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      Frequently Asked Questions About Celiac Disease   04/24/2018

      This Celiac.com FAQ on celiac disease will guide you to all of the basic information you will need to know about the disease, its diagnosis, testing methods, a gluten-free diet, etc.   Subscribe to Celiac.com's FREE weekly eNewsletter   What is Celiac Disease and the Gluten-Free Diet? What are the major symptoms of celiac disease? Celiac Disease Symptoms What testing is available for celiac disease?  Celiac Disease Screening Interpretation of Celiac Disease Blood Test Results Can I be tested even though I am eating gluten free? How long must gluten be taken for the serological tests to be meaningful? The Gluten-Free Diet 101 - A Beginner's Guide to Going Gluten-Free Is celiac inherited? Should my children be tested? Ten Facts About Celiac Disease Genetic Testing Is there a link between celiac and other autoimmune diseases? Celiac Disease Research: Associated Diseases and Disorders Is there a list of gluten foods to avoid? Unsafe Gluten-Free Food List (Unsafe Ingredients) Is there a list of gluten free foods? Safe Gluten-Free Food List (Safe Ingredients) Gluten-Free Alcoholic Beverages Distilled Spirits (Grain Alcohols) and Vinegar: Are they Gluten-Free? Where does gluten hide? Additional Things to Beware of to Maintain a 100% Gluten-Free Diet What if my doctor won't listen to me? An Open Letter to Skeptical Health Care Practitioners Gluten-Free recipes: Gluten-Free Recipes
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    FDA to Issue Gluten-Free Allergy Labeling Rule in 2012


    Jefferson Adams

    Celiac.com 04/26/2012 - A recent statement by the FDA announces that the agency is gathering data to respond to calls for an "alternative approach" to determining a specific gluten threshold level other than the proposed level of under 20 parts per million gluten as one of the criteria to define the term “gluten-free.”


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    The statement directly acknowledges that people with celiac disease must avoid gluten for life in order to prevent harmful health effects.

    Photo: CC--ms4jahThe statement also notes that, in 2011, the Agency, through its Center for Food Safety and Applied Nutrition (CFSAN) conducted the following actions involving accurate gluten labeling of food products: 

    It finished a safety assessment of gluten exposure in individuals with celiac disease, and that it had gotten that assessment peer-reviewed.

    This was done to gather more data regarding possible alternative approaches to establishing a specific gluten threshold level as one of the criteria to define “gluten-free.”  

    These would be alternative approaches that differ from the "analytical methods-based approach" used by the FDA in its proposed rule for "gluten-free" products. That proposal established product ingredients under 20 parts per million gluten as one of the criteria for defining the term “gluten-free.”

    The FDA statement also noted that CFSAN had published a Federal Register notice in August 2011, reopening the comment period on the Agency’s proposed rule on “gluten-free” food labeling. 

    The notice announces the publication of the FDA's safety assessment on gluten exposure in people with celiac disease, and asks for public comment on the safety assessment, and on any other issues that might affect the definition of the term “gluten-free” in the Agency's final rule. 

    Lastly, the statement announces that the FDA will review and consider those public comments before issuing its final rule defining “gluten-free” for labeling food products, including dietary supplements. The FDA intends to complete the entire process and issue the rule by the end of fiscal year 2012.

    Source:


    Image Caption: Photo: CC--ms4jah
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    Guest Heather

    Posted

    Does not really explain what (if anything) is changing - but it is nice to see that the FDA is taking the issue seriously.

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    Guest Linda

    Posted

    By definition "gluten-free" denotes that a product is "free" of all gluten proteins--as in Zero...(or am I missing something?)

    As a newly diagnosed celiac I'm concerned about any gluten exposure. I have been the recipient of cross-contamination (griddle not cleaned). It was not pretty.

    Wondering what the threshold for PPM might be before patients experience symptoms.

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    Guest admin

    Posted

    By definition "gluten-free" denotes that a product is "free" of all gluten proteins--as in Zero...(or am I missing something?)

    As a newly diagnosed celiac I'm concerned about any gluten exposure. I have been the recipient of cross-contamination (griddle not cleaned). It was not pretty.

    Wondering what the threshold for PPM might be before patients experience symptoms.

    There is not test for gluten that goes down to zero, so a level must be set somewhere. The lower the level, the more expensive the tests are. 20 ppm is a level deemed safe by many experts, and one that will not cause a drastic increase in price for products labelled "gluten-free."

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    Guest Donna

    Posted

    Am I the only one who is worried that the "alternative approach" they may be aiming for is something that does not include an actual measurement? For example, we know many things are "naturally gluten free", will that be sufficient to pass their labeling standards? I hope not, since it doesn't address cross-contamination! An analytical method is the only one that will make me happy.

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    Guest Denise Bryan

    Posted

    You are not the only one worried about their "alternative approach". I sure hope they don't do it that way. That would ease the requirements too much for some of us Celiacs that are sensitive to even the smallest amount of gluten.

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    Guest Jefferson

    Posted

    Am I the only one who is worried that the "alternative approach" they may be aiming for is something that does not include an actual measurement? For example, we know many things are "naturally gluten free", will that be sufficient to pass their labeling standards? I hope not, since it doesn't address cross-contamination! An analytical method is the only one that will make me happy.

    Be careful about your reading here. The FDA is NOT calling for an alternative approach. They are responding to calls FOR an alternative approach; most likely so they can then dismiss those calls and stick to the prevailing scientific approach. I would look for the FDS to set the level under 20ppm, similar to the European standard.

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    Guest Melissa

    Posted

    What I want to know is how can we all help? There must be something we can do to encourage new legislation that will protect our health!

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    Am I the only one who is worried that the "alternative approach" they may be aiming for is something that does not include an actual measurement? For example, we know many things are "naturally gluten free", will that be sufficient to pass their labeling standards? I hope not, since it doesn't address cross-contamination! An analytical method is the only one that will make me happy.

    I agree. So many people who don't have celiac disease don't understand how a small amount of contamination affects us people with celiac disease, especially in restaurants. They say the item is gluten-free but then fry it in the same oil that has been contaminated.

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    Scott Adams


    This update comes to us from Frederik Willem Janssen, The Netherlands: fwjanssen@WXS.NL
    About a week ago I promised to post info about agenda item 4 (Gluten Free Food) as dealt with at the meeting of Codex Alimentarius NFSDU (Nutrition and Food for Special Dietary Uses) which was held in September in Berlin Germany. As usual this meeting starts on Monday and continues till Wednesday, Thursday is a day off (time for the secretariat to draw resolutions) and on Friday these draft resolutions are discussed. Unfortunately I wasnt able to stay till Friday. However, the resolutions as discussed on Friday were handed to me afterwards however and I pass them with some corrective changes accepted during that day. For those of you who have no interest in reading this clerical stuff I summarize:
    The proposed limits (20) for food gluten-free by nature and 200 for food "rendered gluten-free" will stay between square brackets (so no decision has been made). The same holds for oats, awaiting further toxicological data about its celiac-toxicity it should be considered as toxic. The main obstacle for finalizing the standard is the lack of an appropriate method of analysis. Progress has been made but still not to that extent that enforcing agencies can be satisfied. Maybe we will see some progress in the next 2 years!
    Proposed Revisions: Alinorm 99/26, Draft Revised Standards for Gluten-Free Foods (Agenda Item 4):
    31. The Committee recalled that the Twenty-second Session of the CAC adopted the Proposed Draft Standard for Gluten-Free Foods at Step 5 while recommending that comments on methods of analysis and on amounts of gluten in gluten free foods should be taken into account when finalizing the standard. The Committee noted that without an appropriate method of analysis it was not scientifically justified to advance the Draft further.
    32. The Delegation of Sweden introduced their recent study on gluten determination in foods by an enzyme immunoassay using a monoclonal antibody against omega-gliadin (CRD 33), noting that the detection limit of the method (ref. AOAC 991.19) was about 20 - 40 ppm and the repeatability was acceptable. Some Delegations pointed out that the method presented raised some technical concerns: it was performed only on wheat and due to this, uncertainty exists as regards its applicability to other cereals. There were also concerns about the reproducibility of the method. It measured only omega-gliadin and other gliadins should also be taken into account. The need of further improvement was raised. Spain expressed concern about setting units where no method of analysis is available and not all the different types of gliadins can be detected.
    33. The Committee noted that in some cases a proprietary method was the most specific way to detect an analyte, such as in the case of gluten detection. Since Codex had not endorsed these techniques as methods of analysis of Codex, the CCMAS (Codex committee on Methods of Analysis and Sampling) should consider this problem.
    34. Several delegations suggested that the Committee should ask FAO and WHO to convene an Expert Consultation to address the issue of the level and the method of analysis. Other delegations proposed to consult the CCMAS on this issue. The Secretariat informed the Committee that on the request of the CCFL (Codex committee on Food Labeling), JECFA (Joint expert committee on Food Additives) was prepared to consider the question of hypersensitivity at its 53rd Session (June 1999) and the intolerance to gluten might be discussed in this context. The Secretariat recalled that the role of the CCMAS was to endorse methods of analysis proposed by specialized Committees and the CCNFSDU needed to specify the method.
    35. Several delegations and the Observer from the AAC (Association des Amidonneries Cooperative) proposed that the discussion of this draft should be adjourned until a reliable method of analysis became available. Other delegations were in favor of continuing work on it in order to meet the urgent need of the patients suffering from coeliac disease and proposed to advance the proposed draft for a single level of 200 ppm to step 8. Taking into account the absence of an appropriate and accurate method of analysis, it was proposed to maintain the gluten free level at 200 ppm for all foods and to include a new preamble suggesting the a revision of the standard when a method of analysis or new scientific evidence became available.
    36. While concerning the proposed definition of "gluten-free" foods, several delegations wanted to point out that the current approach was confusing and misleading the consumer and that the level should be uniform for all foods. However, other delegations and the Observer from AOECS stressed the need for two levels with regard to the naturally gluten free foods and the products which had been rendered gluten free. The Committee noted that the proposed term "gluten-free" might mislead the consumer and recognized that the term "low or reduced in gluten" should be considered.
    37. The Observer from AOECS, supported by some delegations, expressed the view that the level of 200 ppm for all gluten-free foods was too high to protect coeliacs and the gluten level should refer only to the end product for better consumer protection.
    38. The Delegation of Finland proposed to remove the oats from the list as scientific studies showed that oats can be tolerated by celiacs and allows to provide dietary fibers for coeliacs. The Observer from AOECS, supported by some delegations, stressed that the square brackets on oats should be removed as oats might have negative impact on the health of coeliacs and that the medical experts had not reached consensus on this issue.
    39. The Committee recognized that the development of reliable method of analysis of gluten was the key point of this discussion and that the development of the method should be encouraged by all means. Status of the Draft Revised Standard for Gluten-Free Foods
    40. The Committee agreed to leave the text of the draft as it was in CX/NFSDU 98/4 and to return it to Step 6 for further consideration. The Committee also agreed that the question regarding the proprietary techniques should be raised to the CCMAS as a general matter.
    The following documents were discussed during the meeting: CX/NFSDU 98/4 - Add 1 (Comments from Australia, Spain, UK, AAC, ISDI); CX/NFSDU 98/4 - Add 2 (AOECS); CRD 3 (Uruguay, ISDI); CRD 13 (USA); CRD 21 (Spain); CRD 33 = CRD 42 (Sweden); CRD 44 (India); CRD 51 (Norway).

    Scott Adams

    Celiac.com 09/01/2005 - The Food and Drug Administration (FDA) will hold a public meeting to obtain expert comment and consultation from the public to help them define and permit the voluntary use on food labeling of the term ``gluten-free. The meeting will focus on food manufacturing, analytical methods, and consumer issues related to reduced levels of gluten in food. Celiac.com needs your help to speak out to make sure that this regulation will be written in such a way as to provide the greatest benefit to the gluten-free community, and to make sure that the new regulation will not create an undue burden on any exiting and future gluten-free food manufacturers.
    To have an influence on this process please Click Here and send your comments no later than September 19, 2005. If you feel the same way as us feel free to cut and paste the following letter into the comments area of this form:
    Dear FDA:
    We encourage you to adopt a regulation on the use of gluten-free on product labels that is in line with that which has been used in Europe and other countries (including the USA via the Codex Alimentarius) for many years--20 PPM for products that contain naturally gluten-free ingredients, and 200 PPM for products that have been rendered gluten-free such as those that may contain Codex Alimentarius quality wheat starch. The formal adoption of these existing regulations will allow for the continued importation of excellent, safe European products that are labeled gluten-free.
    It is very important that you do not adopt a zero tolerance regulation in this matter because doing so will cause many gluten-free food companies to discontinue their use of the term gluten-free on their labels out of fear of litigation--which is counterproductive for all people with this disease (most, if not all, gluten-free food companies do not grow, transport or mill the gluten-free grains that they use as ingredients--a fact that will make them vulnerable to litigation if a zero tolerance level is adopted). Last, the inclusion of trace levels of gluten in the diets of those with celiac disease have been shown to be safe in many scientific studies, for more details please see:
    http://www.celiac.com
    Thank you,
    Your Name

    Gryphon Myers
    Celiac.com 10/08/2012 - Since 2004 when Congress passed the Food Allergen Labeling and Consumer Protection Act, sufferers of celiac disease have awaited some sort of finalized action from the FDA to set a rule for gluten-free labeling. The FDA proposed a gluten-free food labeling rule in 2007 and since then, there have been multiple open comment periods for it, but as of yet, there has been no finalized action to control gluten-free labeling in food products. In an effort to expedite this process, “Jennifer I” of Sebastopol, CA started a petition on the White House's official website.
    Part of the concern driving this petition stems from the fact that for many, the gluten-free diet is one of necessity, not of choice. 'Gluten-free' has become something of a new marketing buzzword, as the diet's popularity has grown dramatically in recent years. This makes labeling more important than ever: companies seeking to cash in on a growing market may be tempted to cut corners and label products as gluten-free, when in fact they are not.
    Supposedly, the FDA will be finalizing their rule sometime this year. Whether or not they stick to that time frame, this petition is a quick and easy way of putting more pressure on the federal government to finalize a gluten-free labeling rule.
    Source:
    https://petitions.whitehouse.gov/petition/finalize-standards-gluten-free-labeling/SsmdZh3C?utm_source=wh.gov&utm_medium=shorturl&utm_campaign=shorturl

    Jefferson Adams
    Celiac.com 02/06/2015 - Australia is home to some of the most stringent gluten-free product standards in the world. Under current standards, all “gluten free" products sold in Australia must contain about three parts or fewer per million.
    The food industry would like the standard set at 20 parts per million, which would bring Australia into line with the United States, and the EU.
    Moreover, Coeliac Australia, a major celiac advocacy group, has suggested that Australia’s strict standards are becoming unworkable, as improved tests permit detection of smaller and smaller amounts of the gluten protein. The group has signaled an openness to the industry plan to lower the standards to 20ppm gluten content.
    Such a move would allow a much wider range of products to be sold in Australia as “gluten-free, ” but would potentially impact hundreds of thousands of Australians who suffer from celiac disease and gluten-sensitivity, many of whom who fear it will save money for manufacturers while triggering severe illnesses in their population.
    The push to change the definition of "gluten free” is being driven by the food and grocery council, which includes major grocery chain Coles.
    Coles happens to be one of Coeliac Australia’s biggest sponsors.
    However, in the face of vociferous opposition to such changes, Coeliac Australia has backtracked from its initial support, and has announced that it will now review its position.
    What do you think? Is Australia’s gluten-free standard too tough? Will it be better to change the standard to match that of the U.S. and the E.U.? Or would it be better to change American and European standards to match Australia. Share your thoughts below.
    Read more at SMH.com.

  • Recent Articles

    Jefferson Adams
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    Jefferson Adams
    Celiac.com 05/23/2018 - Yes, we at Celiac.com realize that rye bread is not gluten-free, and is not suitable for consumption by people with celiac disease!  That is also true of rye bread that is low in FODMAPs.
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    Source:
    World J Gastroenterol. 2018 Mar 21; 24(11): 1259–1268.doi:  10.3748/wjg.v24.i11.1259

    Jefferson Adams
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    Source:
    Bloomberg.com

    Jefferson Adams
    Celiac.com 05/21/2018 - Just a year ago, Starbucks debuted their Canadian bacon, egg and cheddar cheese gluten-free sandwich. During that year, the company basked in praise from customers with celiac disease and gluten-sensitivity for their commitment to delivering a safe gluten-free alternative to it’s standard breakfast offerings.
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    A few of the choice tweets include the following:  
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    Jefferson Adams
    Celiac.com 05/19/2018 - Looking for a nutritious, delicious meal that is both satisfying and gluten-free? This tasty quinoa salad is just the thing for you. Easy to make and easy to transport to work. This salad of quinoa and vegetables gets a rich depth from chicken broth, and a delicious tang from red wine vinegar. Just pop it in a container, seal and take it to work or school. Make the quinoa a day or two ahead as needed. Add or subtract veggies as you like.
    Ingredients:
    1 cup red quinoa, rinsed well ½ cup water ½ cup chicken broth 2 radishes, thinly sliced 1 small bunch fresh pea sprouts 1 small Persian cucumber, diced 1 small avocado, ripe, sliced into chunks Cherry or grape tomatoes Fresh sunflower seeds 2 tablespoons red wine vinegar  Kosher salt, freshly ground pepper Directions:
    Simmer quinoa in water and chicken broth until tender.
    Dish into bowls.
    Top with veggies, salt and pepper, and sunflower seeds. 
    Splash with red wine vinegar and enjoy!