How Did "Gluten-Free" Food Catch On in America? | Who Decides What You Eat, Part 1

Call them followers of a fad if you like — but underneath is real anxiety about food and real panic about health.

"Eating not for pleasure but for health unquestionably stems from a basic American trait: the fear of getting sick. People are so eager to believe that some particular way of eating will hand them a cheerful, energetic life."

That passage ran in Fortune in May 1936. It describes the changes now under way in how Americans eat just as well.

Labels that stand for health — green, organic, local, natural — are what the American middle class now chases. So the food giants strip out additives, cut sugar, rework recipes and switch to cage-free eggs to settle those worries, while small companies nobody had heard of suddenly take off simply because they happen to fit the new habits.

And when a food is also credited with a medically meaningful "benefit" — usually with scientists and nutritionists behind it — it spreads faster than you would think possible. Right now the best example is the gluten-free wave.

The irony is that most people end up devoted to a food for one reason only: they believe it will make them feel better.

Food companies have a phrase for this: food that is "better for you." It usually means fatter margins, and most of the time it does not even cost much to make.

Plenty of worries that look like a reaction against industrial food end up being dispelled by industrial packaging and marketing.

Whenever a food catches on, a crowd of interests is at work behind it — scientific, professional, commercial, political, even charitable, the government included, in the form of the FDA.

Sometimes these voices agree. More often their interests differ and they argue. And in the arguing they get tangled up with environmentalism, naturalism, vegetarianism, animal welfare and every other "-ism," until what comes out the other end may be something you believe about food. Companies can profit from that, or be carried away by it.

Either way, the result seems always to be a fashion — a fashion in what to eat, or in what not to eat.

You think you chose what to eat. You didn't.

All three pieces in the series "Who Decides What You Eat" look at these questions. Why look at American eating habits? First, the food industry there is the most developed in the world and has already been through several full cycles. Second, what is happening in the American market may be the start of a broader trend, and there may be something in it for China.

Rice Chex gluten-free cereal, Redbridge gluten-free beer, Glutino gluten-free crackers, KIND gluten-free energy bars, Clara gluten-free water…

Walk into a Walmart, or an organic supermarket like Whole Foods, and food labeled "gluten free" is on shelves everywhere. Search "gluten free" on Amazon.com and you get 92,791 products across every food category — and by the time you finish reading this, the number may have gone up again.

A Gallup survey last year found that 21% of Americans put gluten-free food in their diet. Among people aged 18 to 49 the share is higher still: one in four.

According to a report from the consultancy Mintel, sales of gluten-free products in the U.S. grew 136% between 2013 and 2015, reaching an estimated $11.6 billion by the end of 2015. Their share of total food sales rose too, from 2.8% in 2013 to 6.5% in 2015.

It is not only packaged food. The gluten-free wave is sweeping restaurant tables as well: in the second quarter of 2015, American restaurant menus carried 9% more gluten-free dishes than in the same quarter of 2012.

"Gluten-free" has become a fashionable diet label, but what many people don't know is that it began as the mark of a rare disease. In a piece by the American writer Keith O'Brien, he describes being diagnosed with celiac disease in 1999, when few doctors even knew the illness, let alone anything about gluten-free food. The textbooks then put the incidence at one in ten thousand, so the disease drew little attention in the U.S. O'Brien says he could occasionally find food without gluten, but it tasted awful — "like eating a cardboard box."

Gluten is the most common protein in grains such as barley, wheat, oats and rye — what bakers call wheat gluten. Celiac disease is an autoimmune illness set off by gluten: eat it and the small intestine is damaged. Since there is no effective treatment for now, patients have to give up every food that contains it. Besides people with celiac disease, there are also people who are allergic to gluten.

The latest figures: 1% of Americans have celiac disease and 6% are allergic to gluten. Yet as you can see, the share of Americans eating gluten-free food has already reached one in five.

The market research firm Hartman Group interviewed 1,728 American consumers in 2014 and asked why they bought gluten-free products. Thirty-five percent answered "no reason" — the most popular reply of all.

So what happened here?

Call them followers of a fad if you like — but underneath is real anxiety about food and real panic about health.

What first turned American attention to gluten was a report in 2003. Dr. Alessio Fasano, who founded the University of Maryland Center for Celiac Research, did not believe the textbook line that only one American in ten thousand had celiac disease. He gathered more than 13,000 samples from 32 states, and found in the end that one American in every 133 had it.

"Believe it or not, in America celiac disease became a public health issue starting in 2003," Dr. Fasano wrote in his report. It was like opening Pandora's box: studies and experiments on the health threat posed by gluten multiplied from then on.

Professor Joseph A. Murray of the Mayo Clinic examined samples taken from nine thousand U.S. Air Force recruits between 1948 and 1954 and was startled to find their rate of celiac disease was only about a fifth of the rate among Americans today — in other words, the incidence has more than quadrupled in sixty years. Before anyone had worked out the cause, diet was the first suspect named.

In 2011, Professor Peter Gibson of Monash University in Australia recruited 34 people for a double-blind experiment. Gibson had half of them eat gluten-free food and the other half eat muffins and bread containing gluten. When it was over, the gluten-free half said their stomach trouble had largely eased.

Gibson published the finding in the American Journal of Gastroenterology. Suddenly a great many people believed that the stomach trouble they got now and then, for no reason they could name, might be the fault of the gluten they ate every day.

The cardiologist William Davis simply called gluten a poison, and argued that whatever the illness — arthritis, schizophrenia — the cause was the gluten on people's tables. "The wheat we eat today is a product of genetic research… In any case, you and I can no longer eat the wheat of fifty years ago, never mind a hundred years ago, a thousand, or several thousand."

Almost nobody questioned how absurd this was. Medical experts and the press went on announcing the threat gluten posed to health, even though Professor Joseph A. Murray said: "Wheat today isn't much different from wheat fifty years ago. Chemically, at least, the composition has hardly changed."

Another book, published in 2013, reads like a summing-up of all of it: Grain Brain: The Surprising Truth About Wheat, Carbs, and Sugar—Your Brain's Silent Killers. Its author, Dr. David Perlmutter, called gluten "one of the most serious and least appreciated threats facing humanity".

It was the No. 1 New York Times bestseller of 2013, and it is still on Amazon's bestseller list. Yes — America's No. 1 health book.

Google searches for "gluten-free" kept climbing too. And some of the credit for pushing gluten-free all the way into the mainstream belongs to celebrities and athletes.

The great tennis player Novak Djokovic found in 2011 that he was allergic to gluten, changed his diet over the following months, and in that stretch went 64-2. Reporters crowded around him to ask about his eating, certain that the gluten-free menu was the secret of his success.

Around 2012, Victoria Beckham said she kept her figure by following an extremely strict gluten-free diet. Gwyneth Paltrow and Miley Cyrus were fans too.

And so gluten-free was tied first to health, then to energy and losing weight — and you know what health, energy and losing weight do to the middle class. That is enough to make a fashion.

Then the small companies nobody had heard of shot up all at once. Amy's Kitchen, Glutino, Enjoy Life, Bob's Red Mill, Udi's and other sellers of gluten-free products saw business grow fast. Glutino and Udi's were bought by the organic food company Boulder Brands in 2011 and 2012, for $66.3 million and $125 million, and sales of the two brands grew 50% in 2013.

The big food companies soon caught the scent and saw a market worth having.

Anheuser-Busch (later merged with InBev into Anheuser-Busch InBev) moved fastest, launching the gluten-free beer Redbridge as early as 2006 — the first gluten-free beer sold across the whole country. In 2008 General Mills put out a gluten-free version of its Rice Chex cereal; in 2011 Kellogg's did the same with Rice Krispies; and in 2014 Tyson Foods, the biggest meat producer in the U.S., launched gluten-free chicken nuggets, luncheon meat and bacon.

Liz Mascolo, the marketing manager for Rice Chex, called gluten-free cereal a "huge opportunity." In the past, shoppers knew without reading the label that cereal contained gluten, so they never went down the cereal aisle at all. With the new product, General Mills picked up a fresh pool of customers overnight. In the first quarter of fiscal 2012 alone, Rice Chex sales rose 29%.

Anything with a gluten-free label seemed to sell by magic — so much so that besides food there is now gluten-free dog food and gluten-free skin toner.

The other reason gluten-free food caught on is that producers fixed the taste.

When General Mills first took up gluten-free food, Dom Alcocer, then its marketing manager, regularly called a meeting known as the Gluten-Free Advisory Board, where he talked with employees and contractors who had gone gluten-free for one reason or another.

At one meeting someone said the gluten-free version of Progresso cream of mushroom soup was not like the original — it didn't thicken a stew properly — and asked whether it could be improved. Then he asked Alcocer: "Is that even possible?" Alcocer's answer: "Anything is possible."

As a rule, when a big company rewrites a recipe to meet a new demand, it makes sure the new product keeps what was good about the old one. If gluten-free products still tasted like cardboard, as they did in the 1990s, far fewer people would be eating them.

This fast-swelling market soon drew the attention of the U.S. Food and Drug Administration. In August 2013 the FDA issued a rule: producers may decide for themselves whether to put a "gluten-free" label on a product, but once they do, it must meet the agency's requirement of less than 0.002% gluten. The rule covers every packaged food and drink the FDA regulates; the agency says that even people with celiac disease can tolerate gluten at that level. It took effect in August 2014.

In fact, a study in Australia at the end of 2015 found that a gluten-free diet had no clear positive or negative effect on athletes. And anyone who doesn't actually need the diet might have second thoughts after comparing the ingredient labels on the gluten and gluten-free versions of the same product. Shelley Case, a member of the Celiac Disease Foundation's medical advisory board, said: "Many gluten-free packaged foods are higher in carbohydrate, sugar, fat and calories than the regular versions, and lower in fiber, vitamins and iron. Gluten-free doesn't mean nutritious."

A gluten-free diet may even cause other trouble. Research has shown that people on gluten-free diets have a higher rate of metabolic syndrome — a condition that can lead to diabetes and to heart and cerebrovascular disease — possibly because gluten substitutes are less nutritious.

Food companies do not much mind any of this. Gluten-free food costs a good deal more. Willard Bishop, a retail consultant, says food companies tend to price this kind of "better for you" food at double the ordinary version, which makes the margins far better than on traditional products. Naturally they would like the fashion to last a while longer.

Look back at the history of American eating and you find that crazes like the gluten-free wave have come round many times. In Fear of Food: A History of Why We Worry about What We Eat, published in 2012, Harvey Levenstein describes how the American middle class went wild for vitamins; how milk went from a miracle food standing for health and vitality to a health killer once it was linked to heart disease; and how, amid the panic about fat, the big companies developed skim milk, the product that fit the new fashion perfectly.

It always starts with a scientist or a doctor regarded as an authority stepping forward to say that some food causes, or cures, some disease. More nutritionists then endorse it, sometimes all at once, and then the press and the marketing departments of big companies turn it into something the whole country is talking about. Argument and dispute run alongside the whole way, and still people tend to eat for the sake of health.

As one of America's leading authorities on celiac disease, Peter H. R. Green sees more and more people developing orthorexia nervosa — an obsession with eating "perfectly," carried to the point of fixation: "First they drop gluten. Then corn. Then soy. Then tomatoes. Then milk. After a while there's nothing left for them to eat, and then they change what they believe about food."

That's right — we'll take up that question in the next piece.

Cover image: icmedicine, huffingtonpost, Wikimedia Commons