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'Swedish Gastroenterology' Parentelligence posts

No “window of opportunity” for celiac disease prevention

As a pediatric gastroenterologist, I’m often asked whether there is any way to prevent a child from developing celiac disease. Based on what I knew regarding how food allergies develop, I used to counsel families that there might be a “window of opportunity”, between four and six months, when it’s possible to introduce grains and other gluten-containing foods that could potentially “teach” the immune system to tolerate gluten and thus lower the risk of developing celiac disease.

However, my “window theory” recently got thrown out the window when the results of two important scientific studies were published in the New England Journal of Medicine.

FDA finally defines gluten free

On August 5th, 2013, the U.S. Food and Drug Administration (FDA) at long last published a formal rule regulating the use of the term "gluten free" on foods and beverages.  Even though this came with a big sigh of relief to the millions of people with celiac disease living in the US, consumers should be aware that the law gives manufacturers one year to be in full compliance (and goes into effect August 5, 2014).

As we head into the final months before the law’s final compliance date, I thought I’d highlight a few other key points about this brand new law:

1. No symbols needed.  The law does not require or recommend manufacturers use any particular symbol or food label, but if a label should include any of the following phrases, compliance must be ensured:
    •    “Gluten-free”
    •    “Free of gluten”
    •    “No gluten”
    •    “Without gluten”

2.  It’s voluntary.  A manufacturer may produce gluten-free foods, but just choose not to label them as such.   

3.  “Gluten-free” does not mean “zero gluten”. The new law defines "gluten-free" to mean that a food contains less than 20 parts per million (20 ppm) of gluten.  (This tiny amount can be visualized as less than a tenth of a grain of salt on a slice of bread, and is acceptable as the standard for people with celiac disease).

4.  As with any rule, there are exceptions.  Although ...
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