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LRM Social Science and Medicine Article.pdf


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Social Science & Medicine 105 (2014) 76e83

Contents lists available at ScienceDirect

Social Science & Medicine
journal homepage: www.elsevier.com/locate/socscimed

“But we’re not hypochondriacs”: The changing shape of gluten-free
dieting and the contested illness experience
Lauren Renée Moore
University of Kansas, Department of Anthropology, 1415 Jayhawk Boulevard, Fraser 622, Lawrence, KS, USA

a r t i c l e i n f o

a b s t r a c t

Article history:
Available online 22 January 2014

“Gluten free” exploded onto the American foodscape in recent years: as of January 2013, 30 percent of
U.S. adults reported reducing or eliminating gluten in their diets. How do individuals participate in the
expansion of gluten-free dieting, and what are the implications of that expansion? This article is based on
31 in-depth, semi-structured interviews conducted between May and October 2012 with gluten-free and
-restricted persons. I identify three interrelated factors contributing to the expansion of gluten-free
dieting among non-celiacs. Participants broaden the lay understanding of gluten-related disorders, undermine biomedical authority, and diagnose others. Such participant-driven change, termed selfascriptive looping, is one factor in the diet’s rapid popularization. I show how participants question
the doctorepatient relationship and increase social contestability for other dieters. My findings challenge
previous work on contested illness and suggest food intolerances may require a reconceptualization of
contested illness experience.
Ó 2014 Elsevier Ltd. All rights reserved.

Keywords:
United States
Gluten free
Self-ascriptive looping
Illness prototypes
Contested illness
Food intolerance

Introduction
Matilda and her daughter, Amy, were in a café booth when I
arrived for our interview. They sat side by side, admiring the
gluten-free cinnamon bun on the table in front of them. “This is
wonderful,” Matilda said, indicating the bun. “We never get to eat
stuff like this anymore.”
In the hour and a half we chatted over coffee, the cinnamon bun
disappeared little by little. The lack of urgency with which they ate
became a focus of conversation, evidence of Matilda’s success on a
gluten-free diet.
I’ve never been able to stop eating solely by willpower at any
other time in my life. I’m not hungry. I mean, look at [the half
eaten bun]. I am so full, I can’t even imagine eating the rest of
that. Before, I would eat two of those and still be hungry. If that
were really gluten, I would have eaten the whole thing.
Going gluten free used to occur under a doctor’s supervision. The
restrictive diet was largely unknown in popular culture, and anyone
eliminating gluten earlier than a few years ago struggled to find
suitable foods or maintain regular social activities (Lee & Newman,
2003). It recently has become a popular dietary option in the
United States. As of January 2013, 30 percent of U.S. adults report

E-mail address: LaurenRMoore@ku.edu.
0277-9536/$ e see front matter Ó 2014 Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.socscimed.2014.01.009

reducing or eliminating gluten in their diets (NPD Group, 2013).
Restaurants and grocery stores are beginning to accommodate this
trend, and retail sales of gluten-free products have increased almost
28 percent in the last 10 years to become a four billion dollar market
(Packaged Facts, 2012; Sapone et al., 2012). In addition to increased
diagnoses of celiac disease (CD), the autoimmune disorder where
the diet originated, it is now used to treat a host of symptoms, and is
often pursued without medical supervision.
Despite its growing popularity, the examination of gluten free
dieters is nearly absent from social scientific scholarship. How do
individual dieters participate in the expansion of gluten-free dieting, and what are the implications of that expansion? This study
examines how these changes challenge gluten-related disorders’
(GRD) classification as contested illnesses in social scientific literature, and how participants challenge biomedical authority
through their diet.
Gluten is a protein found in wheat, barley, and rye. Gluten
elimination originated as the only treatment for celiac disease, an
“autoimmune disease that damages villi in the small intestine,
preventing proper absorption of vitamins and minerals” (Copelton
& Valle, 2009, p.623). Until recently, medical professionals thought
celiac was rare; many were shocked when a large 2003 epidemiological study found one in 133 Americans has the disorder (Fasano
et al., 2003; O’Brien, 2011). Attention to celiac and other glutenrelated disorders has since increased dramatically.
This article, based on in-depth interviews with 31 non-celiac
gluten-free individuals, shows some of the ways these individuals