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ASU experts put gluten-free diets under the microscope

November 29, 2017

Three ASU professors examine the reasons behind the gluten-free craze

Walk into the local grocery store and you’re likely to find an array of products with the words “gluten-free” splashed across the label. Everything from cereal to frozen pizza to pasta — even water — is getting the gluten-free treatment. Restaurants offering gluten-free menu items are plentiful, as are food-delivery services catering to the diet.

The demand for gluten-free food is greater than ever before, and growing. In 2006, U.S. sales of gluten-free foods were less than $1 billion. Ten years later, gluten-free retail sales were projected to surpass $15 billion.

And yet, in the United States, only 4 percent of the population needs to avoid eating gluten for health reasons. They are either part of the approximately 1 percent diagnosed with the autoimmune disorder celiac disease, or part of the 3 percent who experience a gluten or wheat sensitivity, largely undiagnosed.

For the remaining 96 percent of the population, eliminating gluten from their diet offers no known health benefits. This is according to various health experts interviewed for this story in addition to the larger community of health professionals. Despite that, 30 percent of Americans said they were cutting down or avoiding gluten altogether, according to a 2013 survey by NPD Group.

While the general perception is that a gluten-free diet is good for your health, recent research has shown that it may not actually be. Gluten-free diets have been associated with deficiencies in iron, calcium and fiberNiewinski, M.M. (2008). "Advances in Celiac Disease and Gluten-Free Diet." Journal of the American Dietetic Association, 108(4), 661-672., as well as adverse effects on gut healthGaesser, G., & Angadi, S. (2012). "Gluten-Free Diet: Imprudent Dietary Advice for the General Population?" Journal of the Academy of Nutrition and Dietetics, 112(9), 1330-1333. for those without celiac disease or gluten sensitivity. Why, then, are so many people jumping on the bandwagon?

In an effort to understand the gluten-free phenomenon, ASU Now spoke with three Arizona State University professors who have studied the diet. They offer their observations on the nutritional value of going gluten-free, the food industry’s reaction to the craze and the psychology behind why so many people have adopted the diet.

The science of gluten

Dr.
Carol Johnston

Gluten is a protein found in grains such as wheat, rye and barley. For the majority of the population, gluten consumption is fairly benign. But celiac disease and gluten sensitivity can be debilitating illnesses, and those diagnosed can treat them only by strictly adhering to a gluten-free diet.

For the general population, however, going gluten-free amounts to very little.

“There is no clear evidence that avoiding gluten offers any health benefits for the majority of the population,” said Carol Johnston, professor and associate director of the nutrition program in the ASU College of Health Solutions. In fact, Johnston noted, eliminating gluten could lead to unintended health consequences for those without a gluten sensitivity.

Johnston recently studiedJohnston, C., Snyder, D., & Smith, C. (2017). "Commercially available gluten-free pastas elevate postprandial glycemia in comparison to conventional wheat pasta in healthy adults: a double-blind randomized crossover trial." Food & Function, 8(9), 3139-3144. how blood-sugar levels in healthy adults are affected by eating various gluten-free products as compared with their gluten-full alternatives. She found that adults who consumed gluten-free corn and rice pasta experienced a significant post-meal spike in blood sugar not seen in adults who ate traditional wheat pasta.

Yet when the test was replicated using gluten-free and gluten-full granola bars, the results were reversed: the gluten-free foods produced lower glucose levels.

“There are many versions of gluten-free products, and we need to better understand which substitute ingredients contribute to elevated glucose levels,” Johnston said.

Follow the money

Lauren Chenarides

Twenty years ago, the options for buying gluten-free food were limited to select small, natural food stores. As the demand for gluten-free products grew over time, large retailers took notice and began stocking their shelves with more gluten-free offerings. Today countless grocery stores, both large and small, are catering to consumers hungry for gluten-free options.

Lauren Chenarides, assistant professor in the Morrison School of Agribusiness in the W. P. Carey School of Business, analyzes trends in food retailer competition, market concentration and marketing strategies. She said the money-making potential of gluten-free products is too great for food suppliers to ignore.

“They don’t want to miss out on the market,” she said, which is projected to continue its upward trajectory both in the United States and internationally. Gluten-free products often come with a higher price tag, but for those with celiac disease or gluten sensitivity, “if that’s all they can eat, they won’t be as price sensitive,” said Chenarides.

To understand what differentiates this diet trend from others, Chenarides looks to where it all began.

“It’s one of the only diet trends that started from a diagnosis,” she said. The association of a gluten-free diet as treatment prescribed by a doctor may give it more credence than other diets, she said.

Chenarides also points to the power of celebrity endorsement in sparking the gluten-free trend. Personalities including Gwyneth Paltrow, Miley Cyrus and Kourtney Kardashian, to name a few, have publicly espoused a gluten-free diet. In 2015, Beyoncé and Jay-Z launched an entirely gluten-free meal-delivery service inspired by their personal experiences.

“We hear from a celebrity that something is good or bad, and that shifts demand,” Chenarides said. “If a supplier doesn’t meet that demand, they have the potential to lose profits.”

While small-scale natural grocers continue to offer gluten-free products, it is larger, more established businesses that are seeing the biggest profits, she said. They are capitalizing on their advanced distribution networks, relationships with wholesalers and existing infrastructure to offer gluten-free products at a lower cost. This gives them an advantage in meeting the growing demand.

And as more people adopt a gluten-free diet for its perceived health benefits, retailers are responding with less-expensive, more-nutritious and better-tasting options that will support the market’s continued growth.

Jumping on the gluten-free bandwagon

Glenn Gaesser

Ask someone without celiac disease or gluten sensitivity why they’ve gone gluten-free, and you’ll likely get one of three answers, said Glenn Gaesser, professor in the School of Nutrition and Health Promotion in the College of Health Solutions: “They either want to improve their digestive health, eat healthier or lose weight.”

Unfortunately, said Gaesser, “there is no evidence to support that going gluten-free does any of this.”

He attributes the rise in popularity of the diet to a series of key celebrity endorsements, including Elisabeth Hasselbeck, Victoria Beckham, Lady Gaga and Russell Crowe, and to the rise in popularity of anti-gluten books like "Grain Brain" by David Perlmutter and "Wheat Belly" by William Davis.

“Once people started talking, it spread rapidly through word-of-mouth,” Gaesser said.

As for the future of the gluten-free diet trend, Gaesser doesn’t expect it to last, despite the market’s growth. If people are purchasing gluten-free products for their perceived weight-loss or health benefits, they may find themselves disappointed, he said.

As he sees it, the gluten-free diet is simply the latest in a long line of diet trends marketed to people searching for a quick fix.

“In the long term, they won’t get the desired results, and they will stop buying gluten-free products because they are more expensive and they don’t taste as good as the original product they are replacing,” Gaesser said.

Certainly, there are people without celiac disease or gluten sensitivity who say going gluten-free has made them feel better. Gaesser explains that this is likely due to the elimination of another molecule often found in gluten-full foods: FODMAPs. These fermentable carbohydrates are poorly absorbed in the small intestine and have been associated with digestive symptoms like gas, bloating, constipation and stomach pain. While it may appear that the elimination of gluten has caused a person to feel better, it may have actually been FODMAPs that made the difference.

“Americans are always looking for ways to feel better, to look better,” Gaesser said. “The whole beauty business for women is based on the premise that women are too fat, too ugly, have lousy skin, hair, whatever.”

Glowing skin, improved mood, elevated energy levels and weight loss are just a few of the benefits touted by gluten-free enthusiasts. And for those suffering from a gluten allergy or sensitivity, the outcomes promised may be right on the mark.

But for everyone else, said Gaesser, the explanation for why they might feel better going gluten-free is similar to any other nutritional strategy that has been hawked.

“If you tell someone that this is the problem and if you get rid of it you’ll feel better, they likely will feel better,” he said.

In short, the gluten-free diet’s global rise in popularity is due to influential endorsements, clever marketing and wishful thinking, rather than scientific backing.

“It’s the placebo effect,” Gaesser said. “But no one likes to hear that.” 

 

Top photo courtesy of Pixabay.com

Katherine Reedy

Media Relations Officer , Media Relations & Strategic Communications

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ASU alum bolsters Native American health research in nation's capital

November 29, 2017

Native Americans have distinct health-care needs.

And now they have a new leader in health research who aspires to usher tribal nations across the country into a new era of medical discovery, treatment and support.

David R. Wilson, an Arizona State University doctoral graduate and a Native American, is the first director of the Tribal Health Research Office at the National Institutes of Health in Bethesda, Maryland, which was established in 2015.

In addition to overseeing a current research budget of $130 million and several hundred health initiatives for Native Americans, one of his first collaborative efforts is helping to support an ambitious national health initiative designed to develop more tailored prevention strategies and treatments based on individual differences in lifestyle, environment, and biology.

“It’s precision medicine and precise treatments for individuals across America,” Wilson said, who is referring to the All of Us Research Program, the largest medical research program on precision medicine.

The historic effort’s goal is to gather data over many years from 1 million people in the United States with the ultimate goal of accelerating research and improving health.

Under Wilson's guidance, his office is working with the All of Us Research Program to increase their efficacy when conducting outreach to tribal communities nationwide.

Wilson said getting tribal communities to engage in an initiative like this takes a nuanced and sensitive approach. As a member of the Navajo Nation, he is acutely aware of historical issues involving research and tribal communities.

“We have to be cognizant that when we do this type of work, we recognize the different cultures, traditions and governments of individual tribal nations,” Wilson said. “We also have to be able to incorporate their ways, their thinking into this approach and provide to them the benefits of high-level research.”

Two men at table
David R. Wilson (right) introduces the Tribal Health Research Office to Navajo Nation President Russell Begaye in Window Rock, Arizona, in June. Photo courtesy of the National Institutes of Health

Wilson says he has always been curious by nature, growing up in Manuelito, New Mexico, near the Four Corners region.

“The thing about growing up in a remote area is that you can’t always buy something new when something breaks down, so we were always encouraged to fix things,” Wilson said. “I’d pull something apart to see how it worked and then put it back together again. I’ve learned that I like many others learns best by hands-on experience.”

Working under his father, who was a master mechanic, Wilson fixed brakes and transmissions when he was a teen working for a car dealership in nearby Gallup, New Mexico, where he applied that same philosophy.

He originally started his academic career as an engineer. He said he struggled financially, academically and personally.

“A lot of Native American students have trouble identifying who they are because they’re usually the only indigenous people in those programs,” Wilson said. “It’s only natural to ask, ‘Am I in the right place? Do I deserve to be here? Am I an imposter?’ ”

He says that feeling never wore off, but he was able to better understand what he was feeling through emerging research in the area of STEM and diversity. At the end of a long and grueling sophomore year, Wilson signed up for an internship opportunity at the Rocky Mountain Biological Laboratory in Gothic, Colorado. There Wilson studied the Colorado Silvery Blue Butterfly and why their eggs are laid singly on flower buds and young leaves of the host plants. 

“The experience of chasing butterflies for eight weeks was like the flick of a switch,” he said. “After that, I knew exactly what I wanted to do for the rest of my life.”

Wilson graduated in May 2007 with a doctoral degree in molecular and cellular biology from ASU, drawing parallels to “a unicorn” by one faculty member.

“Dr. David Wilson is a Native man, with a PhD in a heavy-duty science field, leading a national organization to create positive health futures for Native communities, and leading by example,” said Bryan McKinley Jones Brayboy, President’s Professor, director of the Center for Indian Education and ASU’s special adviser to the president on American Indian Affairs. “In many ways, he’s a unicorn — a mythical creature of unparalleled wisdom. ASU should be very proud to have played a role in his intellectual and professional development. He’s doing amazing work in an important arena. That he remains humble and grounded makes him even more special.”

Despite the accolades, Wilson said his academic experience wasn’t without its challenges. He said the new concepts of things you couldn’t see with the naked eye were often hard to grasp, the workload was heavy and the constructive criticism was emotionally rough.

“It’s hard to receive constructive criticism when you’re young and developing, and you don’t understand the overall goal of its purpose,” Wilson said. “Through time and experience, you begin to understand your instructors and mentors are trying to help you become a better writer, scientist and problem solver.”

One of the instructors who continually challenged Wilson was his doctoral mentor, Yung Chang, a professor and immunologist in ASU’s School of Life Sciences. Wilson credits her with preparing him for the rigors of a career in research.

“David was a very special student in that he quickly assumed a leadership role in the lab, a very hands-on learner,” Chang said. “He was persistent and goal-oriented and had aspirations to do big things. He was a dreamer, but he never gave up. He was a great problem solver.”

Since then he has been solving problems on behalf of Native American health: as a senior research scientist at the National Institute of Aging in Baltimore, Maryland; as a public health adviser in the Office of Minority Health at the Department of Health and Human Services; as a legislative analyst in the office of the director at the Indian Health Service; as an adjunct professor at the Johns Hopkins School of Public Health’s Center for American Indian Health; and in January 2017, the first named director of the Office of Tribal Health Research.

Wilson credits his meteoric career rise to his doctorate degree from ASU.

“My PhD gave me a whole new perspective on my career moving forward,” Wilson said. “There were no more expectations of me. I had surpassed everyone’s expectations of me, so whatever I did from that time forward was going to be fun.”

Fun, in this instance, means coordinating more than 250 health initiatives — ranging from substance misuse to mental health to workforce development to diabetes — on behalf of Native Americans throughout the country.

He said his biggest goals in his new position are to take a systematic and scientific approach to problem solving, to offer up effective research to tribal communities and to be a father, mentor and role model for Native peoples to the best of his abilities.

“That is a priority of this office, and we have the capacity to do this,” Wilson said.

 

Top photo: David R. Wilson is the first director of the Tribal Health Research Office at the National Institutes of Health in Bethesda, Maryland. He credits his success to Arizona State University, where he received his doctoral degree in molecular and cellular biology in May 2007. Photo courtesy of the National Institutes of Health

Reporter , ASU Now

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