Bridging the Educational Gap for Non-Celiac Gluten-Free Dieters

INTRODUCTION

Approximately 1% of Americans suffer from celiac disease, an autoimmune disorder triggered by the consumption of gluten, a composite of storage proteins found predominantly in wheat and other cereals. This percentage of Americans with celiac disease has remained fairly consistent throughout the past decade; however, the number of Americans pursuing gluten free diets (GFD) has nearly tripled in the same time period to more than three million (McCarthy). People without celiac disease who avoid gluten (PWAG) form nearly two-thirds of all those following a GFD (Niland and Cash). According to a study by the Mayo Clinic, the benefits to those following a GFD remain uncertain while the risks of nutritional deficiencies increase (Choung, et al.). Research and observation on the gluten-free trend indicate a lack of a clear understanding by PWAGs on gluten and how it functions in the body. Because of the risks involved in blinding following a GFD, there must exist a medium for credible and accessible information on gluten and the GFD. We hypothesize based on scientific research of consumer marketing and social media that creating a mini informative Youtube series on the GFD has the greatest potential to efficiently educate new PWAGs, and those not yet fully committed, on the GFD.

UNDERSTANDING THE FAD

The media stands at the forefront of GFD avocation. Many GF dieters propose gluten as the cause of many health-related conditions, like gastrointestinal distress or even non-GI conditions like acne (Anderson). Celebrities help pave the path for incorporation and elimination of specific foods by promoting diets that engender a “confluence of celebrity and expertise,” thus shaping the public’s perceptions of food (Rousseau, 267). For instance, Kourtney Kardashian has a following of 70.2 million followers on Instagram and has been extremely vocal on her adherence to a GFD, which she claims has enriched her overall wellness (E! Red Carpet & Award Shows).

Although celebrity commercial plays a role in promoting the GFD, the majority of GFD-related articles online are classified as feature or opinion pieces, suggesting a higher possibility of bias and lack of research-based science within these publications (Meyer, 81). In fact, research-framed articles on GFD that discuss celiac disease and non-benefit of the GFD to non-CD dieters lag behind every other frame type of articles including advice, opinion, and news (79). The lack of unbiased scientific material resultantly leads more consumers to other uncertified sources of ‘wellness’ often backed by pseudoscience (Wu, et al., 1540). Specific claims regarding the GFD have included benefits of clearer skin, weight loss, reduced inflammation, increased energy, etc. None of these claims have been scientifically proven. However, the abundance of anti-gluten publications spurs a chain reaction in which published general advice and medical anecdotes, including social media posts, arouse a perceived popularity and safety of the GFD which leads consumers to more published testimonials and pro-GFD advice (Meyer, 78; Borra and Bouchoux, 1215).

Additionally, an assumption of a GF health advantage over non-GF foods has been exploited by the media, marketers, and the GF food industry (Meyer, 77-80). The gluten-free food market in 2017 was valued at $14.94 billion and economists predict a continued surge in growth with North America leading in the number of consumers at 53% (Grand View Research). Given that gluten-free products tend to sell at higher prices than their gluten-containing alternatives, the projected market growth may serve as added impetus for producers to keep marketing and advocating the GFD. The $66 billion U.S. Weight Loss Industry also continues to reap the benefits of growing GFD population, as evidenced by a 2013 study that found that over three-fifths of American adults perceive gluten-free foods as healthier and that 27% pursue a GFD to aid in weight loss efforts (Marketdata LLC; Watson).

CURRENT EDUCATION + RESOURCES

For all people medically diagnosed with celiac disease, a physician creates a required and immediate referral to a dietitian with professional experience in CD in order to provide the patient with a nutritional assessment, diet education, meal planning, and assistance with transitioning to a GFD (Case). However, non-celiac gluten-free dieters and people considering such a diet are far less likely to seek out this type of professional information on their own. A study by Silvester and colleagues evaluated 260 adults on a GFD, 90% of which had celiac disease. A study of the 10% non-celiac adults indicated them as less knowledgeable about the specifics of a GFD and less likely to gather advice from a healthcare professional (Niland and Brooks).

Current resources available for people following a GFD include dietitians, other health professionals, support groups, food companies, health food and grocery stores, the Internet, medical and dietetic associations, government departments, media (Instagram, YouTube, Snapchat), journals and books, medical research papers, and friends and family. However, many of these sources (i.e. some health food and grocery stores, the Internet, media, and some friends and family) often provide people with outdated, inaccurate, and conflicting information.

While those diagnosed with celiac disease are referred to health professionals and given information by their doctors, non-celiac gluten-free dieters who are not directly given these contacts are far less likely to actively go out and seek professional dietitians on their own. Instead, they are often informed by the formerly discussed and less reliable sources that are more readily available to them. Moreover, in a survey of 1612 adults with CD, 88% claimed that the majority of useful information came from celiac support groups (Case). However, these groups are not available to non-celiac gluten-free dieters or individuals from the general public who may be considering such a diet. Instead, the majority of PWAG dieters receive their information from “health” store branding, social media fads, and online articles promoting these fads because they are more accessible, faster to obtain, and cheaper. While online scientific and medical articles may also sit on the more accessible side, people often do not have the time or desire for extra personal research.

 The lack of more accessible, accurate resources that cater to modern day interests, like social media, creates a clear divide between the majority of PWAG and PWAG who actually understand the implications and health effects of their dietary choices. In order to bridge this gap, we must bring more accuracy to the resources that people tend to look towards (media) and we must provide more accessible means to resources like dietitians and support groups.

SPEAKING TO GF CONSUMERS

Successful management of a GFD entails a personalized approach via use of evidence-based research to support a dieter’s needs. Unlike a person with celiac disease, for whom noncompliance with a GFD diet can have nutritional and health consequences, a PWAG dieter can more often fault on his/her diet without detrimental health risk, especially towards the beginning of the diet plan adoption. However, noncompliance caused by the maintenance challenges of a GFD can lead to emotional distress (Case, 130). Therefore, in creating a means for gluten-free education, we attempt to offer a support mechanism for PWAGs to determine if a GFD is manageable for them and if they will in fact benefit from adherence. This system intends to help PWAGs assess the net worth of the GFD to their lifestyle prior to pursuing. Moreover, while dietitians are the most qualified professionals to provide nutrition therapy, several impediments may prevent dieters to arrange appointments and meet with a dietitian. Firstly, insurance companies do not guarantee funding for nutritional therapy; additionally, even those who choose to meet with a dietician often never arrange a follow-up appointment due to factors like lack of time or long-distance travel (Case, 130).

Given the discussed considerations for gluten-free education, we believe easy, accessible education can be achieved through a research-driven, video-blog style of a Youtube series that tackles the basics of a GFD, including questions like “what is gluten” and risks versus benefits. The presence of this educational series on Youtube would curb any necessity for costs by those seeking information and would eliminate deterring factors like travel necessity. Furthermore, Youtube presents a form of online community which can benefit dieters seeking additional support. Cassey Ho of Blogilates demonstrates the effectiveness of such communities through her frequent videos about “eating healthfully” including gluten-free cooking (Ho). Since 2009, the Blogilates channel has accumulated 4.4 million subscribers. This example not only attests to Youtube’s ability to build a network of support but also to the accessibility of Youtube to thousands of people who, as apparent by their subscription to these health and nutrition channels, use the media platform as a means of discovery and education. The broad demographic of people that Youtube can reach without a doubt includes those most susceptible to fad diets as discussed earlier, making it an ideal platform to launch our education initiatives.

In the Youtube series, we aim to target PWAGs since people with celiacs usually have more medical and nutritional support as aforementioned. We focus especially on new and considering PWAGs who may not have fully developed ideas of gluten and the GFD. The people in this group may still be navigating their own nutritional circumstances and trying to learn how to undertake a new diet. Most probably, then, they will have a heightened openness to opinion, support, and education. Game theorist Mark Carnes notes that only those open to change can truly alter personal judgements on a specific subject, in this case the GFD (95-97). By following this train of thought, we can help shape thought about gluten and the GFD based off of scientific, researched-evidence and help consumers better understand the considerations of the GFD and possible risks before fully launching a new diet and lifestyle.

GOING GLUTEN-FREE: A YOUTUBE SERIES

Viewer Appeal

After analyzing the most popular GFD-related YouTube videos and videos by medically attributed sources, we discovered a relationship between video popularity and use of bright, colorful, eye-catching thumbnails with aesthetically-pleasing fonts that attract media consumers. The more popular videos also contained catchier titles. For example, “EASY LOW CARB MEAL PREP (gluten free + dairy free)” on Rachel Aust’s channel has 920K views, “Trying Kourtney Kardashian’s Diet 2018 Gluten Free, Dairy Free!” by Sam Ozjural reached 265K views, and BuzzFeedVideo’s “30 Days Of A Gluten-Free Diet • LIFE/CHANGE” generated an astounding 3.4M views. These titles all showcase an eye-catching usage of capital letters and a more aesthetically pleasing mix of letters with symbols such as “+,” “/,” and “•.” On the other hand, videos from more medically attributed sources, like Mayo Clinic’s “The Effect of a Gluten-Free Diet on Liver Function Tests,” Sutter Health’s “What is Gluten?” and Boston Children’s Hospital’s “Gluten-free Diet, Part 1,” adhered to more conservative titles and simply used a clip from the video as the thumbnail. While the formerly listed high-engaging videos were filmed in a more casual, conversational style, the latter uploaded by medical sources were more stiff and formal. As a result, they only received 1.7K, 4.8K, and 1.4K views respectively.

In addition to having a preference for more fun, creative content, we also found that modern day viewers have shorter attention spans. A Microsoft consumer insights report showed that the average human attention span decreased from 12 seconds in 2000 to just 8 seconds in 2015 (Gausby). Viewers do not have the patience to sit through extremely long videos nor do they enjoy lectures. Rather, they prefer more colloquial videos, resembling of a conversation between friends. In fact, many people in the YouTube community actually consider the YouTubers that they watch to be their friends.

With these factors in mind, we have identified a series of shorter YouTube videos as more effective than a singular, information-dense video. The video series will generate popularity by taking a modernized approach to YouTube, featuring catchy titles and thumbnails. With funny, casual content such as humorous interviews showcasing misinformed gluten-free supporters and less formal vlogs (video blogs) discussing the GFD and its implications, we can appeal to a greater audience while providing accurate and scientific information.

Video Content

What is gluten? Why are people going GF?

We decided to start our series by an informed introduction to gluten and the GFD and then demonstrating the level of misinformation about the two. Thus, we begin with the facts to draw our consumers in—what is gluten, how many people follow a GFD, and what is the market worth? This preface sets a well-defined question that will clearly set up our series and provide the viewer with tangible, researched statistics to build our credibility and initial trust with the viewer (In and Lee, 267; Rampton). We follow the introduction by a re-creation of the 2014 “What is gluten?” pedestrian walk on Jimmy Kimmel Live that has generated over 4.6 million views on Youtube.

To conclude the first video, we summarize the role of celiac disease, media, newspapers, social media, and celebrity to help the viewer come to an informed judgement on the popularity of the GFD. Because our next video tackles the benefits and considerations of a GFD, we end by providing a brief overview of the next part. This closure is important to build curiosity and keep the viewer within the mini series playlist.

Benefits + Myths of a Gluten-Free Diet

As stated earlier in “Understanding the Fad,” the GFD diet has garnered popularity in part due to myths on weight loss, acne, disease prevention, etc. We therefore commence the second part of our series by debunking common myths. Gluten-free foods have a perceived benefit on health, weight loss, treating disease, and/or minimizing risk of future disease (Wu, et al., 1539). In fact, a marketing survey by the NPD Group suggested that three in 10 Americans following the GFD did so for “good health” (NPD Group). On the other hand, GF skeptics argue that GF products tend to undergo more processing and packaging than their non-GF counterparts and expose consumers to higher amounts of salt, sugar, and fat (De Giorgio). Multiple studies in Australia revealed that following a GFD did not lack nutritionally compared to non-GF dieters but also did not provide any health advantages either (Golley, Wu, et al.). While food products and industry differ in the U.S. compared to Australia, these studies debunk myths about the GFD and the perceived benefits. The majority of people following a GFD do not have celiac disease and do not need to follow a GFD and gain no benefit from doing so (Catassi, et al.).

Non-celiac gluten-free dieters may argue that eliminating gluten from their diet has assisted in alleviating gastrointestinal symptoms. Still, for non-gluten related diseases there have been no strongly persuasive research to provide evidence of any benefit (Niland and Cash). In fact, for many patients, gluten-intolerance may be conflated with irritable bowel syndrome. IBS patients have noted a decrease in symptoms when following a GFD. Research studies have shown that the patients who follow a GFD may mistake gluten as a cause of their symptoms rather than an unconscious transition to low-FODMAP foods; resultantly, after following a low-FODMAP diet with the inclusion of gluten, patients demonstrated no gluten-specific symptoms (Biesiekierski, et al.). Thus with no known advantages to a GFD, the risks hold even more weight for PWAG dieters.

Gluten-Free Considerations

After discourse on common misconceptions, we present viewers with the risks involved in pursuing a GFD. The first point involves the nutritional risks, which we base off of research studies and summarize to the viewers visually via charts, images, and conversation.

Nutritional deficiency poses the biggest risk to a GFD. Because the media often associates gluten with wheat and energy-dense grains, dieters may reduce or completely exclude grain consumption, limiting their intake of vital nutrients like fiber and B-vitamins. Multiple studies on gluten-free diets have demonstrated dieters’ deficiency in calcium, iron, folate, zinc, selenium, and B12 among other vitamins and minerals (Saturni, et al.; Wild, et al.). Despite the evidence of nutritional deficiencies in many gluten-free dieters, those who proceed informedly can improve their overall diet by limiting processed foods and increasing the intake of whole foods like fruits and vegetables, thereby creating a new channel for micro-nutrients. If the GFD is a means for weight loss, then this nutritional transition would certainly assist with achieving that goal without necessarily sacrificing essential nutrients. Pseudo-cereals like buckwheat and quinoa and minor cereals like teff and millet may also provide alternative sources for micronutrients like proteins and fiber-rich carbohydrates (Saturni, et al., 23-25).

In many cases, following a GFD can lead to a substantial increase in food costs. One study on the cost of packaged gluten-free foods showed a 242% average increase in gluten-free products compared to their gluten-containing counterparts (Laci and Rashid). Another demonstrated an average price increase of 205% for cereals and 267% for breads and baked goods (Missbach, et al.). As apparent by these statistics, consumers should consider the potential economic burden of a GFD diet prior to pursuance.

Medical professionals Niland and Brooks note the power of food’s “pleasurable and communal aspects,” emphasizing the need to consider psychological factors of a restricted diet (88). Affected social aspects may include the ability to eat away from home, travelling, and difficulty in grocery shopping. A 2006 study reported survey findings that 79% of gluten-free dieters avoided restaurants, 38% avoided travel, and 85% had trouble determining whether grocery store foods contain gluten (Zarkadas). While the survey in question dates back over 10 years and many restaurants and grocery stores have more availability and clearer labels, food choices still remain extremely restricted, especially when eating out. Consequently, a dieter may need to devote extra time to research food selections and gluten-free choices prior to his/her visit.

What don’t we know?

We propose to outline the dearth of information and current research in the last video. While the availability of gluten-free items has increased over the past few years, the impact of a GFD on the quality of life still require further research. Has the quality of life with the increased attention to gluten and gluten-free dieters improved? Currently, most studies, especially those commonly referenced, date back to the late 2000s which may no longer adequately represent the statistics today given the heightened media and public attention to gluten.

Furthermore, consumers may benefit from more studies on the use of pseudo-cereals and minor cereals to reduce nutritional deficiencies and gluten-free food costs. Since consumer interest in the GFD continues to rise, more research in understanding consumer interest and appropriate agricultural communication may provide overall benefits to the market and consumer knowledge.

A recent study found no association between gluten and increased risk coronary-heart disease (Lebwohl). However, there have not been many other robust, long-term studies demonstrating the impacts of gluten on long-term disease like type 2 diabetes. Along the medical lines, more studies should be dedicated to understanding the effects of gluten for non-celiac gluten sensitivity. While some people do experience alleviated gastrointestinal and non-gastrointestinal symptoms from avoiding gluten, there is no clear indication of whether gluten or other another component of wheat causes these conditions.

Is a GFD right for me?

Our mini series aims to help a new or considering PWAG determine if a GFD is right for their health and lifestyle needs. Assuming the PWAG has watched the first two videos, we end by answering some questions that he/she may have. For instance, if the viewer decides the GFD is right for them, then a probable question may be, “Where do I begin?” As discussed earlier, the most qualified professional to provide nutrition therapy is a dietician. We therefore will recommend visiting a dietician or a medical professional and provide in-video links to easy ways to access these healthcare providers and potential questions to discuss. Because most links regarding patient and doctor care for gluten and the GFD relate to celiac, providing this material directly may help limit the amount of time the viewer searches for this information, thereby extracting a potential deterrent.

We also intend to highlight access points to reliable resources for further exploration and education. If the viewer does have remaining unanswered questions, then we consider it of high importance to lead these viewers to trustworthy sources that present evidenced material. As noted earlier, many media outlets provide testimonials or opinion pieces on the GFD which may present a factor of personal bias. By providing a direct stream to credible sources, we can help viewers surpass the flood of unevidenced articles and posts online. Two areas to provide this resource include direct links in the video and links in the video’s description box. However, regardless of our efforts, viewers will more likely than not be subjected to GFD opinion pieces through other mediums like social media, especially Instagram that has a large following dedicated to the GFD. We hope that the education received through our mini series will help dispel common myths and misconceptions about the GFD, allowing the viewer to consume any gluten-free marketing with caution and knowledge.

Gluten free food products.

SPEAKING TO PRODUCERS

Forty-eight companies collectively spent $1.8 billion on child- and teen-targeted US food marketing in 2009. Of this $1.8 billion, 50% was attributed to cross-promotions such as media character merchandising and collaborations with movies, television shows, video games, and social media. This branding is proven to have a “powerful influence on…food preferences, choices and intake” (Kraak and Story). Another study showed that the United States spent $1992.65 million on advertising in the grocery stores industry alone in 2017. Across the country, advertising spending within the grocery stores industry heavily influences consumer purchasing decisions and is directly associated with generating over 190 billion dollars of revenue annually (Schonfeld & Associates). In an increasingly consumerist world, marketing tactics hold an enormous influence over the foods we purchase and the way we eat. Because of its considerable influence on consumer dietary choices, the food industry holds an ethical and moral responsibility to better educate and inform the general public on food health and quality of life implications. In the case of gluten-free foods, it is crucial for brands to actually address the health effects of going on a GFD, rather than merely marketing with food fads.

One way that the food industry can do this is by partnering with medical professionals and dieticians to accurately address health concerns and benefits and to thus filter their target audience to those who would actually benefit from their foods and diets. While companies may worry about a reduction in their customer base, they hold a responsibility to protect public health over higher sales. Additionally, research actually shows that upholding high moral standards often increases brand recognition, loyalty, and sales, as is the case with companies such as Lyft and Patagonia, that have publicly emphasized their adherence to better working conditions and more environmentally ethical resources. By collaborating with health professionals to advertise accurate information on GFDs, food companies could earn more credibility and increase brand loyalty.

Media content producers also hold an enormous influence on dietary choices and health education. A 2018 study found that 61% of teenagers consume commercial foods and drinks when endorsed by celebrities, concluding that “media content on diet and health-related behavior motivates teenagers, particularly those messages laced with celebrities’ endorsements” (Maheshwar, et al.). These celebrities can be actors, singers, athletes, politicians, tech leaders, or even “social media influencers” on platforms like YouTube, Instagram, and Snapchat that have become popular in recent years. It is as important for these individuals as for food companies to publicize accurate health information that may influence their followers.

CONCLUSION

Based on our research on gluten-free diets, current GFD education and resources available, general public knowledge, and most influential information sources, we identified a misalignment between conceptions of the GFD and actual facts and implications that can be attributed to the lack of physical and spiritual connection between health professionals and the general public. Because of the inaccessibility of dieticians to the general public, prospective gluten-free dieters instead obtain the majority of their information from inaccurate media depictions, fads, celebrities, and false food branding from companies with self-motivated monetary interests. We also identified the best mechanism to combat this misunderstanding as a stream of informative communication on platforms in touch with popular modern day interests, specifically a YouTube series. This series will feature conversational videos highlighting misconceptions, debunking myths, and discussing health concerns to consider when deciding whether a GFD might be beneficial for oneself. Through this YouTube series, we hope to shed light on and help bridge the educational gap for PWAGs.

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by Mariam Sulakian + Emily Mi

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