One inevitable side effect of celiac disease is an increased amount of time reading, analysing and agonising over food ingredients and labelling. Certain food manufacturers make it easy; clearly and definitively stating all of the ingredients, including any allergens, removing all doubt regarding potential contamination. Whilst other manufacturers elevate ambiguity to new heights, making it impossible to understand the ingredients and to ascertain whether the product is actually gluten free. Navigating food packaging takes patience, some obscure knowledge and determination. Here are some things you should look out for.
The legislation governing the levels of gluten in food claiming ‘gluten free’ or ‘very low gluten’ was published in 2009 to help celiacs choose the correct food products. The British Specialist Nutrition Association Ltd have provided an overview of this legislation, which can be read here: Composition and Labelling of Foodstuffs Suitable for People Intolerant to Gluten.
Manufacturers aren’t required to label foods gluten-free, but many do. An international organisation called Codex Alimentarius Commission, which develop food standards and guidelines, have recently amended the standard for labelling of gluten free products. There are currently two labelling categories under which gluten free food can be labelled:
- Food can be labelled ‘gluten free’ if it contains 20 parts per million or less
- Food can be labelled ‘very low gluten’ if it contains between 21-100 parts per million
You will see in the ingredients of many gluten free products something called ‘Codex Wheat Starch’. This is actually wheat starch which has been processed to remove gluten to a trace level to which most celiacs can tolerate, and complies with the International Codex Standard for Gluten Free Foods. It is used in many products such as bread and flours to apparently improve the texture and taste. Be aware that products containing ‘codex wheat starch’ is not wheat free4 and therefore not suitable for individuals who are very sensitive to gluten or require a wheat free diet. Similarly, wheat free does not mean gluten free.
An individuals tolerance level to gluten is extremely varied and establishing your tolerance level is something you need to experiment with. Studies have shown that 25mg of gliadin protein (gluten) in wheat per day produces symptoms and intestinal damage but as little as 1mg per day has been shown to actually prevent intestinal healing. Some people can consume small amounts of gluten and have no side effects whilst others experience extreme gastrointestinal symptoms such as bloating and diarrhoea with the ingestion of traces quantities.
Wheat is a common ingredient in a number of processed foods. It can be listed as modified food starch, and it can be sourced from either corn or wheat. Often there will be no indication where it is derived, so unless the product explicitly states that it is gluten free, it could be either. Other proteins and flavourings to be wary of include:
- Vegetable protein or hydrolysed vegetable protein can come from wheat, corn or soy
- Hydrolysed plant protein/HPP
- Both natural and artificial flavorings can come from barley
According to The Vegetarian Research Group, the exact definition of natural flavourings and flavours from Title 21, Section 101, part 22 of the Code of Federal Regulations is as follows:
“The term natural flavour or natural flavouring means the essential oil, oleoresin, essence or extractive, protein hydrolysate, distillate, or any product of roasting, heating or enzymolysis, which contains the flavouring constituents derived from a spice, fruit or fruit juice, vegetable or vegetable juice, edible yeast, herb, bark, bud, root, leaf or similar plant material, meat, seafood, poultry, eggs, dairy products, or fermentation products thereof, whose significant function in food is flavouring rather than nutritional.”
Therefore, natural flavourings can be derived from any product that is approved for use in food. Without contacting the manufacturer to ascertain which food product was used then ‘natural flavourings’ could be literally be anything, including gluten.
In regards to gluten it is important to manage your expectations. Never judge a product as gluten free based on your assumptions and expectations. Just because you would never expect gluten to be in a certain product doesn’t mean that it isn’t. Products which have caught me out are:
- Tea bags
- Washing up liquid
- Dishwasher detergent
- Toothpaste and mouthwash
- Hand wash / soap
- Envelope and postal stamp adhesive
Nowadays I expect everything to contain gluten, and only purchase a product when the manufacturer has assured me otherwise. Not all products will have an ingredient list, sometimes the products website or contacting the manufacturer is the only way to be sure.
Gluten can also be present in medicines, tablets, capsules and vitamins. There is currently no requirement or legislation to label drugs or pharmaceuticals as containing gluten, however prescription medication will be labelled with allergens and the patient information leaflet accompanying the medication will list the active ingredients and should be read carefully.
Once you have confirmed that a product is gluten free, it doesn’t stop there. Manufacturers routinely change ingredients2, and as a consequence you will need to regularly check ingredients. The ingredients can change from one batch to the next, so even though it was gluten free yesterday it could contain gluten today. From experience, complacency can result in the ingestion of gluten. All too often I have been struck down with symptoms seemingly out of the blue, only to discover that a tiny sticker detailing new ingredients has been stuck over the original ingredients of a food that I had previously established as gluten free.
Frequently, and even on specialist free from foods, gluten may not be listed as an ingredient, but there will be a vague and ambiguous allergy warning stating:
- May contain gluten.
- This product is produced in a facility where gluten is handled.
- Not suitable for those with a gluten allergy.
These ambiguous allergy warnings can be printed anywhere on the packaging and often nowhere near the list of ingredients. These warnings infer that cross contamination could have occurred or that wheat / gluten was used in a manufacturing process, and that the manufacturer cannot guarantee that a product is completely gluten free. It then becomes your choice as to whether you take the risk and consume the food. Personally I always choose to never take the risk. Also, as a consumer I refuse to financially support a food supplier that thinks printing such a vague and ineffective statement on a food product is acceptable.
Milk and Other Allergens
If you are lactose intolerant or if you are avoiding milk during the initial stages of the gluten free diet, avoiding milk and its derivatives can be an additional mine field. Exercise caution when checking ingredients for milk as it can be listed under a range of synonyms. A non-exhaustive list includes:
- Acidophilus milk
- Lactic acid
- Malted milk
- Sodium caseinate
- Potassium caseinate
- Nougat caramel colour and flavouring
- High protein flour
- Magnesium caseinate
- Sodium casinate
Like gluten, milk and milk products can be found in unexpected places. Products such as medicines, tablets, capsules and vitamins typically use lactose as a bulking agent. From my experience, the majority of processed foods contain some form of dairy derivative. Even if there are no dairy ingredients listed, always check the allergy advice section as invariably it will state ‘may contain milk’ due to cross contamination during production.
Oats have a similar protein to gluten and may trigger the immune response as if gluten was consumed. This is because oats contain a gluten-like protein called avenin and as such there are different recommendations regarding oats. Some advocate total exclusion as the long-term effects of oats in individuals with celiac disease is still unknown while other resources state that some individuals can tolerate oats however, the danger lies in the possibility of cross contamination with wheat. Therefore, only oats which have been specifically milled separately from other grains and subsequently labelled as 100% gluten free should be consumed.
Looking to the Future
From my perspective as a celiac the current standards of food labelling and allergen warnings is abysmal and without justification. I can see no reason for misleading lists of ingredients or any benefit to be gained from ambiguous labelling. In addition, given the plethora of food testing agencies, I cannot understand why a food manufacturer fails to definitively ascertain as to whether their final product is gluten free. When I was initially diagnosed with celiac disease and I came across a product with ineffective labelling I used to just put it back on the shelf and walk away, but now I actively contact food manufacturers. I advise them of the difficulties their inadequate and unclear labelling causes, I suggest improvements, and ultimately inform them why I didn’t purchase their product. Unless food manufacturers realise that the format of the ingredient and allergen labelling directly impacts upon their profit margin I don’t think they will have any incentive to change.
I do think that food labelling standards are improving, albeit extremely slowly. Hopefully, as celiac disease and gluten free diets receive greater global medical and media attention this improvement will continue.