There is growing consumer confusion about what gluten-free means as more companies, such as Chuck E. Cheese’s and Domino’s Pizza, continue to introduce gluten-free products. For example, while Domino’s called its pizza crust gluten-free, it also said it is appropriate only for people with mild gluten sensitivity, not those with celiac disease. Dr. Stefano Guandalini, president of the North American Society for the Study of Celiac Disease and founder and medical director of The University of Chicago Celiac Disease Center, explained where the U.S. is headed in terms of gluten-free regulation and what food manufacturers and restaurants can do to ensure people understand their food’s gluten content.
Food and menu items are coming out that claim to be gluten-free but contain varying amounts of gluten, which can cause serious reactions for people with celiac disease or gluten sensitivity. How close is the FDA to setting a proposed maximum standard of 20 parts per million for gluten-free products?
We have been working with the FDA for nearly a decade to get to a gluten-free standard enacted. The North American Society for the Study of Celiac Disease, which is made up of leading scientists and physicians, agrees that the European standard of less than 20 parts per million is a safe and effective limit. At this level, one would need to eat 2.2 pounds of a food measuring at the upper limit in one day to be in jeopardy. The FDA has indicated that the rule will go into effect by the end of 2012.
Will setting a standard help restaurants and manufacturers clear up consumer confusion, and what do they need to do regarding labeling of products and menus?
The standard will help with manufactured products — it will be necessary for manufacturers to test product to less than 20 parts per million to put “gluten-free” on the label. Currently, no testing is required. While the FDA rule won’t apply directly to restaurants, having a standard definition of “gluten-free” certainly should help clear up confusion. Serving gluten-free food requires not only that the ingredients be gluten-free but that the environment be free of cross-contamination as well. It is possible for foodservice to achieve this level of safety, and a rule will certainly help, but more important is the education of best practices for those involved in the process.
Even with a maximum standard, can people with gluten sensitivity or celiac disease really know how much gluten it will take to trigger symptoms?
It is important to note that most people with active celiac disease have no symptoms at all, so symptoms are not the best indication of exposure. Research shows that some with celiac will activate the disease with ingestion of as little as 10 milligrams of gluten in the course of the day and that all those with celiac will activate the disease when consuming 100 milligrams per day. In either case, this is a tiny amount, like 1/64 teaspoon of bread. As for gluten sensitivity, it is important to note that very little is understood about this condition. The medical community has yet to define it, and there is no objective test to detect it. That said, until we have solid evidence-based research, we should not assume that “a little” gluten is safe for those with this condition. The prescription for those with celiac disease and gluten sensitivity is the same: a gluten-free diet. We know very well the complications that come from leaving celiac disease untreated or having repeated exposure to gluten: osteoporosis, thyroid disease, infertility, cancer and the like. With gluten sensitivity, we do not yet know the long-term effects of exposure to gluten.
Is it difficult for restaurants or even consumers to create a kitchen that accommodates gluten-free and regular cooking?
No, it is not difficult, but it does take extra effort. With the correct training and education, it can be done very effectively. The Gluten-Free Certification Organization has the most robust program in the industry to attain this goal. The GFCO offers the most rigorous accreditation program for foodservice and certification for food manufacturers. Other programs do not go as far to ensure consistent, reliable standards, practices and outcomes.