Gluten Free in Tennessee
Consumer Analysis & Recommendations

Spring 2011 Will Haven, Julie Stansberry, Jessica Stephens, Lauren West and Bonnie Willard

Table of Contents
Executive Summary............................................................................... Situation Analysis................................................................................. Subculture............................................................................................... Likes & Dislikes Behaviors & Characteristics Personal Values Overarching Philosophy What is/is not important to this subculture Communication Outlets & Media Usage Projection of the Gluten-Free Market 1 3 4

Recommendations................................................................................. 11 Conclusion............................................................................................... 15 Appendices............................................................................................. 16 References............................................................................................. 24

Will Haven

Julie Stansberry

Jessica Stephens

Lauren West

Bonnie Willard

Executive Summary
This lifestyle of excluding gluten from one’s diet is practiced by three different types of consumers: those who are allergic to gluten, those who choose not to eat it for nutritional reasons, not medical reasons, and those who suffer from celiac disease. Celiac sufferers make up the largest portion of gluten-free consumers. Celiac disease is a genetic, chronic intestinal disorder in which damage to the protrusions, known as “villi” that line the small intestine, is triggered by a toxic reaction to the ingestion of a protein found in wheat gluten or similar proteins (“Gluten-free foods,” 2011). These toxic food-grain antigens are found in wheat, rye and barley. If left untreated, studies have shown that those with celiac disease have higher chances of developing gastrointestinal cancer by 40 to 100 times that of the average population (“What is celiac,” 2010). Gluten free was not coined as a lifestyle and dietary solution until numerous centuries after celiac disease was discovered. Greek physician Aretaeus of Cappadocia wrote and identified “The Celiac Affection” in the 1st century. The disease is named after the Greek word koelia, meaning “abdomen.” The disease was originally diagnosed in this way: “if the stomach be irretentive of the food and if it pass through undigested and crude, and nothing ascends into the body, we call such persons celiacs” (“A brief history,” 2007). In the early 19th century, English doctor Samuel Gee determined the only cure for the now diagnosed autoimmune condition, celiac disease, to be a unique diet. During a breakthrough in the 1960s, gluten was identified as the triggering agent for celiac disease after considerable amounts of trial and error experimenting with numerous diets. A gluten-free diet became the universally accepted medical response for celiac disease in 1990, which sparked the growing subculture of Americans abiding by a gluten-free lifestyle (“A brief history,” 2007). An issue currently facing this subculture is the desire for a sense of normalcy instead of isolation from the mainstream consumer segment. To shift the attitudes of consumer isolation for this subculture, strategies that implement partnerships, demonstrations and education can potentially be effective in reaching out to this target audience. Chex is starting to become a leading brand in the gluten-free community, so it is essential to form a partnership with the company. Chex is a popular and reputable product among families and is certainly not limited to those with celiac disease, so by partnering with Chex, disease sufferers are able to feel a connection with those who eat it by choice. Members of this subculture desire to see a growing gluten-free presence in their local communities, so the use of testimonials will relay to both celiac sufferers and average consumers that having the disease is not out of the ordinary. Elisabeth Hasselbeck of The View, who is a self-proclaimed celiac sufferer, will host a program devoted solely to discussing celiac disease and what it entails. The information shared during the program will highlight that living a gluten-free lifestyle does not separate one from average society. A traveling gluten-free food and informational expo held in various locations across the state will also contribute to a growing acknowledgement of the gluten-free community, as both gluten-free and average consumers will attend the event. Many average shoppers simply do not possess the knowledge of what celiac disease is or why gluten-free products even exist. In order to create a sense of unity, this knowledge is necessary. Using both social media and print media to disseminate educational information to the general public will spread the word and prevent gluten-free consumers from feeling isolated in their respective communities.

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Situation Analysis
Celiac disease is a genetic disorder that affects at least 1 in 133 Americans (“What is celiac,” 2010). Because celiac diseased gluten-free dieters are a minority, they encounter feelings of isolation and inconvenience in their eating and shopping routines. These inconveniences include misleading labels, higher costs, fewer item options, lack of restaurant menu accommodations and tedious home meal preparations. Each of these daily obstacles creates a strong desire among gluten-free consumers to eat and shop at the same level of ease as everyone else. The U.S. market for gluten-free foods and beverages has grown by 30 percent each year since 2006, which is a positive development for gluten-free consumers because it means more choices for them (“Gluten-free foods,” 2011). This group utilizes social media and informational websites to communicate advice, recipes and gluten-free venue locations. Gluten-free dieters’ conscious food intake, coupled with the organization of their weekly meal plans, influences their behaviors pertaining to grocery shopping and dining out at restaurants (“Coeliac awareness vital,” 2011). Members of this subculture value healthy lifestyles and precautionary consumerism. Also, their philosophy is to be proactive about creating sensitivity and providing opportunities for those with the disease. Finally, ingredients are important to gluten-free consumers to enable risk-free purchasing of products.

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Subculture
Likes & Dislikes
People with celiac disease, first and foremost, like being diagnosed because of the multiple tests they have endured. This group also likes the growing market for gluten-free foods because this means more choices for them. In fact, a new report by Packaged Facts, a market research firm, says the U.S. market for gluten-free foods and beverages has grown by 30 percent each year since 2006 (“Gluten-free foods,” 2011). Going hand in hand with the favorable growing market is the increasing number of restaurants or fastfood restaurants that are now offering gluten-free menu items. People with celiac disease also like, maybe even love, social media. For example, Twitter users can unite and go through their disease together, all from a certain Twitter #hashtag that enables them to communicate on certain topics. More than 14,000 people literally “like” the Gluten Free community page on Facebook (www.facebook. com, 2011). As technology advances, these glutenfree dieters also enjoy iPhone and Android applications, or apps, such as Gluten Free Ultimate Solution, that provide a range of oppor tunities that make their disease much easier to maintain (“G-Free foodie,” 2011). With just a few touches to their cell phone screens, the subculture can see how to make their favorite recipes, where to dine or simply view more information on celiac disease and what it means for them. Some websites even provide all the restaurants, by location, that have glutenfree menu items. This allows gluten-free eaters to branch out when traveling instead of sticking to eateries with which they are familiar. Two frequently used websites are www.glutenfreeregistry.com and www.gfreefoodie.com. Featured restaurants include Moe’s, Bonefish Grill, Chili’s Grill and Bar, The Melting Pot and O’Charley’s. Those with celiac disease also feel more comfortable around other peers or friends who have been diagnosed with celiac disease – it gives them a sense of accountability and motivation. As stated earlier, the diagnosis can also be a disadvantage. People become scared when they are initially diagnosed with the disease. People with the disease suffer from the unpleasant symptoms, which include stomach issues (gas, bloating, diarrhea, constipation, vomiting, etc.), an increased chance of developing depression, seizures, early hair loss and joint pains. They also have an increased risk of having intestinal cancer, thyroid disease and Type-1 Diabetes (Phaber, 2011). In fact, if a person with the disorder continues to eat gluten, studies have shown that he or she will increase his or her chances of getting gastrointestinal cancer by between 40 and 100 times that of the normal population. Gastrointestinal carcinoma or lymphoma develops in up to 15 percent of patients with untreated celiac disease (“What is celiac,” 2010). Young children with celiac disease suffer from tooth defects, delayed growth and irritability (Phaber, 2011). The

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group dislikes sticking to a gluten-free diet, frequent blood testing and the increased risk of asthma (“Asthma linked,” 2011). For those who have not yet discovered the websites that suggest places to eat in any given location, eating only at familiar chain restaurants while traveling can be montonous. For women trying to have children, it has been discovered that celiac disease indeed affects reproductive performance (Kumar et al., 2011). An added frustration for people with celiac disease is grocery shopping. However, certain books, such as the Gluten-Free Grocery Shopping Guide with more than 37,000 gluten-free products, are making their lives much easier (“Gluten-free grocery,” 2010). As with a lot of things in life, there are likes and dislikes involved with living a gluten-free lifestyle, but it is all about what works for each individual with celiac disease. Becoming more aware of gluten-free products, services and resources is important for people struggling with the disease.

Behaviors & Characteristics
Those diagnosed with celiac disease seemingly live their lives as any ordinary American. The fact is that when these people are told to live gluten free after being diagnosed with celiac disease, remarkable amounts of behaviors become involved in their specific lifestyle. Gluten-free behaviors range anywhere from meticulous eating habits to the organization of a kitchen. Those with celiac disease also have a lifetime conscience of avoiding gluten. The diet for those with celiac disease consists of being free of gluten, which entails a reduction, or elimination, in consumption of wheat, barley, rye and oats. According to Independent Registered Dietician Frankie Phillips, “The remainder of a gluten-free diet should be average, with the exception of a higher intake of calcium, 1,000 mg a day”(Phillips, 2010). See Appendix 2 for “Eating a GlutenFree Diet.” Gluten-free dieters are conscious of their food intake. This subculture’s members are incredibly organized when it comes to their weekly meal plans, and they are extremely cautious when it comes to dining out (“Coeliac awareness vital,” 2011).

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This influences the behavior of grocery shopping, dining at restaurants and the desire to research gluten-free options. An evolving market of gluten-free brands exists for this subculture to purchase. Some of these items include Glutino, Pamela’s Products and Kinnikinnick Foods (“Gluten-free foods,” 2011). Glutenfree shoppers have also become aware of mainstream food brands that now have gluten-free divisions, such as General Mills’ Chex (“Chex goes gluten,” 2011). Most food brands are experimenting with gluten-free labels to attract those with gluten-free needs and to provide a wider range of the subculture’s dietary choices. Market research shows that the majority of those who live a gluten-free lifestyle shop at Wal-Mart because it provides a variety of gluten-free choices at a cheaper price (“Glutenfree foods,” 2011). Gluten-free dieters order off gluten-free menus provided by restaurants such as Red Lobster, Outback Steakhouse and Chili’s (Parekh, 2010). As stated earlier, the restaurant industry has taken notice of this need and provided the subculture with solutions. Several other restaurants have a gluten-restricted menu that can be viewed in Appendix 1.

Those with celiac disease are also characterized by having homes that include gluten-free kitchen layouts. According to The Food Service Director (FSD), celiac sufferers need to prepare food in gluten-free trays and use disinfected utensils. Being aware of cross-contamination is also vital. The FSD advises using fresh cleaning clothes because sanitized crumbs are still allergenic. If one family member lives a gluten-free lifestyle, more than likely, the rest of the family will follow suit (Legge, 2005).

Personal Values Healthy Lifestyles
This subculture values maintaining healthy lifestyles for one very big reason: to eliminate their symptoms. According to the National Center for Biotechnology Information (NBIC), people with celiac disease have higher risks of developing other serious health conditions. As previously mentioned, these include down syndrome, intestinal cancer, diabetes, and several autoimmune disorders (“Celiac disease,” 2010). Once diagnosed with celiac disease, sufferers have to change their diets completely. Currently, the only treatment of the disease is to maintain a gluten-free diet, but these diets often lack critical nutrients. Doctors Dave Sheluga and Elizabeth Arndt found that most people with celiac disease lack fiber and other nutrients obtained from whole grains. Thus, they have to make an effort to meet with dieticians to discuss additional supplements they may need (Sheluga & Arndt, 2010).

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Since the subculture’s individuals are forced to be gluten free because of their condition, they are forced to seek and value information about nutrition at extensive levels.

Family
People with family members who have been diagnosed with celiac disease have increased chances of developing the disease themselves. Families with a member observing a gluten-free diet are forced to make major changes to avoid cross-contamination and support family members suffering with celiac disease. An article in The Western Mail spotlighted the extreme alterations one family faced after three members were diagnosed with celiac disease. Kay Thomas and her two daughters have all been diagnosed with celiac disease, but Kay’s husband, Simon, does not suffer from the disease. Kay struggles not only with living gluten free herself, but also with finding ways to explain the necessary lifestyle changes to her kids. Simon somewhat conforms to the gluten-free diet in order to support his family members. Since Simon is not completely gluten free, the family has to take serious precautions. “Simon’s area for bread is one side of the kitchen, and ours is the other,” Kay explains. “We also have separate toasters because of the cross-contamination issue, and we have to be careful with spreads - butters are all gluten-free, but we can’t share, so his butter has his name on it” (“Why our family,” 2010).

Vigilance
Once diagnosed with celiac disease, one’s life becomes much more complicated. Those suffering from the disease are required to take extreme caution while reading labels and eating at restaurants. “It doesn’t just mean avoiding bread and pasta,” gastroenterologist Brian Landzberg notes. “It’s reading every label, and every time you go to a restaurant, giving the waiter the third-degree as to what might have been thickened with flour” (“The gluten-free,” 2009). People with celiac disease want to live a normal life. They want to shop at the same grocery stores and eat at restaurants with friends and families. “By offering a gluten free-menu and adhering to strict protocol to avoid cross contamination, gluten-free dieters will find they can gain the loyalty of this important market…Best of all, word of mouth will spread like wildfire. Gluten-free menus are coveted by those who absolutely need them, and those guests will reward a restaurant that caters to them with loyalty, appreciation and by telling others about the glutenfree menu options,” (“The gluten-free,” 2009).

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Shopping is usually a long, dreadful process until those suffering with celiac disease become familiar with glutenfree products and brands. “Consumers often talk about being forced to contact a manufacturer to clarify the glutinous status of a product or ingredient” (“The glutenfree,” 2009). It takes time, trial and often third-party endorsements for customers to trust labels on packaged products. Most consumers feel safer preparing meals from scratch but lack the time. Meticulousness is a necessary precaution but complicates the lives of those with celiac disease. Gluten is in so many common products; it is very difficult to ensure that food at a restaurant has not been cross contaminated during preparation. “Looking at a restaurant menu can be frustrating, discouraging and depressing when few, if any, choices are available,” (“The gluten-free,” 2009). The complications while shopping and preparing food are other reminders of the subculture’s lack of normalcy. However, the subculture has come to appreciate the presence of a growing glutenfree market. “Packaged Facts previously projected that sales of gluten-free foods and beverages would reach $2.3 billion by 2011, but current estimates put the market at $2.64 billion in 2010, for a compound annual growth rate of 30% over the 20062010 period” (“Gluten-free foods,” 2011). The subculture values the rise in popularity of gluten-free products because it has created a less complicated shopping experience for this niche market.

Overarching Philosophy
As a minority, gluten-free consumers’ philosophy is to be proactive about creating sensitivity and providing opportunities for those with celiac disease. The previous lack of products and services available to the gluten-free consumers has produced a proactive attitude within this segment. They are dedicated to changing this inconvenience in the market by pressuring food manufacturers, restaurants, physicians and pharmaceutical companies to meet their consumer needs. Thus far, they have been successful in their efforts. The Gluten-free Food and Beverage Magazine cites consumer activism as being the driving force of the gluten-free market and notes that it shows no signs of abating (“Gluten-free foods,” 2011). Gluten-free consumers are accomplishing their goals by becoming bloggers, authors, producers or retailers of products for gluten-free living. These blogs, books, restaurants and stores are all aimed at making life more convenient for celiac sufferers. Gluten-free consumers are also dedicated to disseminating educational materials about celiac disease as well as the benefits of gluten-free living. This segment has created several organizations, such as the Celiac Spruce Association (2008) and the Celiac Disease Foundation (1998), dedicated to educating the public about this lifestyle. Celiac sufferers also strive to take public education a step further by creating public sensitivity for conditions of the disease. Increased awareness of celiac disease will ease the transition of gluten-free products and services from obscurity to a prominent place in the market.

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Each of these efforts ties into the gluten-free consumers’ desire to be a normal customer. The Grocer states that gluten-free consumers do not always want substitute products and instead prefer mainstream brands that happen to be gluten free. They are also described as loyal customers who stick with a brand for life if they discover one they prefer (Legge, 2005). Knowledge of the gluten-free consumer philosophy of activism and promotion to create a more convenient market of products and services could be utilized by food manufacturers, restaurants and pharmaceutical companies. This is a consumer segment that is eagerly seeking out available products they can be loyal to. They appreciate information that aids in making their lifestyle as normal and convenient as possible.

them more comfortable with the purchase. Buying glutenfree-specific products can also make members of the subculture feel less normal (“The gluten-free,” 2009). Thus, they often prefer to shop at retail outlets where gluten-free products are intermingled with other products. The transition to a gluten-free lifestyle is made much more complex because the selection of ready-to-serve food is incredibly limited. People with celiac disease are just like other Americans, always looking for a more convenient way to do things. Unfortunately, they are often forced to tediously prepare meals consisting of naturally glutenfree foods like fresh fruits, vegetables, meats and eggs. This is another way that gluten-free people feel isolated from other people in society. They desire ready-to-serve choices that are gluten free and convenient. Ingredients are important to gluten-free dieters to because they enable risk-free purchasing of products. “Thirdparty endorsements from a highly regarded entity like the Gluten-Free Certification Organization” are extremely important to gluten-free dieters (“Gluten-free foods,” 2011). Gluten-free dieters value a sense of manufacturer credibility when purchasing the product they have to eat. “Ultimately, gluten-free consumers want risk-free shopping, and once they begin to feel more confident that the products they buy are allergen-free through clearer labeling, this will have a positive impact on sales” (Legge, 2005).

What is/is not Important to this Subculture
Of utmost importance to those suffering from celiac disease is the desire for normalcy. From the time of diagnosis until the gluten-free lifestyle becomes familiar, these consumers have the desire to feel normal and belong. But unfortunately, the gluten-free lifestyle is more expensive, less convenient and leaves consumers with an undesirable taste in their mouths. These simple needs are often overlooked by retailers and restaurants. While shopping for gluten-free products, celiac sufferers appreciate transparent packaging. When the specialty products look similar to all the other products, it makes

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People with celiac disease place a high importance on exposing the public to general knowledge associated with living a gluten-free life. This enables people outside the subculture to understand the required adaptations resulting from celiac disease.

Projection of the Gluten-Free Market
Originally, gluten-free products began as small portions of product lines for organic food companies. Nature’s Path was one of the first companies to pioneer in the organic food movement in the U.S., expanding from Canada in 1999. At this time, the company’s total product line consisted of a significant minority of gluten-free products (“The gluten-free,” 2009). This subculture finds it crucial to keep an eye on the growth of the gluten-free market as well as the implications from the projections. As mentioned earlier, the market has an annual growth rate of 30 percent over the 2006 to 2010 period. Although there has been a steady growth in the market for the past four years, the market had the lowest growth rate from 2009 to 2010. The market is experiencing acceleration, but at a decelerating rate (“Gluten-free foods,” 2011). This presents a sizeable problem for gluten-free eaters, especially those with celiac disease. This drop in the gluten-free market is mainly due to the individuals who view the diet as a fading fad. This decline in the market is affecting celiac sufferers because some individuals view the lifestyle as a fad. However, the subculture values other gluten-free consumers in order to maintain the stability of the market.

Communication Outlets & Media Usage
Those with celiac disease have turned to innovative communication outlets to enhance the gluten-free community. These celiac sufferers obtain much of their information from iPhone apps like iCanEatOnTheGo and Foodcontentalerts (Parekh, 2010). This subculture uses resources from gluten-free Twitter accounts and blogs like TheCeliacDiva, which provide daily tips and advice for those who live gluten free (Vasser, 2010). Thousands of people “like” certain gluten-free Facebook pages, such as Living Gluten-Free, Udi’s Gluten Free Foods, Genius Gluten Free, Marjie’s Gluten Free Pantry and more (www.facebook.com, 2011). These Facebook pages allow members of the celiac community to upload photos, share recipes or post questions pertaining to their disease. It is very important to gluten-free dieters to get their information about products from user-generated content on the Internet. User-generated material is the best way to get information because it is first hand and minimizes feelings of isolation. Once diagnosed, eating right will be crucial for the remainder of these individuals’ lives, so they enjoy the immediacy of advice provided by these social media outlets. See Appendix 3 for a table of media usage.

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Recommendations
Goal: To reduce the feelings of consumer isolation among gluten-free consumers with celiac disease. Objective: To shift attitudes of consumer isolation from slightly isolated by the market to slightly acknowledged by the market among Tennessee gluten-free consumers with celiac disease by August 2013. Strategy 1: Partner the Chex brand gluten-free division with a retail outlet. Tactic 2: Promote gluten-free recipes on the back panel of Chex products. Include facts about the growing number of celiac disease sufferers on the back panel of Chex cereal boxes. Provide a seasonal recipe that can accommodate both the average consumer and gluten-free consumers. By incorporating products that can be found at the partnered retail outlet to create these recipes, the retailer and Chex will increase awareness of the gluten-free products while allowing the subculture to feel included at holiday parties.

Chex is a popular and reputable product among families as well as a forerunner in the gluten-free product movement. It is easy for the retailer to partner with Chex because there is already an established buyer relationship between the brand and the retailer. The gluten-free consumer feels more acknowledged by the market when buying a product that is used among people outside of the subculture. Tactic 1: Offer Chex gluten-free product samples in retail outlet. By distributing gluten-free product samples within the retail outlet, this creates a higher sense of normalcy for the gluten-free consumer because average consumers and gluten-free consumers alike can enjoy these products without feeling isolated.

Evaluation: By August 2013, harvest consumer data from the retail outlets’ customer rewards program of people who purchase Chex gluten-free products. From this data list, send surveys to gluten-free customers that include questions asking if they are satisfied with the product, if they tried the recipe ideas provided on the product packaging, if they have been present for glutenfree sampling in the store, if they are gluten-free because they suffer from celiac disease and if they feel the retail outlet is catering more to their specific needs.

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Strategy 2: Demonstrate the presence of a gluten-free community. Tactic 1: Produce a segment on major ABC Tennessee affiliate stations in which self-proclaimed celiac disease sufferer, Elisabeth Hasselbeck of The View, informs the community about her gluten-free lifestyle that she highlights as being extremely normal.

Tactic 2: Create “Gluten Free in Tennessee,” a traveling informational expo across the state of Tennessee. Grocers, bakeries, bloggers, dieticians, nutritionists, support groups, organizations and local food manufacturers will host an expo at each major Tennessee city. Each party at the expo will have an individual booth explaining its products or services for the gluten-free market and offering samples to the attendees. Vendors can advertise the expo during their normal business operations through grassroots promotion strategies, social media, websites and other partnerships. The event is open to the public, and tickets will be sold at a small price before and during the expo.

Evaluation: Calculate viewership numbers for Elisabeth Hasselbeck’s segment. Assess number of attendees at each city’s “Gluten Free in Tennessee” expo through turnstyle devices.

During the 30-minute segment, Elisabeth can talk about gluten-free-friendly restaurants, demonstrate the preparation of gluten-free meals and highlight feature bloggers and reputable resources. The subculture’s members will feel comforted by relating their lifestyle to a public figure and working mother. Also, the consumer will gain practical knowledge and advice from Elisabeth’s testimonials.

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Strategy 3: Infuse educational information to create an attitude of acceptance among average consumers for the gluten-free lifestyle. Tactic 1: Create a social media buzz on Facebook and Twitter. For example, the headlining news the Breast Cancer Awareness Facebook campaign stirred between both patients and the general public was a notable success. Facebook and Twitter are all-inclusive networks used by a wide array of people; therefore this same campaign approach could be utilized by the gluten-free community to effectively spread knowledge about the specifics of the lifestyle. These media outlets will allow the gluten-free community to rapidly spread awareness in a way that is interactive and entertaining for followers. Tactic 2: Use print media to provide gluten-free information to the public. News releases about the gluten-free lifestyle of celiac sufferers will be disseminated to several credible newspapers such as The Tennessean and the Knoxville News Sentinel. Because of the growing gluten-free diet trends, such news releases will provide facts about celiac disease as the origin of the diet, symptoms of the disease and how this diet enables celiac sufferers to manage their condition. Quotes about celiac disease from local doctors should be used in the article.

Also, feature stories highlighting interviews with local gluten-free bloggers will be pitched to Tennessee magazines such as CityView. These articles will focus on their personal experiences with being diagnosed and how their lives have since changed. Each of these tactics aligns with celiac sufferers’ desire to make the disease common knowledge to the public, which further improves their normalcy as consumers. Evaluation: Number of “likes” and followers on Facebook and Twitter accounts will be used to measure how quickly awareness is spreading and how large the movement is becoming. To measure the success of the print media tactic, a website address that takes the reader to an informational website will be included at the end of each article. Once logged into the website, the reader will be asked to complete a survey. This survey will ask readers how aware of celiac disease they were before reading the article, if their awareness has changed after reading the article and what their current attitudes are toward celiac sufferers.

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Conclusion
The gluten-free consumers who suffer from celiac disease are a worthwhile target audience to embrace in this increasingly prominent market. Being diagnosed with celiac disease requires these consumers to be meticulous, proactive consumers. These characteristics make this subculture unique because they not only actively seek trustworthy information and products, but demand them. Celiac sufferers have a specific set of needs that must be met by the product, service or resource they choose to use, therefore providers must be prepared to address these requirements by providing reliability and quality if they wish to gain the loyalty of these consumers. This subculture responds well to engaging outreaches such as social media, blogs and events, which allow them to come together as a community and also to expose the general public to their condition in hopes of promoting acceptance for the lifestyle. Product, service or resource providers who wish to exploit this $2 billion market and gain these consumers in the future should keep in mind they are savvy customers who wish to close the gap on the vast options available to average consumers as opposed to the limited amount of gluten-free options. The niche for this market is primed with demand from gluten-free consumers and now needs suppliers to provide the quality alternatives this subculture craves.

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Appendix 1

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Appendix 2

Eating a Gluten-Free Diet Fact Sheet About Celiac Disease or Gluten Intolerance People suffering from celiac disease are unable to tolerate gluten, which is the protein component of certain grains like wheat, rye, barley, and oats. In these people, gluten can affect the absorptive ability in the small intestine, causing eventual malnutrition. In many people with Celiac disease, even small amounts of gluten can cause harm and need to be avoided. In eating a gluten-free diet, it is important to learn how to read food labels before purchasing or eating any products that you do not know to be or are not listed as gluten-free. Avoid Grains Containing Gluten and Products Made from These Grains • • • • • • • • • • • Barley Durum Kamut Noodles Pasta/couscous/orzo Rye; rye flour Semolina Spelt Triticale Wheat and all wheat products; whole wheat; whole wheat flour; wheat bran All baked goods made from wheat, rye, semolina, barley, or pearl barley

Avoid Other Products that May Contain Gluten • • • • • • • Flour or Cereal products unless made from pure rice flour, corn flour, potato flour, or soy flour Hydrolyzed vegetables protein (HVP) unless made from soy or corn Malt vinegar; malt or malt flavorings unless derived from corn Modified starch or modified food starch unless arrowroot, corn, potato, tapioca, waxy maize, or maize Soy sauce or soy sauce solids unless they say they do not contain wheat Vegetable gum unless vegetable gums are carob bean gum, locust bean gum, cellulose gum, guar gum, gum Arabic, gum aracia, gum tragacanth, xanthan gum, or vegetable starch Vegetable protein unless made from soy or corn

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Eating A Gluten-Free Diet, page 3

Foods by Category, continued Fruits & Vegetables Gluten-free: All fruits and vegetables are gluten-free, unless they are fruit and vegetables products made with gluten-filled products Nuts, Seeds, & Legumes Gluten-free: All nuts, seeds, and legumes are gluten-free, except for certain brands of baked beans and anything made with sauces or other products that contain gluten Sugars Gluten-free: Jam, marmalade, sugar, honey, molasses, golden syrup, some brands of chocolate and sweets Contain gluten: Confectioners containing flour, some brands of lemon curd

Soups and Sauces Gluten-free: Can be gluten free if thickened with non-gluten flour and made without gluten ingredients Contain gluten: Many manufactured sauces, stocks, and soups contain gluten; need to read labels carefully Miscellaneous Gluten-free: Salt, pepper, vinegar, herbs, spices, tamari, yeast, most food colorings Contain gluten: Some pepper compounds, shoyu, ready-mix spices, some seasoning powders, certain brands of mustard, many vitamins and mineral supplements and medicines Helpful Resources on Celiac Disease and Gluten-Free Foods Celiac Disease Foundation, www.celiac.org Celiac Sprue Association, www.csaceliacs.org

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Appendix 3

Gluten-Free Media Usage

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References
A brief history of celiac disease (2007). Impact. Retrieved from https://celiacdisease.net/assets/pdf/SU07CeliacCtr.News.pdf Asthma linked to celiac disease (2011). Retrieved from http://www.msnbc.msn.com/id/41759610 Celiac Disease Foundation. (1998). Celiac disease – sprue (2010). Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/pmh0001280/ Celiac Spruce Association. (2008). Chex goes gluten-free (2011). States News Service, Inc. Retrieved from http://global.factiva.com/ha/default.aspx Coeliac awareness vital. (2011). Caboolture News. G-free foodie adds features and updates to 2 in 1 ‘Gluten Free Ultimate Solution’ app for Apple devices and Android phones (2011). Retrieved from http://www.prweb.com/releases/2011/2/prweb8162764.htm Gluten-Free Grocery Shopping Guide 2011-2012 Edition (2010). Retrieved from http://www.celiac.com Gluten-free foods and beverages in the U.S., 3rd edition (2011). [Abstract]. Retrieved from http://www.packagedfacts.com/gluten-free-foods-2710664/. Kumar, A., Meena, M., Begum, N., Kumar, N., Gupta, R., Aggarwal, S., … Batra, S. (2011). Latent celiac disease in reproductive performance of women. Fertility and Sterility, 95 (3). Retrieved from http://www.sciencedirect.com.proxy.lib.utk.edu:90/science?_ob=ArticleURL&_udi=B6T6K-51J7CKJ1 _user=422010&_coverDate=03%2F01%2F2011&_rdoc=1&_fmt=high&_orig=gateway&_ origin=gateway&_sort=d&_docanchor=&view=c&_acct=C000019958&_version=1&_urlVersion=0&_ userid=422010&md5=bb3948f241708c1fad3ab61d000f093d&searchtype=a

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