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    Jefferson Adams

    Gluten-Free Restaurant Food Often Contains Gluten

      Crowd sourced Nima study reveals restaurant food labeled gluten-free often contains gluten.

    Caption: Image: CC--Nima Labs

    Celiac.com 04/05/2019 - Avoiding gluten is literally the most important dietary practice for people with celiac disease. A gluten-free diet is the only way to avoid major health problems down the line.

    Until now, anyone on a gluten-free diet looking to eat food in restaurants had to rely on lots of detective work, gathering information from menus, word of mouth, intuition, and restaurant workers' advice, with little or no supporting data. 

    Portable Gluten Detection Data Drives Restaurant Study

    With the development of handheld gluten detection devices, like Nima, it’s now possible to take some of the guesswork out of equation by testing small bits of food on site in real time before it is consumed.

    A team of researchers recently analyzed data from Nima portable gluten detection devices, collected across the United States during an 18-month period by users who opted to share the results of their point-of-care tests.

    The research team included Lerner, Benjamin A., MD; Lynn T. Phan Vo, BA; Shireen Yates, MBA; Andrew G. Rundle, Dr PH; Peter H.R. Green, MD; and Benjamin Lebwohl, MD, MS.

    They are variously affiliated with the Department of Medicine, Celiac Disease Center, Columbia University Medical Center, New York, NY, USA; the Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA; and with Nima Labs in San Francisco, California, USA.

    The study team used crowd-sourced data from users of a portable gluten detection device to estimate gluten contamination rates and identify risk factors in supposedly gluten-free restaurant foods

    Opt-In Study Shares Gluten Data with Researchers

    The team analyzed data voluntarily shared by users of Nima gluten detection devices to check restaurant meals across the United States during an 18-month period. The team sorted data by region, restaurant type, food items, time of day, and median household income near the restaurants tested. 

    The team used the χ2 test for bivariate analysis and multiple logistic regression for multivariate analysis to identify predictors of gluten detection in restaurant food.

    Gluten Found in One-Third of Gluten-Free Restaurant Foods

    In all, the data included 5,624 tests, conducted by 804 users over 18 months. Data showed gluten in just under one-third of foods advertised as Gluten-Free in restaurants. Gluten detection was highest with dinner foods, at 34.0%, compared with 27.2% for breakfast tests (P = 0.0008). 

    Pizza & Pasta Major Gluten Culprits

    Of all the foods tested, pizza and pasta labeled as gluten-free were most likely to test positive for gluten, with gluten detected in 53.2% of pizza and 50.8% of pasta samples. 

    On multivariate analysis, food sold as gluten-free was less likely to test positive for gluten in the West than in the Northeast United States, yielding an odds ratio of 0.80 and a 95% confidence interval 0.67–0.95). This analysis of crowd-sourced data suggests that a high percentage of restaurant foods labeled gluten-free contain detectable gluten, especially pizza and pasta, where it’s over 50%.

    The Nima device is highly accurate and very sensitive to gluten. In some cases, Nima may detect levels below 20ppm. So, in theory some of these readings might be for foods that are actually gluten-free. Still, these findings are alarming. 

    The team’s findings of high rates of gluten contamination in general, and in pizza and pasta, in particular, are a sobering reminder for people with celiac disease to choose carefully when dining out. Please be careful when eating out. Stay tuned for the latest news and information regarding gluten contamination in food labeled gluten-free.

    Read more at American Journal of Gastroenterology: March 26, 2019

    Discosure: Nima is a paid advertiser on Celiac.com, but publication of this summary is not influenced by their ad.

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    Well, I'm glad there is a study to back this up, but honestly, it's not news to me.  Out of approximately every 10 visits to a restaurant that gave me 'gluten free' food I would estimate that 8 or 9 of those visits gave me a reaction.  A lot of the servers/cooks/staff are genuinely trying, but I stopped going to these places.  I just don't think they have the facilities and/or understanding to make a safe meal.  Cooking at home is just the best prospect for me at the moment.  Don't know how in the world I'm going to travel anywhere... .

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    2 hours ago, Ging said:

    Well, I'm glad there is a study to back this up, but honestly, it's not news to me.  Out of approximately every 10 visits to a restaurant that gave me 'gluten free' food I would estimate that 8 or 9 of those visits gave me a reaction.  A lot of the servers/cooks/staff are genuinely trying, but I stopped going to these places.  I just don't think they have the facilities and/or understanding to make a safe meal.  Cooking at home is just the best prospect for me at the moment.  Don't know how in the world I'm going to travel anywhere... .

    I fully agree, not only that but the restaurants have their butt's covered by the statement normally located on the Gluten Free menu or under the foods listed Gluten Free stating they cannot guarantee the food has not been cross contaminated! Or this is what's listed on the menu's I've viewed in the past at the restaurants where I'm located!

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    It’s no wonder pizza and pasta are the biggest culprits.  Think about the usual restaurant kitchen environment where pizzas and pasta are made...wheat flour is often in abundance and anyone who bakes knows flour can get in the air and settle everywhere.  As far as pasta goes, gluten-free pasta might get boiled in the same pots or even in the same water that was already used to boil regular wheat pasta.  I try to avoid restaurants where wheat or gluten-containing flour is used for fresh baking and I’ve learned not to trust gluten-free pasta in most restaurants.  I’ve had best luck with steakhouses, Mexican food places (make sure those corn tortilla are made with corn only - no wheat added), and sometimes Indian and Thai restaurants.  I avoid places that tout their own on-site baking, and Italian places in general (lots of pizza and pasta creation).

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    Guest Made in Finland

    Posted

    When it comes to traveling overseas and making sure the advertised gluten free food really IS gluten-free, I recommend to visit my natal Finland! Apart from extensive gluten-free menus at restaurants, you can also get gluten-free sandwiches and whatever pastries like everyone else when you stop at a gas station. No more "hmmmm, I'm hungry, but no FG stuff to buy" - everything everyone else can buy, you can buy a gluten-free version of. It's made separately and tastes just as awesome as regular versions! Yum! No more second guessing. In general, I've seen more gluten-free products there than anywhere else in the world, and I've lived and traveled around the world (now living in the U.S.) 😉😊  

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    As someone with "silent" celiac (no overt physical reaction) I rely on the website Findmeglutenfree.com where I can read about the experiences of other people with celiac at specific restaurants.  That usually gives me confidence when choosing a safe restaurant.  When there are no reviews or the reviews are old, I have to go with talking to a manager and emphasizing with my server the importance of avoiding gluten for me. 

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  • About Me

    Jefferson Adams earned his B.A. and M.F.A. at Arizona State University, and has authored more than 2,000 articles on celiac disease. His coursework includes studies in biology, anatomy, medicine, science, and advanced research, and scientific methods. He previously served as Health News Examiner for Examiner.com, and devised health and medical content for Sharecare.com. Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of the book "Cereal Killers" by Scott Adams and Ron Hoggan, Ed.D.

  • Related Articles

    Tracy Grabowski
    Celiac.com 11/28/2016 - The title of my article might seem a little shocking to most of the celiac community. Why wouldn't I want restaurants to offer high quality, safe meals to those who suffer from celiac disease or from non-celiac gluten intolerance so they could also enjoy dining out with their family and friends like everyone else? It's not that I don't want restaurants to offer gluten-free options: I do. But, I want them to be high quality, high integrity, and offered by a properly trained and knowledgeable staff. Otherwise, I truly don't think your establishment should bother offering gluten-free options to your diners and guests.
    The truth is that genuinely gluten-free dishes should be more than just replacing a bun, or using a corn or rice version of pasta in your dishes. Claiming to be "gluten-free" or "celiac-friendly" needs to go much further than just claiming such or simply swapping a product for your gluten-free diner.
    Without the benefit of training and education, many restaurants are not going to take into account any cross-contamination factors such as where the food is prepared, or who has touched it (and what did they touch last?) or where the plate was prepped and cleaned. It doesn't consider the air-borne flour coating almost every surface of a bakery or kitchen, and, it certainly doesn't involve investigating ingredients in the finished dishes for "hidden" sources of wheat, rye, or barley whose derivatives (such as malt or "flavorings") might be lurking around the kitchen and in prepared foods.
    There are so many sources of cross-contamination that are simply not explored, or may not even be known by a dining establishment. Unless a typical restaurant or bakery staff is well-versed and knowledgeable in what to look for, the questions to ask, and the proper procedures that will ensure a safe dining experience for gluten-free guests, and until all of the sources of cross contamination are explored and eliminated, it is highly doubtful that a gluten-free dish is truly gluten-free at all.
    With the FDA's recent updates to the gluten-free standard, restaurants, bakeries and dining establishments need to start following suit. Anyone offering a gluten-free meal should be aware that not only are their customers expecting adherence to the 20ppm of gluten (or less) standard that has been accepted as the standard for certifying something is gluten-free, but that the FDA expects their dining establishment to live up to that standard.
    As with any product that comes to market with a claim, restaurant menus are subject to abide by the same guidelines. For instance, if you claim something is "reduced fat", then it better, by all means, be reduced fat from the original version of the same dish. The same principal applies to gluten-free dishes with the standards taking full affect in the summer months of 2014. If your restaurant claims it is gluten-free, then it better be gluten-free, and not just "assumed" gluten-free.
    Living in blissful ignorance can not be an option for restaurants or for any establishment offering gluten-free products. As with any other food allergy or intolerance (FAI) there can be dire consequences for not adhering to procedures for safe preparation and service of food. Not to mention the damage that can be done to an establishment's reputation should the word get out that their integrity or food knowledge is questionable.
    Personally, I believe restaurants have a lot to gain in terms of offering gluten-free meals, or menu options in their establishment. I believe that restaurants who establish—and enforce- gluten-free procedures to eliminate cross contamination, accidental exposure, and provide training to their staff can benefit greatly in terms of business growth and satisfied repeat guests and their referrals from gluten-free diners to both gluten-free dieters and "traditional" diners alike.
    Gluten-free diners, just like all diners, place a great deal of faith and trust in people who prepare their meals at restaurants, diners, bakeries and cafes. With this great measure of trust being established at the first encounter with a restaurant guest, it pays to educate everyone from host/hostess to head chef on the proper way to handle gluten-free meals, and for that matter, all FAI's.
    That is why I recommend that until you are completely certain that your food is gluten-free, and that your staff is in complete compliance with your establishment's gluten-free policy, it is probably better that your establishment NOT offer gluten-free menu options. Those with gluten intolerance and celiac disease would appreciate your honesty and your integrity in doing so. The good news is that we'll be willing to become your dinner guests when you can honestly say that your kitchen staff, servers, management team, and even your host or hostess are educated, trained, and 100% on-board with providing a safe gluten-free experience for all of us.
    Trust and integrity go a long, long way for those of us with special dietary needs.

    Celiac.com Sponsor: Review
    After years of dreaming about such a device, a pocket-sized home gluten sensor is finally here!
    I received mine and immediately began testing products that I eat often, just to make sure that they are really gluten-free. It is well known that even products that are labeled gluten-free sometimes test positive for gluten.
    After opening a fairly large box that it was beautifully packaged in, I was surprised to see that it is indeed pocket-sized! The quick start guide allowed me to run a test almost immediately, and the first product I tested was a can of re-fried black beans that I eat regularly on corn tostada shells.
    The test was very simple to run: I took a pea-sized sample of the beans and put them in the one-time-use capsule, inserted the capsule into the sensor, pressed start and waited about 3 minutes. The sensor made some noises while running, and then I saw a smiley face appear, which meant that my beans were safe and below 20 ppm (if the wheat icon shows up it isn't safe).
    Another key feature Nima offers is their smartphone app that allows you to share and upload test results with other Nima users.
    If you are looking for the ultimate peace of mind, I highly recommend Nima Sensor!
    For more info visit their site.

    Jefferson Adams
    Celiac.com 09/14/2018 - Celiac.com was all set to do a story on the latest peer-reviewed data on the Nima gluten testing device, when along comes Gluten-Free Watchdog with another of their famous non-recommendations. Gluten-Free Watchdog says they cannot recommend the Nima gluten test kit because of alleged flaws.
    But what does the science say? The latest Nima article and Gluten-Free Watchdog’s complaint both focus on the science, so let’s start there.
    Nima makes two different food sensors: one detects gluten, the other detects peanuts. Each sensor comprises a small, handheld electronic device and a cartridge. To test food, consumers place a pea sized amount into the cartridge, place the cartridge inside the sensor, and run the device.  They then receive a smiley face or wheat symbol with "gluten found," depending on whether or not the Nima device detected the allergen.
    Nima reported their original data in a peer-reviewed scientific journal. Among the conclusions: “Compared with reference R5, Nima antibodies (13F6 and 14G11) had 35- and 6.6-fold higher gliadin affinities, respectively. Nima demonstrated device performance using a comprehensive list of foods, assessing detection sensitivity, reproducibility, and cross-reactivity. Nima presented a 99.0% true positive rate, with a 95% confidence interval of 97.8%–100%.”
    Gluten Free Watchdog says that:
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    It’s worth noting that for all his accomplishments, Rogers is neither a doctor, nor a PhD. Rogers' LinkdIn page lists his education as: Bsc (Hons), Microbiology, University of Wales, Aberystwyth. A Bachelor of Science degree may not necessarily make an expert in this subject, yet he is presented as one.
    Rogers also seems to have a potential conflict of interest that was omitted in Thompson’s press release. Directly from Rogers’ LinkdIn site:
    “Romer Labs®, Inc. developed an immunochromatographic lateral flow assay for the qualitative detection of gluten in raw ingredients, processed foods, finished food products, and environmental surfaces, using the G12 antibody developed by Belén Morón. The G12 antibody targets a 33-mer peptide which is resistant to enzymatic digestion and heat denaturation, as well as being the fragment of the gliadin protein to which celiac disease sufferers react, making it a reliable analytical marker.” The company Rogers works for, Romer Labs, makes its own gluten testing kits. It seems a bit disingenuous for Gluten Free Watchdog to use a spokesperson from a potentially competing company to try to counteract a peer-reviewed scientific publication for a device which is made by a potential competitor.
    Nima’s Scientific Advisory Board includes some of the most highly respected celiac disease researchers and scientists in the world. They include: Peter HR Green, MD Phyllis and Ivan Seidenberg Professor of Medicine. Director, Celiac Disease Center at Columbia University; Jody Puglisi, PhD Stanford University Professor of Structural Biology; Lucille Beseler, MS, RDN, LDN, CDE, FAND Family Nutrition Center of South Florida; Benjamin Lebwohl, MD, MS Director of Clinical Research Celiac Disease Center at Columbia University; John Garber, MD Gastroenterology, Mass General; and Thanai Pongdee, MD Consultant, Division of Allergic Diseases, Mayo Clinic.
    Nima says that Gluten Free Watchdog’s view of their recently published validation is incomplete and misleading. Nima wrote:
    “All the studies show Nima is highly sensitive across a range of both low and high levels of gluten." "The Nima third party data accurately reported gluten found at 20 ppm and above between 93.3% for food as prepared (a food item that is spiked with an intended quantity of gluten) and 97.2% for food as quantified by an ELISA lab kit (used to determine the exact ppm of gluten in the food)." "The Nima peer reviewed study published in the Food Chemistry Journal reported gluten found at 20 ppm and above at 96.9% accuracy." The statement that:
    “'Nima will fail to detect gluten at 20 ppm 20% of the time' is almost entirely driven by 1 specific food out of 13 tested. That sample, when quantified, was actually below 20 ppm." "In real life, people get glutened at many different ppm levels, not just 20 ppm. Nima has been shown to detect gluten at levels below, at and above 20 ppm across a variety of foods in a number of studies.” Reading the peer reviewed data provided by Nima, and reading Gluten Free Watchdog’s complaints, it becomes clear that Gluten Free Watchdog’s complaints sound serious and authoritative, but ring a bit hollow. 
    Consider the Following Analogy
    Imagine a gluten-sniffing dog that performed as well as Nima in scientific trials; same performance, same exact data. 
    You can give this dog a sniff, or a small bite of food, and he can signal you if the food’s got gluten in it with 97% accuracy at 20ppm or below. Nearly 100% accuracy at 40ppm or above (as stated by Gluten Free Watchdog).
    People would think that the dog was not only cute and fluffy, but wonderfully helpful and everyone would love it, and everyone with celiac disease would want one. And it would be a great big gushing warm and fuzzy feel-good story. Pretty much no one would be arguing that the dog was potentially dangerous, or somehow unfit for people with celiac disease. Such dogs would also be far more expensive to own and maintain than the Nima device. Apparently such dogs can cost upwards of $16,000, not including the cost of food, vet bills, etc.
    So, what’s the accuracy rate of a gluten-sniffing dog, anyway? From Mercola.com: Willow, a German shorthaired pointer, is another gluten-sniffing dog, in this case living in Michigan. Her owner, Dawn Scheu, says she can detect gluten with 95 percent to 98 percent accuracy. She worked with a trainer (the same one who trained Zeus) to teach her own dog to detect gluten, with excellent results.
    Gluten-sniffing dogs may detect gluten in amounts as small as .0025 parts per million with 95 percent to 98 percent accuracy. So, will Gluten Free Watchdog be warning against gluten-sniffing dogs anytime soon?
    Somehow, because Nima is a mechanical device made by a company, it's not so warm and fuzzy, not so feel-good. Maybe Nima needs to shape their device like a cute little doggy, or a Pez candy dispenser?
    But the data remains, as does the fact, whatever its drawbacks, anything that detects gluten like Nima does, as well as it does, is potentially very helpful for celiac disease in numerous situations. And it is extremely unlikely to do them any harm.
    Nima seems very much committed to transparency, scientific excellence, and continual product improvement. These are noble goals and generally a win for people with celiac disease. Think of it, just ten years ago, a portable gluten-sensor with the kind of accuracy Nima is reliably achieving would have been the stuff of fantasy. Yet here it is. More accurate than any gluten-sniffing dog, and for a couple hundred bucks. People with celiac disease are living in a very different world than just a few years ago.
    Nima did not have to publish its data, but it chose to do so, and in a reputable, peer-reviewed scientific journal. Nima conducted its research using solid scientific standards, and reported those results publicly. They explained their methodology and results, they acknowledged product limitations and expressed a commitment to improvement. How is this remotely controversial?
    The celiac disease community is fortunate to have companies committed to investing time and money into products and devices that help to improve the lives of people with celiac disease. We feel strongly that the perfect should not be the enemy of the good. Devices like the Nima gluten sensor can be helpful for numerous people with celiac disease.  
    Disclosure: Nima is a paid advertiser on Celiac.com. Celiac.com's advertisers do not influence our editorial content. 
    Read Nima’s full report on test data at: Food Chemistry.com Read Gluten Free Watchdog’s Statement on the Nima device at: Glutenfreewatchdog.org Read Nima’s Reply to Gluten Free Watchdog at: Nimasensor.com

    Jefferson Adams
    Celiac.com 10/15/2018 - If you’re on a gluten-free diet for medical reasons, then you’re probably already cautious about eating out. A new study tells us exactly why people with celiac disease and other gluten-sensitive conditions have reason to be very careful about eating out.
    According to the latest research, one in three foods sold as "gluten-free" in U.S. restaurants actually contain trace levels of gluten.
    This is partly due to the fact that the gluten-free diet has become popular with many non-celiacs and others who have no medical need for the diet. That has led many restaurants to offer gluten-free foods to their customers, says study author Dr. Benjamin Lebwohl, of Columbia University's Celiac Disease Center. 
    But, if this research is any indication, too many restaurants don’t do a good job with gluten-free. For the study, more than 800 investigators set out to assess the true gluten content of dishes listed as "gluten-free" on menus. Armed with portable gluten sensors, they tested for gluten levels that met or exceeded 20 parts per million, the standard cutoff for any gluten-free claim.
    Based on more than 5,600 gluten tests over 18 months, the investigators determined that 27 percent of gluten-free breakfast meals actually contained gluten. At dinner time, this figure hit 34 percent. The rise could reflect a steady increase in gluten contamination risk as the day unfolds, the researchers said.
    Off course, the risk is not all equal. Some restaurants are riskier than others. Unsurprisingly, the biggest culprit seems to be restaurants that offer gluten-free pastas and pizzas. Nearly half of the pizza and pasta dishes from those establishments contained gluten, according to the study.
    Why is that? Well, as most folks with celiac disease know all too well,  kitchens aren’t really set up to segregate gluten, and "sharing an oven with gluten-containing pizza is a prime setting for cross-contamination," says Lebwohl. Also, too many restaurants use the same water to cook gluten-free pasta as they do for regular pasta, which contaminates the gluten-free pasta and defeats the purpose.
    Moreover, although the U.S. Food and Drug Administration regulates gluten-free labels on packaged food products, there is currently no federal oversight of gluten-free claims in restaurants. 
    The results of the study will be presented today at a meeting of the American College of Gastroenterology, in Philadelphia. Research presented at meetings is usually considered preliminary until published in a peer-reviewed medical journal.
    In the absence of federal enforcement at the restaurant level, the burden for making sure food is gluten-free falls to the person doing the ordering. So, gluten-free eaters beware!
    These results are probably not surprising to many of you. Do you have celiac disease? Do you eat in restaurants? Do you avoid restaurants? Do you have special tactics?  Feel free to share your thoughts below.
    Read more at UPI.com

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