Prior to adopting a gluten-free diet, tennis sensation Novak Djokovic was sometimes considered second-tier, routinely finishing behind Roger Federer and Rafael Nadal. After adopting a gluten-free diet in 2011, he quickly rose to the #1 ranking, a dominance he at least partially attributed to his new diet.

A few years ago, gluten-free products were virtually unheard of, limited to patients with Celiac disease. You would find a few vendors exhibiting at the Natural Products Expos, and retail product distribution was limited to health food stores. Today there are isles of gluten-free vendors at expositions and gluten-free products encompass a significant section in mainstream supermarkets and club stores.

This column will review the gluten-free market, probing for insights relevant to emerging medical nutrition segments.

Gluten-Free Trend Basis
Gluten is a protein found in wheat, rye, barley and their crossbred varieties. In baking, gluten serves as a binding agent in the flour that prevents baked goods from crumbling. Serving this function, gluten is found in many non-grain-based processed and packaged foods.

In individuals with Celiac disease, consumption of gluten causes an immune response that attacks the small intestine. These attacks lead to damage to the micro-villi, small fingerlike projections lining the small intestine that promote nutrient absorption. When the villi are damaged, nutrients are not properly absorbed. More than 2 million people in the U.S. have Celiac disease, a hereditary condition. Unfortunately, there are no pharmaceutical options for Celiac disease today; a 100% gluten-free diet is the only effective treatment.

Many consumers suffer with symptoms that may appear related to consumption of gluten, though they do not have Celiac disease. This condition is often referred to as non-Celiac gluten sensitivity, or simply gluten sensitivity. Scientists estimate that 18 million Americans may have gluten sensitivity—more than six-times the number diagnosed with Celiac disease.

Researchers are just beginning to explore gluten sensitivity. Early research suggests that non-Celiac gluten sensitivity is an innate immune response, as opposed to an adaptive immune response (such as autoimmune) or an allergic reaction.

Healthcare professionals do not necessarily agree with the trendiness of adopting the diet. There’s so much misinformation, perpetuated by well-meaning celebrities (e.g., Oprah Winfrey) and books (e.g., Wheat Bellies), according to Sheila Campbell, PhD, RD. Thanks to improved testing, more cases of gluten sensitivity and Celiac disease are diagnosed. However, many use the diet for less than efficacious indications, everything from weight loss to reducing gastrointestinal gas.

Simply eliminating gluten may lead to a nutritionally challenging diet that is often high-fat, high-sugar and low in fiber and B vitamins. Another potential concern is restaurants riding the wave of popularity. Gluten-free pizza crust and bread/toast are often provided from not-gluten-free kitchen production areas. Gluten protein is airborne and easily contaminates other products in the area. This can be a serious concern for Celiac disease patients.

The Ever-Expanding Market
Manufacturers of foods and beverages are well aware of the growth potential of this emerging market. The global gluten-free market is projected to reach $6.8 billion dollars by 2019. North America is the largest market for gluten-free products, followed by Europe and Asia-Pacific.

The European gluten-free market is estimated to grow at a compound annual growth rate (CAGR) of 10% through 2019. In addition to being the largest market, North America is projected to be the fastest-growing, experiencing even greater growth, according to a report from MarketsandMarkets titled “Gluten-Free Products, Global Trends & Forecasts to 2019.”

Table 1 summaries retail sales of gluten-free foods in the U.S. by food category. As a growth segment, gluten-free dairy products or dairy alternatives amounted to $1.95 billion in sales in 2012, demonstrating growth beyond the grain-based segments.

Consumer Motivators
Once thought a fad, gluten-free is now a legitimate consumer trend. The Natural Marketing Institute (NMI) reported 38% of U.S. adults said they consumed gluten-free products in the past year, up from 29% in 2013. What reasons do consumers give for this behavior? According to NMI research, consumers reported an array of motivations and drivers, many far from the substantiated health benefits. These include:

• Perceptions of weight loss
• Association with “healthier”
• Avoidance of “negative” ingredients
• Potentially the next manifestation of “low-carb”?
• Celebrity endorsements

From a demographic standpoint, Millennials are heavy users of gluten-free products. In fact, three-times as many consumers aged 18-24 eat gluten-free foods compared to those aged over 65. By the year 2018, Millennials (18-34 years old) are expected to make up 23% of the U.S. population. Since this cohort represents the largest segment of gluten-free consumers, their demand will drive continued category growth.

Celebrity Influence
High-profile public figures—from Oprah to athletes—have certainly elevated public awareness of the purported benefits of going gluten-free.

For athletes who have Celiac disease, like collegiate hurdler Shelby Kaho, the benefits of a gluten-free diet are obvious. A gluten-free diet helped Ms. Kaho become faster after being diagnosed with the disease. What is less obvious is why so many athletes without Celiac disease are adopting gluten-free diets.

As previously mentioned, tennis star Novak Djokovic claimed his near dominance in professional tennis is at least partially attributable to his adoption of a gluten-free diet in 2011. Previously, in long matches he had difficulty breathing and seemed to lose energy. “I have lost some weight (on the diet), but it’s only helped me because my movement is much sharper now and I feel great physically,” Mr. Djokovic said.

Gluten-free has continued to permeate professional athletics since then. An article published on Triathlete.com in 2012 cited a growing number of world-class triathletes who are going gluten-free, including Simon Whitfield, Tim O’Donnell, Tyler Stewart, Heather Wurtele and Luke McKenzie. Other sources have announced that LPGA star Sarah-Jane Smith, the entire Garmin professional cycling team, NFL running back James Starks (Green Bay Packers) and quarterback Drew Brees (New Orleans Saints) also adopted gluten-free diets. Clearly, no athlete wants to compete while experiencing health issues attributed to gluten sensitivity.

An array of celebrities have also increased awareness of Celiac disease and gluten intolerance. Elisabeth Hasselbeck, Billy Bob Thornton, Chelsea Clinton, Mariel Hemingway, Geri Halliwell and Scarlett Johansson are all reported to have adopted gluten-free lifestyles.

In previous columns I have discussed Key Success Factors for health and wellness products. These include, for example, Safety, Efficacy, Value, Sensory/Organoleptics, Applications Development and Convenience. Beyond efficacy, historically, issues with gluten-free products have included sensory, applications development/formulation and convenience.

Gluten-free products have improved dramatically in taste, quality and options, both as base ingredients like flours and as ready-to-eat packaged goods. And the variety of gluten-free products has grown significantly from snacks and breakfast cereals to a wide range of bakery and confectionery items. From a consumer convenience standpoint, gluten-free products have moved from health food stores to supermarket shelves.

Whether driven by an increase in diagnosed Celiac patients, athletic performance or other real or perceived benefits, the gluten-free market is experiencing a revolution. It has rapidly evolved from a specialty niche category to today’s mainstream category star. Millions of Americans have adopted gluten-free lifestyles and food scientists and marketers continue to respond to demand.   

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Greg Stephens, RD, is president of Windrose Partners, a company serving clients in the the dietary supplement, functional food and natural product industries. Formerly vice president of strategic consulting with The Natural Marketing Institute (NMI) and Vice President of Sales and Marketing for Nurture, Inc (OatVantage), he has 25 years of specialized expertise in the nutritional and pharmaceutical industries. His prior experience includes a progressive series of senior management positions with Abbott Nutrition (Ross Products Division of Abbott Laboratories), including development of global nutrition strategies for disease-specific growth platforms and business development for Abbott’s medical foods portfolio. He can be reached at 215-860-5186; E-mail: gregstephens@windrosepartners.com.