When arm pain made it difficult for Victoria Yeh to play her electric violin, she decided to make a change.
Yeh suffered from chronic headaches, nausea, sinus inflammation, stomach pain, gas and digestive issues for several years. But the pain was Yen's biggest motivation to follow her doctor’s advice to avoid gluten, a protein found in wheat, barley and rye.
"I consider gluten-free to be a diet of necessity. I wasn't healthy, I was really thin and I would get sick often," said Yeh.
Eliminating gluten from her diet had a positive effect. "I put on more weight and put on more body fat, and I'm much healthier now."
These days, lots of people are giving up gluten. Eighteen per cent of American adults buy gluten-free products, according to market researcher Packaged Facts. Some eat gluten-free to treat celiac disease, the autoimmune disorder triggered by gluten. Some are fad dieters who think it will help them lose weight.
But Yeh is eating gluten-free for another reason.
She is one of an increasing number who are reporting non-celiac gluten-sensitivity.
Experts estimate that celiac disease affects one per cent of Canadians. It prevents the uptake of nutrients from food by damaging the small intestine and can lead to neurological disorders and vitamin deficiencies, like anemia or osteoporosis. Celiac disease has even been linked to infertility, schizophrenia and cancer. The only treatment is a strict gluten-free diet.
Less is known about non-celiac gluten-sensitivity.
Dr. Mohsin Rashid, a gastroenterologist at the IWK Health Centre in Halifax, says that non-celiac gluten-sensitivity is a newly coined phenomenon. "We don't know exactly what happens. We're just trying to probe the surface of this issue."
What doctors do know is that people with non-celiac gluten-sensitivity have celiac-like gastrointestinal and neurological side- effects but no autoimmune reaction to gluten. There is no way to diagnosis sensitivity: the blood-tests and biopsy for celiac disease come back negative.
But some researchers think non-celiac gluten-sensitivity may be more prevalent than celiac disease and that the prevalence may be increasing at a faster rate.
It's a lifestyle, not a diet
The gluten-free industry is valued at $4.2 billion US and it's still growing. Industry sales are projected to exceed $6.6 billion US by 2017, according to Packaged Facts.
But eating gluten-free is still challenging because gluten is so ubiquitous. It's in the obvious products, like bread, pasta, and cookies, but it is also lurking in many prepared foods, like soup, salad dressing, and soy sauce.
"You will never be successful with the gluten-free diet if you just simply see it as a diet. It really is a lifestyle change," said Yeh.
Registered dietitian Alexandra Anca in Toronto says that gluten-free eating isn't inherently healthy for those without a medical reason to follow the diet. She says gluten-free processed foods are often low in fibre and nutrients like calcium, vitamin D and folate.
Diet books, like Wheat Belly by Dr. William Davis, encourage the gluten-free diet as a weight loss strategy.
But Anca said the diet can actually lead to weight gain. "Most [processed] gluten-free foods offer a higher amount of carbohydrates, fat and calories all in all," said Anca.
For anyone eating gluten-free, Anca recommends eating a variety of healthy carbohydrates like quinoa, flax, sorghum, millet and teff.
Potential future treatments
Dr. Rashid says it isn't yet clear why the prevalence of celiac disease and non-celiac gluten-sensitivity seem to be increasing. "All autoimmune disorders and allergies are on the rise — celiac disease is just one of them."
But a number of therapies for gluten-related disorders are already in clinical trials.
Larazotide acetate is the pill attracting the most attention: the theory is that it works by preventing gluten from entering the lining of the small intestine.
One therapy in development involves using enzymes to break gluten into smaller non-toxic parts. Another is thought to work by attaching a chemical to gluten that makes it too big to be absorbed during digestion.
The biotechnology company ImmusanT is developing a vaccine that will increase tolerance to gluten in people with celiac disease.
Dr. Rashid says these options may be on the market within five to 10 years. But the treatments won't reverse celiac disease or gluten-sensitivity.
"It seems that the cure will probably not be that one can eat everything," said Dr. Rashid. Rather, treatment will protect people from small quantities of gluten.
Even without a cure, being gluten-free is becoming easier and more affordable.
There are more gluten-free products on the market, manufacturers are labeling food that contains gluten, and people with celiac disease are eligible for a gluten-free tax breaks.
Going gluten-free is hard at first but can lead to delicious and healthy eating. "One of the ancillary benefits of a gluten-free diet is that it makes you really think about what you’re eating," said Yeh. "You're forced to discover new foods."
For Yeh, the initial difficulty of changing her lifestyle has been worth it. "I had been living with this brain fog for the past number of years, and I didn’t realize that I did until it was sort of lifted away from me. My pain went away."
She is still playing her electric violin.