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More Americans follow gluten-free diet despite stable rate of celiac disease

The prevalence of celiac disease in the United States has plateaued, but the number of people following gluten-free diets has increased, according to findings published in JAMA Internal Medicine.

Hyun-seok Kim, MD, MPH , from Rutgers New Jersey Medical School, and colleagues reported that these two trends may be related, as a decline in gluten consumption may contribute to the stabilization of celiac disease levels.

"Previous studies have reported that the prevalence of celiac disease in the United States is increasing, although these studies were limited to narrow populations and were not nationally representative," Kim and colleagues wrote. "At the same time, there is a current popular trend of people following gluten-free diets, beyond what would be expected if it were solely attributable to the increasing prevalence of celiac disease. It may be in part because of a public belief that the diet is healthier."

The researchers analyzed data from 22,278 individuals aged at least 6 years old who participated in the National Health and Nutrition Examination Surveys (NHANESs) 2009 to 2014. The participants underwent serologic testing for celiac disease and provided prior gluten-free diet use and celiac disease diagnosis information via interview.

Kim and colleagues reported that 106 participants had a celiac disease diagnosis (0.69%; 95% CI, 0.53-0.84) and 213 participants adhered to a gluten-free diet without a celiac disease diagnosis (1.08%; 95% CI, 0.8-1.35). They estimated, based on these percentages, a prevalence of 1.76 million people in the U.S. with celiac disease and 2.7 million people adhering to a gluten-free diet without a celiac disease diagnosis.

Results also showed that celiac disease prevalence remained stable, with 0.7% in 2009-2010, 0.77% in 2011-2012 and 0.58% in 2013-2014. Adherence to a gluten-free diet without a celiac disease diagnosis increased from 0.52% in 2009-2010 to 0.99% in 2011-2012 to 1.69% in 2013-2014.

"There are many reasons, beyond celiac disease, that may account for the increasing popularity of gluten-free diets," Kim and colleagues concluded. "First, the public perception is that gluten-free diets are healthier and may provide benefits to nonspecific gastrointestinal symptoms. Second, gluten-free products were difficult to obtain in the past but now are more widely available at most large supermarkets and online. Third, there is also an increasing number of individuals with self-diagnosed gluten sensitivity but not the typical enteropathic of serologic features of celiac disease who have improved gastrointestinal health after avoidance of gluten-containing products."

Daphne Miller, MD, from the University of California, San Francisco, wrote in an accompanying editorial that there may be various factors driving the increase in gluten-free diets. She recommended that physicians respect patients' choices and use experiences with them as learning opportunities.

"Following a gluten-free diet likely means different things to different people, and a heterogeneous group of individuals are adhering to this dietary trend," Miller wrote. "Although the choice to be gluten free may be driven in part by marketing and a misperception that gluten free is healthier, it is important that this choice not be dismissed as an unfounded trend except for those with celiac disease and wheat allergy. Instead, researchers and clinicians can use this as an opportunity to understand how factors associated with this diet affect a variety of symptoms, including gastrointestinal function, cognition, and overall well-being." – by Chelsea Frajerman Pardes

Disclosures: The researchers report no relevant financial disclosures.