ATLANTA -- It sounds like an unfolding epidemic: A decade ago, virtually no one in the U.S. seemed to have a problem eating gluten in bread and other foods. Now, millions do.
Gluten-free products are flying off grocery shelves, and restaurants are boasting of meals with no gluten. Celebrities on TV talk shows chat about the digestive discomfort they blame on the wheat protein they now shun. Some churches even offer gluten-free Communion wafers.
"I don't know whether there's more people getting this or that more people are noticing" they have a problem, said the Rev. Richard Allen, pastor at Mamaroneck United Methodist Church in Westchester County.
Or is it just another food fad?
Faddishness is a part of it. Americans will spend an estimated $7 billion this year on foods labeled gluten-free, according to the market research firm Mintel. But estimates are that more than half the consumers buying these products -- perhaps way more than half -- don't have any clear-cut reaction to gluten. They buy gluten-free because they think it will help them lose weight, or because they seem to feel better, or because they mistakenly believe they are sensitive to gluten.
In the most serious cases, gluten triggers celiac disease. The condition causes abdominal pain, bloating and intermittent diarrhea. Those with the ailment don't absorb nutrients well and can suffer weight loss, fatigue, rashes and other problems.
It was once considered extremely rare in the U.S. But about 20 years ago, a few scientists began exploring why celiac disease was less common here than in Europe and other countries. They concluded that it wasn't less common here; it was just underdiagnosed. Indeed, research confirms estimates that about 1 percent of U.S. adults have it today, making it four times more common now than it was 50 years ago, the Mayo Clinic's Dr. Joseph Murray and colleagues reported Tuesdayin the American Journal of Gastroenterology. That translates to nearly 2 million Americans with celiac disease.
Celiac disease is diagnosed with blood testing, genetic testing, or biopsies of the small intestine. The case for gluten sensitivity was bolstered last year by a very small but often-cited Australian study. Volunteers who had symptoms were put on a gluten-free diet or a regular diet for six weeks, and they weren't told which one. Those who didn't eat gluten had fewer problems with bloating, tiredness and irregular bowel movements.
Clearly, "there are patients who are gluten-sensitive," said Dr. Sheila Crowe, a San Diego-based physician on the board of the American Gastroenterological Association. What is hotly debated is how many people have the problem, she added. It's impossible to know "because the definition is nebulous," she said.