While all food trends are potentially dangerous, some seem to stick in the public imagination more than others. Few have gained the acceptance, and notoriety, as gluten, a composite of proteins found in grass-related grains that, if you believe some holistic blogs, is responsible for most of society’s (and your digestive system’s) ails. 

Or, more specifically, celiac disease, an autoimmune disorder affecting the small intestine which results in a host of gastrointestinal-related problems, including chronic diarrhea, malabsorption, nausea, fatigue, and distention. There is no argument that gluten is a cause of this. What is argued is how many people actually have it (as compared to how many self-diagnosed because they read it on a blog) and, more interestingly, other potential causes not discussed as often. 

If untreated celiac disease can lead to cancer and early death; quality of life is greatly reduced in the meantime. Exact numbers of celiac disease sufferers are hard to pinpoint because symptoms are more prevalent in some than others. In some regions it is estimated that 1 percent of the population suffers; in others, the number is closer to one in forty

A genetic prerequisite greatly enhances the possibility you’ll acquire celiac disease; roughly 40 percent of people are born with this disposition. Yet not everyone will get it in their lifetime, making it even harder to understand.

Add to this the fact that gluten has health benefits that are often overlooked. More specifically, gluten’s delivery mechanisms, such as wheat, rye, spelt, and barley, as well as its popular incarnation as the foundation of imitation meats, provide necessary fiber while delivering protein and dietary minerals. In developed nations with diverse menus gluten can generally be avoided, but in many countries wheat, and therefore gluten, is a necessity. 

While celiac might be in the heads of the holistically minded, there is actual cause for concern: celiac disease is, like bread in fermentation, on the rise. Over 31,000 infants born at a Denver hospital between 1993 and 2004 were tested for a genetic predisposition to celiac disease; over thirteen-hundred of these children were tracked for two decades. The results indicated an increase in the disease, much higher than the expected 1 percent in developed nations. By age fifteen more than 3 percent of those children had acquired it.

Celiac disease only started being diagnosed in the first years of this century, making it difficult to track long-term increases. Yet one Minnesota study compared blood samples taken from young adults in the Air Force in the fifties with a similar age group starting in 1995 and found an .8 percent increase, from .2 percent to the national average of 1 percent. It appears that rates are indeed increasing.

As researchers learn more about the disease gluten is not considered the only culprit. In a half-century—using such reverse-engineering tactics as in Minnesota—rates have gone from negligible to 2 to 3 percent of children. Doctors are considering the idea that risk factors are also environmental: 

Some of the more unusual candidates blamed for triggering celiac disease include microwaves, plasticware, and diatomaceous earth—an abrasive powder applied to flour containers as an insecticide—although scientific evidence to incriminate these supposed culprits is scant.

Also being considered are Caesarian section births and intestinal infections. It is known that our reliance on antibiotics has negatively impacted our microbiome, which could also play a role in the formation of many diseases, including celiac. 

While these are mostly speculative, gluten remains the only clear cause of celiac disease, though even here it’s difficult to assess why that is. One reason, which I wrote about last year, could be time: rushing the fermentation process of bread makes it harder to digest. A proper loaf needs a day or two to get where it needs to go, which is, eventually, inside of our stomachs. Long rise times breaks down phytic acid and slows the absorption of starch. 

Researchers are working on developing remedies. Early vaccines are showing success, while inserting intestinal parasites may result in a stronger immune response. Gluten-targeting proteases might also break down gluten molecules. For the moment the only silver bullet is avoiding gluten completely.

In 2015 gluten-free products brought in 2.79 billion in the United States alone. The term ‘gluten-free’ is often synonymous with ‘healthy,’ but it’s not: replacement starches, emulsifiers, and sugars wage their own wars in your microbiome. The quick and easy way is rarely the most beneficial. 

Professionals believe the dietary trend is harming and not helping combat the disease. The problem of self-diagnosis means potential sufferers are skewing statistics, making it harder for researchers to pinpoint and treat celiac disease. The perfect storm of misinformation and business interests is striking at a time when thorough and credible research is needed. Our intestines are the victims just as we’re realizing how important what we put into our body is. Fake breads, like fake meats, are just that. Don’t be seduced by the packaging—what goes inside matters.

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Derek's next book, Whole Motion: Training Your Brain and Body For Optimal Health, will be published on 7/17 by Carrel/Skyhorse Publishing. He is based in Los Angeles. Stay in touch on Facebook and Twitter.