These days, gluten-free diets have become a popular trend. Although Coeliac Disease rates are not “on the up” (less than 1% of the population has the disease – read our Gluten-Free FAQ – Science Based Nutrition), the number of consumers eating gluten-free foods is continually increasing.  However, what are the long-term effects of this trend?  A recent study has highlighted that long term consumption of gluten is not associated with risk of heart disease. On the other hand, avoiding gluten in the diet could lower wholegrain intake which, in turn, could increase the risk of heart disease.  Researchers concluded that the promotion of gluten-free diets among people who do not have coeliac disease should not be encouraged.

Although many consumers choose gluten-free diets for reasons other than heart health, this study shows that the gluten-free diet may not be the ‘magic bullet’ some proponents make it out to be. Whole grains are part of healthy diet recommendations worldwide. Whole grain versions of gluten-free ancient grains like quinoa, millet, and sorghum are an excellent way to deliver the health benefits of whole grain to those choosing gluten-free diets. By using these types of whole grain ingredients in gluten-free products, food manufacturers can help deliver the health benefits consumers may expect from gluten-free foods.

With 86% of US consumers report experiencing gastrointestinal issues on a regular basis, it should come as no surprise that the digestive health market is booming at a value of over €64 billion and set to grow globally at 4.4% (CAGR 2015-2020) (Euromonitor 2016).

What Digestive Health Benefits Do Consumers Want?

Emerging research is seeing digestive health moving beyond symptoms isolated to the gut, such as bloating, constipation and diarrhoea and start to encompass total health of the body and mind.

Every day, media headlines are linking the gut microbiome to a myriad of benefits for conditions such as anxiety, depression, stress, weight management and obesity, diabetes, auto-immune disorders and allergies. This is what has been coined the ‘Digestive Wellness 2.0’ trend.

There is a budding excitement amongst researchers and consumers alike at the plethora of possibilities that unique microbe strains may bestow.  Prebiotics have long been recognised for their digestive and immune health benefits, as 70% of immune cells reside within the digestive tract.

A recent study highlighting the role of prebiotic Bimuno galactooligosaccharide (B-GOS) in reducing cortisol (sometimes referred to as the ‘stress hormone’) levels in healthy subjects (Shmidt et al., 2015) led prebiotics to be termed the new ‘mood food’.

This game changer in digestive health could see these functional ingredients take centre stage within the evolving ‘mindful’ consumer lifestyle trend, which sees more and more consumers seeking out sophisticated and user-friendly solutions that help manage their mood, de-stress and achieve more mental balance within their hectic and busy lives.

Free From is the Driving Force in Digestive Health

The digestive health market is extremely dynamic and most likely underestimated. The quest for digestive wellness is not only driven by functional ingredients but dually by ingredient avoidance.

The ‘free from’ trend can be tracked back to a central desire for digestive health.  It has been reported that more than 1 in 4 British consumers now regularly buy free from products (lactose, dairy, gluten or grain-free products) with 23% choosing such products to avoid ‘feeling bloated’ (The Grocer UK 2016).

Gluten is often slated as the cause of digestive discomfort and removed from the diet.  One in three (31% of UK and 36% of US) consumers are likely to limit their intake or avoid of gluten despite the fact that only around 1% are diagnosed with Coeliac Disease (Mintel, Gluten-Free Foods Report, October 2016).

In parallel, the launch of dairy alternative products has grown substantially, accounting for 15% of digestive products in the US in 2015, up from 1.4% in 2010, whilst the number of dairy product launches has reduced from 48% to 35% within the same time period (New Nutrition Business 2016).

Fuelled by the growing tendency amongst consumers to self-diagnose themselves with a food allergy or intolerance, the free from trend is now worth over €11 billion globally and is forecast to grow at 5% CAGR from 2015-2020 (Euromonitor 2016).

The Rise of FODMAP Friendly Foods

‘FODMAP friendly’ foods could be the next generation in the lucrative free from market. FODMAPs (Fermentable Oligosaccharides, Disaccharides, Monosaccharide’s and Polyols) are a group of ingredients that may be responsible for digestive discomfort.

They are rapidly fermentable, short chain carbohydrates, which are poorly absorbed within the gastrointestinal tract.  The Low FODMAP Diet was developed by researchers at Monash University, Australia, in an effort to control the gastrointestinal symptoms associated with Irritable Bowel Syndrome (IBS).

There are many high FODMAP foods, from milk and ice cream (lactose), to apples and pears (free fructose), to wheat, onions and garlic (fructans), to legumes (galacto-oligosaccharides), and prunes, bell peppers and sugar-free gums (polyols).

Although this diet is aimed at people suffering from IBS, it’s likely that as awareness of the diet expands, coupled with the growing tendency to self-diagnose, other consumers seeking digestive wellness may be drawn to ‘FODMAP friendly’ claims.

The ‘FODMAP friendly’ logo, developed by the Australian-based FODMAP Friendly certification programme,  is the only government approved accreditation that tests products to determine if they are eligible to display the logo.

Opportunities for food manufacturers who wish to develop new products in this space include optimising processing capabilities to reduce FODMAP levels in food and beverages (e.g. milling process, baking process, wheat type and duration of fermentation) and fortifying low FODMAP friendly foods with nutrients that are restricted with this diet e.g. calcium.

The Horizon of the Digestive Health Product Market

New products are quickly emerging in this growing market. Within food and beverages, prebiotics and functional fibres are the leading digestive health ingredients and dairy is the largest category for products touting digestive health benefits, accounting for 22% of new food and beverage launches globally carrying a digestive health claim from 2011-2016 (Mintel, Emerging Science Global Annual Review, 2016).

Emerging digestive health ingredients include fruit enzymes such as kiwi enzymes as well as proteolytic enzymes, which are primed to grow in popularity with the trend towards ‘high protein’, as these enzymes are thought to help digest protein.

Next generation ‘Plusbiotics’ claim to support the regrowth of intestinal mucosa (the innermost layer of the gastrointestinal tract) by repairing damage and strengthening the intestinal lining.

Innovative ingredients with a natural positioning will win consumer appeal within food and beverage products aimed at the digestive health market.

Digestive Wellness 2.0 is undoubtedly an exciting platform that connects with personalisation, holistic health and consumer desire for food-based contributors to positive mental health.

As the science unravels, food and beverage manufacturers can lead in innovation in delivering these much anticipated health benefits to consumers.

Gluten can be a serious concern for some consumers, while others pursue gluten-free for alternative reasons.

Here is an FAQ to help navigate this landscape but this FAQ is not intended to diagnose, treat, cure, or prevent any disease.

What is Gluten?

In general, the term “gluten” refers to specific proteins found naturally in grains (1).

These are tenacious elastic proteins that are important for the texture of foods like bread, condiments, beverages and soups.

Where is Gluten Found?

Grains like wheat, rye, barley and their varieties (e.g. spelt, farro, bulgur) contain the proteins that make up gluten (2).

What Grains are Gluten-Free?

Gluten-free grains include corn, oats, quinoa, rice, sorghum, millet, buckwheat, amaranth and teff.

It is important to note that although these grains are inherently free of gluten, they are sometimes processed in facilities which also process gluten containing foods which can lead to contamination (see below).

Why Do People Eat Diets That Are Gluten-Free?

Individuals with diagnosed challenges to gluten must totally avoid these proteins.

Other individuals feel better on a low gluten or no-gluten diet and still other individuals may avoid gluten for the perceived benefits, like weight loss or skin health (these benefits are unproven in people without gluten challenge).

What is Gluten Challenge?

Gluten challenge refers to two conditions: Coeliac Disease and Gluten Sensitivity.

In general, both Coeliac Disease and Gluten Sensitivity can be defined as conditions where consumption of gluten-containing foods results in intestinal and extra-intestinal damage by the immune system (3, 4).

In some people, the proteins in gluten are highly antigenic, especially gluten’s sub-component gliadin, meaning they can activate the immune system.

This results in inflammation of the intestines and which can decrease nutrient absorption, promote diarrhoea and cause general weakness and weight loss, depending on the severity of the response (5).

However, Coeliac Disease and Gluten Sensitivity have substantial differences.

Coeliac Disease is an autoimmune condition that damages the lining of the small intestine and prevents it from absorbing parts of food that are important for staying healthy (3).

Gluten Sensitivity is a non-allergic and non-autoimmune condition with one or more of a variety of intestinal manifestations similar to those seen in coeliac disease, as well as extra-intestinal symptoms not seen in Coeliac Disease (4).

What are the Symptoms of Coeliac Disease and Gluten Sensitivity?

In Coeliac Disease, gastrointestinal symptoms are often characterised by abdominal pain, bloating, gas, indigestion, constipation, decreased appetite, diarrhoea, lactose intolerance, nausea and vomiting, abnormal stools (float, smell foul, bloody, or white) and unexplained weight loss (7).

In contrast, Gluten Sensitivity’s gastrointestinal symptoms are limited to abdominal pain, bloating, gas, indigestion, diarrhoea and lactose intolerance (common when the person is diagnosed, usually goes away after treatment) (8).

Both Coeliac Disease and Gluten Sensitivity have extra-intestinal issues.

However, in Gluten Sensitivity these extra-intestinal issues are more prevalent and include head aches and migraines, difficulty concentrating, fatigue, muscle cramps and joint pain (8).

It should be noted that in Coeliac Disease, most of the symptoms outside of the intestines are secondary to vitamin and mineral malabsorption resulting from destruction of the intestinal villi (3, 4).

Gluten Challenge at-a-glance

What are the Nutritional Concerns for Individuals with a Gluten Challenge?

In 20-38% of those suffering from Coeliac Disease, intestinal damage can lead to malabsorption of macronutrients (carbohydrates, protein and fat) and micronutrients (vitamin and minerals).

At initial diagnosis, most Coeliac sufferers need nutritional intervention including extra calories/protein, fibre, iron, calcium, magnesium, vitamin D, zinc, folate, niacin, B12 and riboflavin.

In Gluten Sensitivity, absence of extensive intestinal damage makes vitamin and mineral malabsorption less likely (3).

However, gluten-free diets are typically lower in dietary fibre, folate, niacin and B12.  Individuals eating a gluten-free diet long-term will want to take extra care to ensure they are meeting their needs of these essential nutrients (3).

What does Gluten-Free Mean?

Gluten-free is defined by the FDA as a food which is either inherently gluten-free or does not contain an ingredient that is:

• a gluten-containing grain (e.g., spelt wheat, rye),
• derived from a gluten-containing grain that has not been processed to remove gluten (e.g., wheat flour),
• derived from a gluten-containing grain that has been processed to remove gluten (e.g., wheat starch),

if the use of that ingredient results in the presence of 20 parts per million (ppm) or more gluten in the food.

Also, any unavoidable presence of gluten in the food must be less than 20 ppm (2).

Why didn’t FDA adopt zero ppm gluten rather than less than 20 ppm gluten as one of the criteria for a food labelled gluten-free?

Most coeliac disease researchers and epidemiological evidence suggest that most individuals with coeliac disease can tolerate trace amounts of gluten in foods less than 20 ppm gluten without suffering from adverse health effects (9).

In addition, analytical methods that are scientifically validated to reliably detect gluten at a level lower than 20 ppm are not currently available (2).

How do Manufacturers Test for Gluten in Their Products?

Testing for gluten refers to the presence or absence of the proteins that make up gluten in the food we consume.

Manufacturers who elect to analyse their foods for gluten can select the test methods most appropriate for them, considering the type of foods they manufacture.

Manufacturers are not obligated to use any one specific method to check for gluten in their foods.

The FDA recommends the use of scientifically valid methods in order for the gluten test results obtained to be reliable and consistent.

It is of note that many test kits detect gliadin, which is a component of gluten, so manufacturers must be aware that the measurement must be adjusted to represent gluten (e.g. 6ppm gliadin represents 12ppm gluten).

Can Gluten-Free Foods Become Contaminated by Gluten or Wheat?

Yes.  Although whole-grains or seeds like oats, amaranth, buckwheat and quinoa are generally viewed as gluten-free, they may be processed in facilities that also process wheat, leading to recommendations to avoid such foods (10).

This is most common with oats.  In addition to being in the whole grain/seed, gluten peptides can be found in processed foods even where the majority of protein has been removed (starch, for example).

The levels of gluten peptides in these products, when consumed as food (gram quantities), may not be sufficiently low to be safe for gluten challenged individuals to consume.

This makes labelling a challenge for food and supplement companies and creates frustration for individuals and companies alike.  In these cases it is most important to identify these grains with labels indicating that have been tested to be gluten-free.

If someone does have a gluten challenge, it is important for them to pay attention to the foods they are eating, even if the package claims the product is gluten-free, due to the possibility of contamination.

Some Individuals are Avoiding Gluten But Still Have Symptoms. What is Wrong?

Individuals may be eating food that contains hidden gluten or that is contaminated with gluten.

Although the FDA published the definition of gluten-free in August of 2013, it did not take effect until August 5, 2014.

Companies may want to suggest that consumers choose only trusted brands of food and supplements that use rigorous and validated testing protocols to verify the “gluten-free” label claim.

Also, consumers should be aware that FDA does allow statements on labels like, “made with no gluten-containing ingredients” and “not made with gluten-containing ingredients.”

However, the FDA cautions that unless the phrase “gluten-free” also appears on the label, “…consumers should not assume that the food meets all FDA requirements for the use of the “gluten-free” claim.” (2)

Does Eating a Gluten-Free Diet Have Any Side Effects?

Gluten-free diets are typically lower in dietary fibre, folate, niacin and B12.

Individuals eating a gluten-free diet long-term will want to take extra care to ensure they are meeting their needs of these essential nutrients (3).

Providing these nutrients in gluten-free products is an opportunity for companies producing these products to help consumers eating a gluten-free diet meet their nutrient needs.