The Gluten-Free Diet: Recognizing Fact, Fiction, and Fad.

T he gluten-free diet (GFD) is a critical medical treatment for the millions of individuals worldwide with celiac disease (CD), an autoimmune condition for which no other therapy is currently available. The prevalence of CD is increasing, reflected by escalating awareness of CD in the scientific community. This increase in disease prevalence and awareness of CD, however, does not account for the disproportionate increase in growth of the gluten-free food industry (Figure). According to market research, consumers without CD purchase the vast bulk of glutenfree products. In reality, remarkably little is known about the motives of most individuals who adopt a gluten-free lifestyle. According to a 2015 survey of more than 1500 American adults, “no reason” (35%) was the most common explanation for selecting gluten-free foods, followed by “healthier option” (26%), and “digestive health” (19%). “Someone in my family has a gluten sensitivity” (10%) was more common than those reporting, “I have a gluten sensitivity,” which was the least common rationale cited (8%). The increasing popularity of the GFD has important implications for children. Parents sometimes place their children on a GFD in the belief that it relieves symptoms, can prevent CD, or is a healthy alternative without previous testing for CD or consultation with a dietitian. Although some children experience relief of symptoms, signifying that CD testing is warranted, many are asymptomatic from the start. The health and social consequences worthy of consideration in advance of starting a child on a GFD are not described adequately online or in books promoting an empiric GFD trial. This Commentary will provide an update on the current GFD fad and will disentangle facts from commonly held beliefs regarding the GFD, its known benefits, and disadvantages, specifically addressing several issues related to children.