As trace amounts of gluten can cause intestinal damage, maintaining strict threshold standards for gluten-free products is crucial for the safety of individuals with coeliac disease.
Manufactured products that are labelled gluten-free must meet the threshold standard of containing 20 ppm gluten or less. Through multiple research studies [1-3] it was determined that individuals with coeliac disease could tolerate up to 10 mg (10 ppm) of gluten per day without intestinal damage. In a typical diet the average individual consumes approximately 15 to 20 g of gluten per day (10g of gluten = approx. 4 slices of bread). In household terms, 20 ppm is equivalent to 20 mg of gluten per kg. Therefore, the designation of gluten-free as under 20 ppm provides a safe limit for those on a gluten-free diet.
Lower threshold since 2008
A threshold of 20 ppm as a safe level for gluten within foods labelled as gluten free, was adopted in early 2009 [4]. Both Canada and the US have adopted the standard threshold of 20 ppm more recently. The reversal of symptoms and healing benefits of a gluten-free diet are achieved by maintaining strict adherence to the gluten-free diet standard threshold of under 20 ppm.
Labelling is crucial for dietary adherence
For individuals with coeliac disease, maintaining a strict gluten-free diet, including careful selection of naturally gluten-free foods and labelled manufactured gluten-free products, is a necessity for repair and recovery of the gut. Persons with non-coeliac gluten sensitivity should also consume a gluten-free diet following diagnosis. It’s possible that over time, and under the guidance of a healthcare professional, small amounts of gluten may be tolerated by this group of patients.
References
- A prospective, double-blind, placebo-controlled trial to establish a safe gluten threshold for patients with celiac disease. Catassi C, Fabiani E, Iacono G, D'Agate C, Francavilla R, Biagi F, Volta U, Accomando S, Picarelli A, De Vitis I, Pianelli G, Gesuita R, Carle F, Mandolesi A, Bearzi I, Fasano A. Am J Clin Nutr. 2007 Jan;85(1):160-6.
- Consumption of gluten-free products: should the threshold value for trace amounts of gluten be at 20, 100 or 200 p.p.m.? Gibert A, Espadaler M, Angel Canela M, Sánchez A, Vaqué C, Rafecas M. Eur J Gastroenterol Hepatol. 2006 Nov;18(11):1187-95.
- The safe threshold for gluten contamination in gluten-free products. Can trace amounts be accepted in the treatment of coeliac disease? Collin P, Thorell L, Kaukinen K, Mäki M. Aliment Pharmacol Ther. 2004 Jun 15;19(12):1277-83
- Commission Regulation (EC) No. 41/2009 concerning the composition and labelling of foodstuffs suitable for people intolerant to gluten