What would happen if much of what the food industry understands as “gospel" regarding digestion was invalidated by new medical research, pointing to new issues, new problems and potentially new solutions? It’s not as far-fetched as it sounds.
Experts have been struggling for years to explain the ravenous consumer appetite for gluten-free foods at a time when a relatively small percentage of consumers have been diagnosed with celiac disease. Despite perceptions, relatively few Americans suffer from celiac disease and the inability to digest gluten. According to an October 2012 study published in The American Journal of Gastroenterology and based on a nationally representative sample of consumers, just 0.7 percent of Americans were found to suffer from celiac disease. This level is said to be similar to that reported in several European countries, but it fails to explain the love for everything gluten-free.
Less than 1 percent of the population actually suffers from celiac disease, yet 10 times that number say they are avoiding gluten entirely. According to Datamonitor Consumer’s 2013 consumer survey, 10 percent of American consumers say they avoid gluten entirely, and another 22 percent say they are trying to limit their intake of gluten. It’s a similar situation globally, with 13 percent of consumers saying they avoid gluten entirely. Researchers at Australia’s Monash University were equally intrigued by this dichotomy, and came up with a possible explanation in 2011, postulating that a new condition called “non-celiac gluten sensitivity" (NCGS) may be a driver. The theory was that the consumption of gluten could induce celiac disease symptoms, even in patients who did not have celiac disease. This seemed to provide a plausible explanation for the boom in gluten-free products relative to the small percentage of consumers who suffer from celiac disease.
But an updated study by researchers at Australia’s Monash University to reproduce the earlier results came up dry, with results published in the journal Gastroenterology in 2013, eroding the case for NCGS. Moreover, a 2014 study published by a research team, including Jessica Biesiekierski, who participated in the two previous Monash University studies on NCGS, further complicated matters. The studybased on a consumer surveycame to the distressing conclusion that one in four respondents self-reported they had NCGS and only “poorly controlled" symptoms, despite avoiding gluten.
What is really going on here? Is this a case of mass delusion? Or is there another reason why large percentages of consumers swear by gluten-free diets? The answer may be that gluten is not the sole source of digestion problems; short-chain carbohydrates collectively called FODMAPs may be a contributing factor. “FODMAP" is an acronym for “fermentable oligo-, di- and mono-saccharides and polyols," referring to a class of sweet carbohydrates with a tendency to blast through the lower intestine undigested and unabsorbed, only to hit the large intestine where they attract water and tend to ferment, which produces gas and causes diarrhea. FODMAPs have long been linked to irritable bowel syndrome (IBS), a chronic condition that the Mayo Clinic said affects one of every five Americans.
While none of this may be a surprise to those who suffer from IBS and have adjusted their diets accordingly, the real revelation may be FODMAPs causing gastrointestinal (GI) distress previously blamed on gluten.
Researcher Jessica Biesiekierski recently noted in a report from Real Clear Science that “patients who believe they have non-celiac gluten sensitivity are likely to benefit from lowering their dietary intake of FODMAPs." Consumers who believe they feel better when on a gluten-free diet may really be responding to a reduction in FODMAPs, because these carbohydrates are common in gluten-rich products such as bread.
These studies reveal how little we know about digestion and how different foods can affect digestion. Research focusing on the human microbiome, which includes the community of microbes in the digestive tract that influence how food is digested, is beginning to heat up to fill the knowledge gap. Food consumption is now believed to have a greater than expected ability to alter the makeup of a person’s personal microbiome. This can have a big impact on how foods are digested, especially those rich in FODMAPs. A new study out of Israel raises some intriguing issues.
Researchers at Israel’s Weizmann Institute of Health found artificial sweeteners can induce glucose intolerance by altering gut microbiota (flora). A research team headed by immunologist Eran Elinav tested the effect of the artificial sweeteners saccharin, sucralose and aspartame on mice. What the team found was that mice ingesting the artificial sweeteners actually had higher blood sugar levels than mice that ate real sugar. Subsequent testing that used antibiotics to kill gut bacteria in mice that ate the artificial sweeteners saw blood sugar levels return to normal. A second experiment found that when feces from artificial sweetener-fed mice were transplanted into mice that had not ingested artificial sweeteners, blood sugar levels quickly rose and microbial colonies changed. If substantiated in future studies, this tendency of artificial sweeteners to change the gut microbiome could have major implications for digestion products.
In the near term, the digestion market may see growing interest in new foods and beverages that adhere to a low-FODMAP diet as a way to manage digestion and GI distress. This is already happening in Australia, where a growing number of packaged foods feature a “FODMAP Friendly" logo. As the first Australian government-approved label for fructose-friendly and lactose-friendly foods, the “FODMAP Friendly" logo was the brainchild of Australian dietician Sue Shepherd. Shepherd was also one of the first to market a product line featuring the logo, recently launching Sue Shepherd soups, pasta sauces, meal kits, stocks and simmer sauces in Australia.
The range of available “FODMAP Friendly" foods is growing rapidly in Australia, and now includes Kez’s Fructose Friendly Cereal from Kez’s Kitchen; Alpine Breads Sourdough Breads, including Spelt & Barley and Sour Rye breads, from Alpine Breads; and Bayview Crunchy Crumbled Big Fish Cocktails (essentially breaded fish nuggets) from Bayview Seafoods.
The trend is just getting started in the United States, where a November 2014 launch of the Nice FODMAP bar from a new entity called Nicer Foods is expected to take place. Flagged as “the original FODMAP Friendly bar," Nice has 7 g of protein per bar and is gluten-free, soy-free, corn-free and dairy-free. This quinoa-based bar claims to be part of a low-FODMAP diet, a diet said to significantly reduce symptoms of IBS in up to 75 percent of patients. Jesse Watson, founder of Nicer Foods, said while the low-FODMAP diet concept is “already much more mainstream in Australia" than the United States, it “could be huge" in the United States in the future. It will be interesting to see how this market develops as we move into 2015.
Visit INSIDER’s Digestive Health Content Library to read more about ingredients to sooth digestive woes.
Tom Vierhile ([email protected];  396-5128) is the innovation insights director for Datamonitor Consumer. Follow him on twitter at @TomVierhile. Part of Informa plc., the Datamonitor Group (www.datamonitor.com) is a world-leading provider of premium global business information, delivering independent data, analysis and opinion across several industries.