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Should you trust gluten free labels?

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Should you trust gluten free labels?


guy with magnifying glassThe gluten-free labeling rule officially went into effect August 4, 2014. It obligates manufacturers who label their product “gluten-free” to ensure a product contains less than 20 ppm of gluten. This level is the amount of gluten deemed safe for people with celiac disease, an autoimmune condition activated by ingesting minute amounts of gluten.

But, people avoiding gluten for medical reasons still question whether products are truly gluten-free as labeled. They are confused by a variety of ambiguous labeling practices. Terms such as “no gluten ingredients “and “made without gluten” are now frequently seen on products.  Advisory warnings such as “made on shared equipment” or “made in a shared facility” are common. What do these really mean and how seriously should you consider them?

1. Are foods labeled “gluten-free” actually gluten free?

question flowersThere are very few studies that address this question, but a recent market survey by researchers at the FDA’s Center for Food Safety and Applied Nutrition attempted to quantify the risk. The study published in the February 2015 issue of the journal Food Chemistry and was the subject of an article in Food Navigator.  I am very encouraged that the FDA is committing the resources to study food safety for consumers who are on a gluten-free diet for medical reasons.

The FDA researchers evaluated 275 different foods that were labeled gluten free by testing them for the presence of gluten. Their results were encouraging. Only three out of 275 products contained more than 20 ppm of gluten (1.1%). Based on these numbers it appears that manufacturers are doing a very good job of ensuring their gluten-free labeled foods are actually gluten-free. Of the three products that were misbranded (contained more than 20 ppm gluten), my hope is that the FDA is following up with those companies to correct the issue.

Take home point: Manufacturers are doing a very good job of ensuring that products labeled “gluten-free “ are safely below 20 ppm.

2. If food is not labeled gluten-free, can you rely on the ingredient list?

ingredient listIf a packaged food is not labeled gluten free, yet the ingredients appear to be gluten free, what are the chances it may contain gluten? Gluten can be accidentally introduced into a product through cross contamination which can occur during production, preparation, transportation or storage of ingredients and food products. Gluten from cross contamination may be enough to cause illness in someone with celiac disease, wheat allergy or gluten sensitivity. But, how often does this really happen? Can you rely on simply reading the ingredient list?

The FDA study analyzed whether consumers could rely on reading the ingredient list if a food was not labeled “gluten-free.”They evaluated 186 foods that appeared to have no gluten ingredients but were not labeled gluten free.  Unfortunately, they inexplicably included products containing oats. It has long been known that oats, while inherently gluten free, are frequently cross contaminated with gluten. This is so well known, in fact, that there are a number of companies that specialize in producing certified gluten-free oats that are specially grown, harvested and packaged to prevent contact with gluten.

In the results, the FDA study states that 19.6% of unlabeled foods with no gluten in the ingredients contained unacceptable levels of gluten. But when we take oats out of the equation, only 4% of these products contained gluten.

Take home point: If the ingredients appeared gluten free, and did not contain oats, 4% had unacceptable amounts of gluten. Thats a pretty small number, so the risk if fairly low, but it would be wise to inquire about manufacturing procedures, especially on products you consume regularly.

3. Interpreting a label that contains a warning statement

riskThe FDA study found that if a food contained an advisory label such as “made on shared equipment,” 43% of the products contained unacceptable levels of gluten. Again, if we take out products containing oats, we are left with only four products to evaluate that contained an advisory label. This is hardly a large enough sample on which to base a recommendation. On this point, further evaluation is needed and common sense taken into account until we have more data. If the risk of cross contamination is high, such as in a shared facility or production line for baked goods, it would be wise to avoid these products. The risk may be lower for non-bakery products, where there is no aerosolized gluten, but it depends on many different factors at the production facility.

Gluten-free shoppers often assume that advisory warnings on labels are used to protect the company from a legal standpoint and are not related to actual risk for the consumer. While in some cases this may be true, many companies are doing it to maintain transparency and protect the consumer from real risk. When possible, it is best to contact the manufacturer to clarify the risk if it’s not clear. There are many safe gluten-free alternatives today and countless naturally gluten-free foods available.  Hopefully other options will be available if a warning cannot be clarified.

Take home points: Advisory labels are meant to be taken seriously. Each product must be considered individually. It is best to contact the manufacturer for additional information if necessary. 

4. What if the product is labeled “gluten-free,” but contains oats?

oatsTo comply with the labeling regulation, if the product contains a gluten-free claim at all, it must contain less than 20 ppm of gluten.

Take home point: These products should be safe.


5. What about “no-gluten ingredients “or “made without gluten         ingredients”?

deceptive manThese phrases are unfortunate loopholes in the labeling rule and are now seen on many packages. These terms do not need to adhere to the labeling regulations so their meaning is vague. The FDA in this study did not evaluate products with these claims, but it is my hope that they or someone else will do so soon. Contacting the manufacturer for products with these claims is recommended.

It is reasonable to assume that there is a substantive reason that these products are not labeled gluten free. It’s a valuable selling point if a product is labeled gluten-free, so it should raise suspicion if the company is deliberately using a similar-sounding term that evades regulation. Perhaps they are made in a shared facility or the ingredients are not sourced from gluten-free manufacturers. If the manufacturer cannot clarify the situation to your satisfaction, it would be prudent to avoid these products.

Take home point: These products should be avoided if the manufacturer cannot adequately explain why they are not using a regular gluten-free label.

Fresh, whole food is still best

Learn-to-cook-8-300x155I am grateful for all the efforts put forth by the people who have spent countless hours to make the gluten-free labeling rule a reality. There is more progress to be made, but we should all appreciate the work that has been done to make gluten-free packaged foods safe. However, we should remember that the healthiest foods are naturally gluten free and have no packaging. Packaged foods should be a supplement to a diet that is based on whole, fresh foods. Fruits, vegetables and many other unprocessed foods are naturally gluten free and carry benefits for you beyond the absence of gluten.


Past columns by Dr. Burkhart:

April/May 2016: Reasons People Follow a Gluten Free Diet: 7 Types of Gluten Free Dieters 

March 2016: Ten Positive Aspects of a Celiac Disease Diagnosis

February 2016: Gluten Causes Keratosis Pilaris (a.k.a. “Chicken Skin”): Fact or Myth?

January 2016: Fingernail Changes in IBS,Gluten Disorders and Celiac Disease “A window to health”

December 2015: 20 Gluten-Free Gift Ideas: From Budget to Luxury, Sentimental to Practical & More

November 2015: Cold Sores, Canker Sores and Gluten

October 2015: Celiac Disease and Gluten Sensitivity Research: Snippets from ICDS 2015 (Part 2)

September 2015: Celiac and Gluten Sensitivity Research: Ten Snippets from ICDS 2015

July/August 2015: A New Home Test To Monitor Gluten Exposure

June 2015: Six Reasons to Test for Celiac Disease Before Starting a Gluten-Free Diet

May 2015: POTS, Celiac Disease and Gluten: An Undiscovered Connection?

February/March/April 2015: Arsenic in the Gluten-Free Diet: Facts and Tips

December 2014/ January 2015: The Microbiome and Celiac Disease: A Bacterial Connection

November 2014: Celiac disease and gluten sensitivity: The doctor-patient disconnect

October 2014: Should You Trust Gluten-Free Labels?

September 2014: Triggers for celiac disease: One possible answer

July/August 2014: Ten Tips for a Healthier Gluten-Free Diet

June 2014: Back Pain and Gluten

May 2014: Self-Diagnosis of Gluten Sensitivity: Four Alarming Trends

April 2014: Update on Restaurants and Gluten-Free Dining

March 2014: Histamine Intolerance: Could it be causing your symptoms?

February 2014: Celiac Disease and Non-Celiac Gluten Sensitivity (Reprinted with permission from Sonoma Medicine)

January 2014: Four Vitamin Toxicities on a Gluten-Free Diet

December 2013: Move Over Gluten-Free, Low FODMAP is Next

November 2013: SIBO, Gluten and IBS: What Is The Connection?

October 2013: Pesticides, Wheat and Gluten Sensitivity: What is the Connection?

September 2013: Is gluten really the culprit in gluten sensitivity?

August 2013: Clarifying the Gluten-Free Labeling Rule

June/July 2013: No such thing as Mild Celiac Disease

May 2013: Magnesium Deficiency

April 2013: Six Reasons to test for celiac disease before starting a gluten-free diet

March 2013: Why am I having migraines?

February 2013: What is fructose malabsorption?

January 2013: Educating doctors about celiac disease

December 2012: Are supplements to digest gluten safe and useful?

November 2012: Top 5 reasons for persistent symptoms after Going Gluten Free

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“I have been a patient of Dr. Amy Burkhart for several years. I suffer from Crohn’s disease and was having difficulty in my daily life. After visiting many doctors, all of whom were unable to help me, Dr. Burkhart took the time and patience to create a plan which brought me back to health. I still follow her plan to this day and have been living a normal healthy life. Dr. Burkhart listened to my symptoms along with listening to me, she took her time in preparing a plan which led me to the road for recovery. I cannot thank Dr. Burkhart enough, and I would recommend her to anyone.”

8 months ago

Stone Brewing company Stone Brewing - Napa opened recently in Napa in an historic building adjacent to the river. A great venue to enjoy life! The gluten free menu options are coming (per the manager ) but please visit and inquire about GF options. The more people who show interest and discuss cross contamination the more likely they are to get it right! Wine is available. Maybe they will even consider a GF beer! . ... See MoreSee Less