In 2004, a National Institutes of Health conference sparked global discussion after research indicated celiac disease —which at the time was considered a rare condition in the United States and Europe—was likely underreported or not recognized by physicians. Scientists suggested there were potentially millions of Americans unaware they have the autoimmune disease, and diagnostic and therapeutic developments gave celiac disease the platform for a worldwide awareness campaign.

Since then, the gluten-free market has become big business. According to the Mintel Global New Products Database, there have been more than 27,000 food and beverage products launched with the “gluten-free” claim worldwide since 2006, and a Datamonitor report titled The Future of Gluten-Free: Consumer Insight and Product Opportunities predicts a $4.3 billion industry over the next five years. Major food retailers also are joining the gluten-free market with a myriad of private label products such as cookies, donuts, cakes, to pastas, rolls and pizza crusts.

Add to this a number of celebrities touting success in weight loss, having more energy or simply “feeling better” after going gluten-free, and it is easy to see how this disease management therapy has evolved into a mainstream diet trend.

Having product options is beneficial for people with celiac disease or gluten sensitivity, but it can also pose a problem when consumers believe that gluten-free means “healthier,” and that wheat, barley and rye are not good for them.

In fact, some gluten-free diets, particularly those that focus on products made with refined grains and that are not enriched with vitamins and minerals, are often higher in fat, lower in carbohydrates and fiber, and low in iron, folate, niacin, vitamin B12, calcium, phosphorus and zinc. Incorporating non-gluten grains such as rice, corn, buckwheat, quinoa, millet and wild rice can help, but consumers looking to lose weight or improve health may actually find it more difficult on a gluten-free regime.

However,  the greatest risk may be for the very population that gluten-free products are designed to help, according to Tricia Thompson, MS, RD, who specializes in celiac disease.

“The danger is that many people may be following a gluten-free diet before being tested for celiac disease, when some of them may in fact have this damaging autoimmune disease,” says Thompson.

The scientific consensus is that diagnostic tests for celiac disease should be performed before gluten restriction, particularly the serologic test for high levels of IgA tissue transglutaminase antibodies (tTGA).

Unlike an allergy, which generally becomes problematic only when certain foods are consumed, celiac disease is an autoimmune disease that in some cases may be associated with other conditions, such as type 1 diabetes, thyroid disease, irritable bowel syndrome, miscarriage, delayed puberty and recurrent migraines.

According to the Celiac Sprue Association, only 3 percent of people with Celiac disease know they have the condition, leaving an estimated 2.1 million people unaware and undiagnosed. “I highly encourage testing for celiac disease before anyone begins a gluten-free diet,” says Thompson. “The first step is a simple blood test.”