The details on 'gluten-free' labeling

The only treatment for celiac disease is a gluten-free diet. Anyone who is newly diagnosed should realize that "the learning curve is steep" for leading a gluten-free lifestyle, says registered dietitian Tricia Thompson in the February 2012 issue of Practical Gastroenterology.

One of the big eye-openers for celiac disease is the ever-present need to read labels on processed foods. It's imperative to avoid gluten -- the naturally occurring proteins in wheat and a handful of other grains.

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Thompson is the founder of Gluten Free Watchdog and advocates for accurate information for celiac patients. In "Celiac Disease: What Gluten-Free Means Today," Thompson gives a rundown on how to interpret the proposed Food and Drug Administration rules on gluten-free labeling that are scheduled to be finalized in 2012.

For a food to be labeled gluten-free:

-- It cannot contain barley, wheat of any kind, rye or triticale.

-- It cannot contain an ingredient that is derived from any of these prohibited grains unless it has been processed to remove gluten. Thus, a consumer will have to pay attention to labeling for items such as wheat germ, wheat bran, barley malt extract or flavoring, malt vinegar and certain flours.

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-- It can contain an ingredient derived from a prohibited grain as long as the gluten-removing process leaves less than 20 parts per million of gluten in the product. This can include products such as wheat starch, modified food starch from wheat and dextrin.

-- Generally, the product must contain less than 20 ppm of gluten, which is considered the threshold for keeping celiac patients safe from adverse reactions.
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Thompson's article includes a chart called "Categories of Food Allowed on a Gluten-Free Diet," which warns about processed foods not labeled gluten-free.

The chart also points out that oats -- although they can be a good addition to a celiac patient's diet -- can sometimes be contaminated with gluten. It's important to choose oats and oat products that have been labeled gluten-free, she writes. 

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Another area of concern is the category of grains that are inherently gluten-free, such as corn, rice, millet, sorghum, buckwheat and quinoa, yet could be cross-contaminated with gluten during processing.

Celiac patients buying gluten-free grains, gluten-free flours and products made from these grains and flours might want to follow Thompson's recommendation to buy products with the gluten-free label whenever possible.

"It is essential that patients receive up-to-date, timely, and ongoing counseling from a registered dietitian proficient in CD (celiac disease) and the GFD (gluten-free diet)," Thompson concludes.

A consumer-oriented article on the FDA website notes that most people have digestive systems that can tolerate gluten, but for those with celiac disease the ingestion of gluten is a serious health threat.

The FDA says that its definition of gluten-free will eliminate uncertainty about how food producers may label their products. In addition, new labeling will assure consumers who must avoid gluten that the gluten-free label meets a clear standard enforceable by the FDA.