Lentis/Gluten-Free: Nutritional Principle or Social Value

Gluten is “a substance found in cereal grains that is responsible for the elastic texture of dough”. The two proteins gliadin and glutenin are the main constituents of gluten, which are joined via disulfide bonds in the presence of water to create gluten. The United States government recommends that grains compose about 25% of the daily diet. Many of these grain products contain gluten, with gluten composing up to 75% of the proteins found in most breads. Foods commonly containing gluten include bread, baked goods, cereals, and pastas. However, gluten can also be found in soups, sauces, cosmetics, toothpaste, and prescription drugs, making gluten consumption difficult to avoid. Yet a 2012 survey found that 18% of American adults buy or consume gluten-free products, such as quinoa and tapioca bread. While some Americans avoid gluten to avoid adverse health conditions, such as celiac's disease, others believe that gluten abstinence leads to a healthier diet and lifestyle. This chapter explores the popularity of the gluten-free diet and its effect on American culture.

=Gluten-Free Boom=

Origins of Gluten Insensitivity
Celiac disease has been the main manifestation of gluten insensitivity throughout history, with the Greek physician Aretaeus of Cappadocia credited for creating the first written account of celiac-like symptoms in the first century C.E. The first contemporary documentation of celiac disease occurred during World War II when Dutch pediatrician Willem-Karel Dicke observed that celiac patients experienced relief from their symptoms when starved during a war-induced famine. These patients subsequently relapsed following food resupplied, leading Dicke to investigate the relationship between a gluten diet and celiac symptoms. Since then, dietitians have recommended gluten-free diets to patients experiencing celiac symptoms, even if they are not confirmed to have celiac disease. The gluten-free diet gained mainstream notice in the 1980’s during the green revolution as some consumers began looking for healthy alternatives to commonly available food options.

Recent Trends
Gluten was first vilified in the media in the early 2000’s when several celebrities and gluten-free advocacy groups decried the perceived negative effects of gluten consumption. At that time, around .2% of the United States’ population abstained from gluten consumption. The gluten-free diets was further popularized in the 2010’s, with many restaurants and grocery stores making gluten-free accommodations and products. Today, approximately 2% of nonceliac Americans are gluten free, the largest proportion in recorded history. In response, some food distributors began increasing production of gluten-free foods to meet the growing demand. In 2008, the gluten-free industry was valued at $1.6 billion, and gluten-free products were 242% more expensive than regular products. By 2013, the industry had tripled in value, and gluten-free products were only 162% more expensive than regular products. This gluten-free boom is largely attributed to an increase in demand for gluten-free products, prompting food corporations to increase gluten-free product manufacturing. This increase in demand may be explained by the groups that eat gluten-free.

Celiac Disease
Celiac disease is a gastrointestinal disease that makes it difficult to digest gluten, resulting in irritable bowels, as well as damage to the small intestine. To avoid this stomach pain, celiacs abstain from consuming gluten. The celiac population has increased four-fold in the last 50 years, yet celiacs still represent less than 1% of the US population. Additionally, 1 out of 5 people with celiac are aware of their disorder. Since celiacs that are aware of their diagnosis constitute a small portion of the population, it is unlikely they are the sole cause for the 21st century gluten-free boom.

Gluten Sensitivity
Studies have found that non-celiacs consuming gluten may still experience celiac-like symptoms, with the exception of intestine damage and weight loss. This reaction is called gluten sensitivity. Approximately 18 million Americans have a gluten sensitivity, which is drastically higher than the number who have celiac disease. However, 93% of people who believe they have gluten sensitivity suffer no adverse health effects from gluten consumption, so the number of people eating gluten-free from thinking they have a gluten sensitivity is even higher. It is very difficult to determine who has and does not have a gluten intolerance, as the cause is unknown currently. The leading theories are that it is a result of a faulty intestine or poor gut-health. While it is not the same as gluten sensitivity, Irritable Bowel Syndrome (IBS) is also believed to be influenced by gluten, as gluten is implicated in 25% of people who have IBS.

Lifestyle
While medical conditions force people to eat gluten-free, there are those that voluntarily partake in the diet. Many believe that cutting out gluten can lead to increased energy, better nutrition, and better quality of life. With blogs and social media influencers praising the health benefits of a gluten-free diet, more and more people have tried the diet to experience these same effects.

Pop Culture
In 2010, the gluten-free diet started to gain popularity in mainstream media. One of the first appearances of gluten-free products in mainstream media was the gluten-free cake at Chelsea Clinton's wedding. Isaiah Mustafa, known for his role in Old Spice commercials, touted his gluten-free diet on The Tonight Show with Jay Leno. Miley Cyrus announced her gluten-free diet in 2012 by tweeting, "[E]veryone should try no gluten for a week! The change in your skin, phyisical[sic] and mental health is amazing! U won't go back!" There is even a list of the celebrities that have gone gluten-free. Celebrity backing of the gluten-free diet further increased the diet's publicity and contributed to the increase in demand for gluten-free products.

Beyond simple backing of gluten-free diets, celebrities have also created related products and services that have brought gluten-free diets to the forefront. Gwenyth Paltrow, a proponent of gluten-free diets early on, published her 2015 gluten-free cookbook titled IT'S ALL GOOD: Delicious, Easy Recipes That Will Make You Look Good and Feel Great. This book was credited with "set[ting] off the gluten-free diet explosion." Other celebrities, such as Elisabath Hasselbeck and Jessica Alba, have also published gluten-free recipes. Celebrities Beyonce and Jay-Z have gone as far as launching a gluten-free meal-delivery service in 2015 that was "designed to create healthier eating practices."

The rise of social media has led certain users to gain traction in promotion of gluten-free diets. Influencer Ella Mills has amassed 1.6 million Instagram followers and uses the platform to promote her plant-based food line called Deliciously Ella and her cookbook series titled Deliciously Ella: The Plant-based Cookbook. Similarly, Danielle Walker posts photos of her gluten-free recipes to engage her followers and promote her published Against All Grain series and Eat What You Love: Everyday Comfort Food You Crave. With the continual rise in social media usage and creation of platforms, social influencers like Ella and Danielle will continue to have access to a user audience to advertise their gluten-free experiences.

Celebrity backing and action combined with widespread accessibility to social media has played a major role in the promotion of gluten-free diets as a healthier dieting option. These factors are expected to continue to impact the gluten-free movement and promote diet adoption.

Other Diets
A gluten-free diet can be a stand-alone diet, but it is also commonly combined with other diets. For example, the Keto diet involves the participant almost completely cutting out carbs, a major contributor to gluten intake. A natural next step for people practicing this diet may be to completely cut out gluten and go gluten-free. Veganism and plant-based diets are also common partners with a gluten-free diet. Veganism involves eating no animal products, and plant-based diets do not include any products not derived from plants. Some people adopt these diets for environmental, conversationalist, or health reasons, and these are some of the primary demographics targeted by health media. As a result, many people already adhering to one of these diets could easily be swayed to becoming gluten-free.

Research on Gluten-Free Diet
Due to the increased popularity of gluten-free diets, numerous studies have analyzed their nutritional value. A study from the Federal University of Minas Gerais revealed that excluding gluten from diets can reduce obesity and metabolic disorders. Gluten-heavy foods were found to increase fat tissue production and insulin resistance, resulting in unhealthier animal test subjects. In going gluten free, many people eat more greens and less processed foods, which will lead t health benefits.

Other studies have uncovered conflicting results regarding the health benefits of a gluten-free diet. One study found that 20% of diagnosed celiac disease patients experienced a slight increase in BMI after adhering to a gluten-free diet. Research has shown that gluten-free products have one-third of the protein and twice the saturated fat as their gluten-containing counterparts. This results in the reduction of gut bacteria that is imperative to the immune system. Many gluten-heavy foods also have essential vitamins for humans, so cutting them out of the diet without replacement can lead to adverse health affects.

Based on conflicting work within the field, a direct link remains unestablished between a gluten-free diet and health benefits.

Psychological Analysis
Psychological phenomena may help explain the perceived health benefits of a gluten-free diet.

Nocebo Effect: One psychological phenomenon that helps explain this trend is the nocebo effect. This is essentially the inverse of the placebo effect, where people experience positive outcomes from neutral substances. On the other hand, for the nocebo effect, if a subject is led to believe, prior to undergoing a treatment, that the treatment will harm them, they are more likely to experience this harm. As the the alleged health benefits of a gluten-free diet are published more and more, the adverse effects of gluten consumption were assumed by many to be real. This creates an anti-gluten bias that may lead to phantom indigestion or bowel discomfort from consuming gluten.

Garcia Effect: The Garcia effect, also known as taste aversion, occurs when someone associates a specific food with a negative physical feeling, making that food less desirable. In a gluten example, a person might feel sick after eating an entire pizza and attribute their sickness to the gluten in the pizza, when the excess fat likely caused the sickness. In the future, this person may feel sick when eating pizza, even if they don't eat enough for their body to actually have a reaction. With more anecdotes available about the adverse effects of gluten, taste aversion to gluten-containing products is increasingly likely.

Bandwagon Effect: Another psychological explanation of why people go gluten-free involves the bandwagon effect. The bandwagon effect is when the rate of a trend increases the more people participate in it. Everyone wants to be a part of the crowd, so if someone sees others doing something, that person will want to join. With a significant number of people participating in the gluten-free diet, and it being popularize via social media, more people want to join.

=Effects of the Gluten-Free Diet= While the scientific reasoning for the rise in popularity of gluten-free diets may be unfounded, the effects of this boom have reached many social groups. The gluten-free boom has shifted values of social groups such as consumers and has encouraged the changing of agendas for corporations and food industries to meet consumer demand. Additionally, the gluten-free boom has promoted targeted advertisement of associations' values and actions.

Consumers
Prior to the gluten-free boom, gluten-free products were limited and much more expensive than regular products. As a result, the diet was considered unappealing. As it became popularized and demand increased, prices were driven down. This resulted in both a higher quality and number of gluten-free food options at a reduced price. This is advantageous to all gluten-free consumers.

Corporations
Many companies see the growing gluten-free market as an area of potential investment. Food companies such as Betty Crocker, Pillsbury , and Kellogg recently released gluten-free products. Since the total number of individuals with celiac disease or a gluten intolerance has not significantly changed, this product shift may be accredited to the people eating gluten-free by choice.

Smaller brands that are exclusively gluten-free have also been able to make their way into the market. Udi’s was established in 1994, yet they were more recently able to sell packaged products as a result of popularization of the diet in 2008.

Associations
The trend of gluten-free food consumption negatively affects groups that cannot readily adapt their business plan. This is evident in the wheat, barley, and rye industries. The largest wheat producer in the U.S., Kansas, has responded by releasing a monthly magazine called Rediscover Wheat. .The Kansas Association of Wheat Growers (KAWG) and the Kansas Wheat Commission (KWC) have partnered to advertise the benefits of a wheat diet based on the nutritional value and its historical importance. The KWC has invested $200,000 to create genetically modified wheat that is safe for people with celiac disease.

Other groups such as the Gluten Intolerance Group (GIG) work to regulate the gluten-free industry through education and certification. Along with the Celiac Disease Foundation (CDF), these organizations have increased their educational and promotional efforts of gluten-free habits due to the diet's rise in popularity. With diverse groups going gluten-free, GIG and CDF have needed to change their recommendations for lifestyle and diet choices.

Food Industry
The introduction of gluten-free foods into regular diets has profoundly impacted food industry operations. Some restaurants have introduced gluten-free labels to their menus, modified original recipes, and added entirely new gluten-free options in response to the growth of the gluten-free diet. The addition of gluten-free items to menus influences the ingredients ordered and the preparation steps taken to avoid contamination. This creates additional costs for gluten-free processors and distributors.

Previously seen as an unappealing food choice, gluten-free products are seen in a new light with the help of independent bloggers and cookbook makers. The growing gluten-free community has provided a new niche for recipe makers.

=Conclusions=

Does it Work?
Although the science behind the nutritional value of a gluten-free diet remains unclear, the diet succeeds in many facets. Since gluten-free products are typically more expensive, individuals choosing to adhere to the diet are willing to spend more money on healthier alternatives, such as fruits and vegetables. Choosing to replace certain carb-heavy foods with healthy, gluten-free options can lead to a healthier lifestyle. However, many gluten-free foods are just as unhealthy as gluten-rich options, meaning that eating gluten-free does not lend automatic health benefits. In order for a gluten-free diet to increase overall health, the participant must choose healthy gluten-free options, not just gluten-free options. Because of this, some people adopting gluten-free options may experience health benefits while others may not. Therefore, society may perceive their new diet to be working, even if excluding gluten provided no benefit by itself.

Generalizations
The gluten-free boom has demonstrated the conflict between the opinion of the masses and scientific evidence. Even though gluten-free diets are not necessarily the healthiest, they are oftentimes adopted as a means of "healthy eating." The public's acceptance of gluten free-diets for this purpose demonstrates the power of social influence. Celebrity endorsements, social trends, social media, and industrial growth have collectively contributed to the diet's rise in popularity and the expected global gluten-free market size of $43.65 billion by 2027. These factors in combination with psychological phenomenon such as the snowball effect have perpetuated the diet's popularity.

The impact of other psychological phenomena observed with the gluten-free diet boom may also be generalized across other societal trends. The Thomas Theorem describes public perception of consequences overshadowing scientific evidence, which is a major component of the gluten-free boom. Such phenomena like the snowball effect and Thomas Theorem are seen in Korea surrounding fan death and the worry of drowning by swimming after eating. Similar applications may be applied to 1973 oil shortage, which led to a rumour of a toilet paper shortage due the decline in oil importation. However, even though there was no evidence to support these claims, individuals still stockpiled toilet paper. The interplay between psychological phenomena and scientific evidence remains and will likely continue to persist and evolve future trends such as the gluten-free movement.

Further analysis and generalizations may be made regarding related fields, such as the allergy movement. Comparisons between the gluten-free movement and other social trends may provide insight into the impact of sociotechnical factors in societal adoption of ideas like those evident in the gluten-free boom.

=References=