice blends ?
Dextrin ?
Modified Food Starch ?
FALCPA
In 2006, the Food Allergen Labeling and Consumer Protection Act (FALCPA) requires that companies identify in “plain English” the eight most prevalent food allergens:
egg, fish, milk, peanuts, shell fish, soybean, tree nuts and WHEAT
Example of FALCPA
Including the ingredient list with parentheses • Ingredients: Enriched flour (wheat flour, malt flavoring, niacin, reduced iron, thiamin mononitrate, riboflavin, folic acid), sugar, partially hydrogenated soybean oil, and/or cottonseed oil, high fructose corn syrup, whey (milk), eggs, vanilla, natural and artificial flavoring) salt, leavening (sodium acid pyrophosphate, monocalcium phosphate), lecithin (soy), mono‐and diglycerides (emulsifier)
Or…
Use a “Contains” statement
Ingredients: Enriched flour (wheat flour, malt flavoring, niacin, reduced iron, thiamin mononitrate, riboflavin, folic acid), sugar, partially hydrogenated soybean oil, and/or cottonseed oil, high fructose corn syrup, whey (milk), eggs, vanilla, natural and artificial flavoring) salt, leavening (sodium acid pyrophosphate, monocalcium phosphate), lecithin (soy), mono‐and diglycerides (emulsifier)
Contains Wheat, Milk, Egg, and Soy
Page 39
FALCPA does not include…
1. Barley (malt), Rye or Oat (but not “hidden” ingredients)
2. Cross contamination. If wheat is in a product unintentionally it does not need to be declared
3. Meat products covered by USDA (although 90% of manufactures are voluntarily following the same guidelines as FALCPA)
4. Over the counter or prescription medications (glutenfreedrugs.com) 5. Alcoholic beverages (Distilled beverages are gluten free)
Labeling Law…shopping made easier!
Only 6 basic ingredients you need to look for on the label of food not labeled Gluten Free include:
Wheat
Rye
Barley
Malt
Oats (if not labeled GF)
Brewer’s yeast
Safe List
•
•
•
•
•
•
•
•
•
•
•
•
•
Vinegar (except malt vinegar)
Distilled Alcohol
Carmel color
Citric acid
Spices
MSG
Maltodextrin
Mono and Diglycerides
Artificial flavor and color
Natural flavor and color
HVP or HPP (wheat will be identified if used)
Stamps and envelopes Shampoo, deodorants, lotions (not absorb through the skin)
“May contain wheat” ?
Allergen Advisory Statements
“Manufactured in a plant that contains wheat”
– Voluntary statements manufacturers use in labeling their products that could indicate the “potential” unintended
presence of a food allergen
– Not reliable way to determine whether a food product is contaminated with gluten.
Products with this statement have been tested to less than 5 ppm while other products with no statement test above 20 ppms
Page 44
FDA Proposed GF Labeling Rule
A product may be defined as “Gluten Free” if all of the following conditions are met: 1. Will not contain a prohibited grain, such as wheat, barley, rye, and crosses.
2. Will 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 parts per million or more gluten.
4. The food product contains less than 20 parts per million gluten
What can you eat?
Gluten‐Free Grains
•
•
•
•
•
•
•
•
Brown Rice*
Whole Corn*
Amaranth*
Buckwheat*
Flax*
Quinoa*
Sorghum*
Teff*
•
•
•
•
•
•
Millet*
Montina*
Arrowroot
Potato
Tapioca
Flours made from nuts, beans and seeds*
* High fiber grain/flour
Nutritional Concerns…what about whole grains?
Surveys have found that adults with CD on a GFD consume less than recommended amounts of:
Fiber
Calcium
Iron
Buckwheat
Brown rice
Amaranth
Quinoa
Amaranth
Quinoa
Teff
Quinoa Amaranth Teff
Millet
Folate & B vitamins
Amaranth
Millet
Teff
Quinoa
Naturally GF Foods
• Fruits and Vegetables
– All fresh produce
– Most canned and frozen (without added sauces)
• Dairy (look for low fat)
– Milk
– Cheese
– Yogurt*
– Pudding*
– Cottage cheese
*read labels carefully
Naturally GF Foods
• Protein
– Fresh beef, pork , poultry
• Check labels carefully for additives on processed meat products such as hot dogs
– Eggs
– Peanut butter
– Canned tuna
– Dried beans, lentils, peas
More GF Foods
• Cereals and grains (Look for whole grains)
– Rice
– Corn tortillas
– Chex cereals (exception: wheat/multigrain)
– Quinoa
– Flours made from • Amaranth, buckwheat, millet
• Nuts, beans, tapioca
• Teff, flax, montina
More GF Foods
• Condiments, misc.
–
–
–
–
–
–
–
–
Jams, jellies
Honey
Sugar, spices and herbs
Pickles, olives
Ketchup, most mustards, vinegar (no malt)
Vegetable oils, margarine, butter
Fruit juices
Most chocolate
Look‐ a‐ like foods
• Pasta
– Annie’s GF rice pasta and cheese
• Chicken nuggets
– Bell & Evan
– Ians
• Pizza
– Foods by George
– Whole Foods pizza crust
• Cookies by Kinnikinnick
– Oreos
– Graham cracker
– Animal crackers
Got Questions??
Celiaccenter.org
• Visit our website for – Latest research updates
– Instructional videos on the GFD
– Educational resources
– Walk/vender fairs dates and locations
Thank you!