General Health - Is it really gluten free?
New labelling legislation - what you need to know
New legislation from Brussels for the labelling of gluten-free foods is currently in effect. Understanding these changes will affect the everyday life of anyone wishing to avoid gluten in their diet. Here’s what you need to know:
The Codex Standard
There is a level of gluten which is considered safe to eat for people who have coeliac disease and sensitivities to gluten. This level, which is the amount of gluten allowed in gluten-free products, is known as the Codex Standard. The Codex standard for gluten is decided by an international body called the Codex Alimentarius Commission, which works to protect the health of consumers and ensure fair trade practices in the food trade.
Until recently, the standard for gluten-free labelling was set at a level of 200mg gluten/kg or 200 parts per million (ppm). This standard was changed in July 2008 to a dual standard.
Foods containing less than 20ppm gluten will be labelled ‘gluten-free’. This may apply to specialist substitute gluten-free products like breads, flours and crackers, which may contain Codex wheat starch (products mainly on prescription), as well as naturally gluten-free mainstream products like soups, baked beans and crisps. The gluten-free label may also be used for pure, uncontaminated oat products.
The term gluten-free implies no gluten but, in practice, a zero level does not exist. It is impossible to eat a zero gluten diet, because even naturally gluten-free cereals such as rice can contain up to 20ppm or 20mg/kg of gluten. Research shows that this tiny amount of gluten is not toxic to people with coeliac disease, who can eat unlimited amounts of products with gluten at a level of <20ppm.
Foods containing between 20 and 100ppm gluten will be labelled as ‘very low gluten’. This will include specialist substitute products (such as breads and flour mixes) that contain Codex wheat starch.
The aim of the dual approach is to provide safer limits overall and allow a clearer choice of products for people with coeliac disease. The thinking behind the new labelling requirement reads as follows: Different people with intolerances may tolerate small amounts of gluten within a restricted range. In order to enable individuals to find a variety of foodstuffs appropriate to their level of sensitivity, a choice of products should be available with different low levels of gluten within such a restricted range. It is important, however, that the different products should be properly labelled to ensure the correct use of these products.”
This change in the way low gluten products will be labelled will be complete by January 2012 but labels are already being produced which show these new descriptions.
For certain clients with coeliac disease, the new legislation may be particularly beneficial, since everyone with coeliac disease is different in terms of their sensitivity to gluten. Most can tolerate a low level of gluten without ill effects. However, some people with coeliac disease are more sensitive and can only eat foods with less than 20ppm gluten (those labelled ‘gluten-free’). This new labelling helps people to adopt a gluten free diet suited to their needs and levels of sensitivity. It will mean, however, that previously gluten-free foods may not comply with the new lower Codex Standard (and will no longer be labelled gluten-free) which may cause confusion for clients.
For practitioners, it is worth noting that a level of gluten 100ppm (very low gluten) is tolerated by people with gluten intolerances or coeliac disease. However, overconsumption of these foods on a daily basis can cause problems in certain people. In contrast, individuals will be able to eat unlimited amounts of foods that contain less than 20ppm (gluten-free foods). The following checks can be used for individuals who are changing the range of gluten-free foods they are eating but may not be showing any symptoms:
Review antibody levels
Monitor weight and BMI
Nutritional screening tests e.g. iron, calcium, B12, folate; plus liver and bilirubin tests
When advising clients on allergen labelling’ it is worth remembering that cereals which contain gluten (wheat, rye, barley, oats, spelt, kamut or their hybridised strains) are one of the 14 food allergens that must be declared on the ingredients list, regardless of the amount used. In addition, manufacturers can also highlight an ingredient which contains gluten in an allergy advice or ‘contains’ box which is recommended by the Food Standards Agency. However, this allergy box is not compulsory so it is important for clients to check the ingredients list carefully. If gluten is not present, it will not necessarily to be labelled as gluten-free. Some manufacturers also use the Crossed Grain symbol – recognised by Coeliac UK for gluten-free foods. Coeliac UK also produces a Food and Drink Directory which lists foods which comply with the new labelling legislation.
When looking at ingredients, check labels carefully as it is not always obvious which items contain gluten. The following terms are not gluten-free: wheat and oat bran, farina, barley malt, MSG, wheat rusk, wheat starch and modified wheat starch. Malt extract is most commonly prepared from barley, although it can be produced from other grains. It is widely used in small amounts in the food industry as a flavour enhancer. For example, it is used as an ingredient in most brands of breakfast cereals and many other branded manufactured products. The quantity of barley malt extract used in products can vary. Products containing barley malt extract in low levels that meet the Codex Standard can be tolerated by most people with gluten sensitivities, including coeliac disease. Food products high in barley malt, such as malted drinks, are not suitable for people with coeliac disease.
To add to the confusion, gluten-free foods may contain Codex wheat starch, which is a specially manufactured wheat starch that has been processed to remove the gluten to a trace level which is within the Codex standard. This is often used in gluten-free foods on prescription and is safe for the majority of people with coeliac disease and gluten sensitivities. It must always appear in an ingredients list if it has been used.
The vast majority of oats and oat products on the market are contaminated with wheat, rye and/or barley. Processing, such as milling, makes them generally unsuitable for people with coeliac disease. Under current food allergen labelling, oats are classed as a gluten-containing cereal. If oats have been used as a deliberate ingredient, they must be declared on the ingredients list. If a manufacturer chooses to use an allergy advice box (which is not compulsory) patients will see the term ‘contains oat gluten’. Pure, uncontaminated oats may, however, be included under the new ‘gluten-free’ label. However, some coeliacs may react to even to pure, uncontaminated oats so should be considered for inclusion only on an individual basis.
Fortunately, infant foods and follow-on-formulae are not included in the same regulations but are considered under dedicated strict regulations relating to these very important food groups.
To help your clients adopt a gluten-free diet, bear in mind there are lots of healthy, nutritious alternative grains including rice, millet, quinoa, corn, buckwheat, amaranth, tapioca, teff and sorghum. These are available as the whole grain or made into flour, crackers, breads, pasta and cereals. Other useful flour substitutes include potato, yam, soy, arrowroot, coconut flour, ground nuts, cassava and gram or chickpea flour. Gluten-free flour mixes are also available.
Since gluten provides the elastic quality needed when baking, you’ll need to make up for this to provide a similar texture. Two useful ingredients are xanthan gum and guar gum, which are readily available in health shops and some larger supermarkets. Substitutes for thickeners include agar, arrowroot, cornflour, kudzu, tapioca and xanthan gum. Higher Nature has produced a recipe book featuring their omega excellence products and includes many gluten free, nutritious recipes.
Higher Nature will continue to identify whether its products ‘do not contain gluten, wheat, etc.
For Higher Nature, ‘gluten-free’ will continue to mean ‘absence of gluten’ because we identify the source of all ingredients, we know if wheat or other grains have been part of the manufacturing process of other ingredients. Where a gluten -containing grain, such as wheat, is a starter material for maltodextrin, for example, we take the view that it is better to identify this and allow practitioners and consumers to make individual decisions on the suitability of the product.
If you are not sure where the gluten may be present in any of our products, our helpful team of nutritionists are at hand to advise.
It is now known that coeliac disease affects far more people than previously thought – up to one in 100. However only one in 8, or 12.5%, of these has been diagnosed. This is an auto-immune disease, where the body produces antibodies that attack its own tissues.
This attack is triggered by the protein gluten and can lead to malabsorption and malnutrition. The only treatment is a life-long, gluten-free diet. Common symptoms include abdominal pain, nausea, constipation, diarrhoea, tiredness, anaemia, headaches, mouth ulcers, weight loss and skin problems. However some people with coeliac disease may not show any obvious symptoms at all. A variety of tests are available. Typically the first test is an anti-tissue Transglutaminase Antibody (TTG), IgA or an antiendomysial antibody (EMA), IgA. If the initial screening anti-TTG, IgA is moderately or strongly positive, or both tests (TTG, IgA and EMA, IgA) are positive, it is likely that the patient has coeliac disease. The doctor may then arrange an intestinal biopsy to confirm that there is damage to the intestine – this is the gold standard for diagnosis. Additional tests include IgA antibodies, serum IgA levels (about 2-3% of coeliac patients are IgA deficient). Other tests may also be conducted to assess malnutrition and malabsorption which is common in coeliacs. It is important to ensure a patient is eating gluten before a test is conducted. If gluten has already been eliminated prior to testing then auto antibodies may not be detectable. In this case you will need to advise your client to put gluten back into their diet for at least four weeks before testing can be considered.