© 8-2005 food labeling concerns for cd/dh mary schluckebier, ma, executive director, csa toll free...
TRANSCRIPT
© 8-2005
Food Labeling Concerns for CD/DH Mary Schluckebier, MA, Executive Director, CSA
Toll Free 877-CSA-4-CSA www.csaceliacs.org
© 8-2005
Told At Diagnosis - Celiac Disease/DH
No known threshold for evoking the IgA immune response - cumulative
No fool-proof way to measure “offending”amino acid fractions in all foods
Research: health complications most common in those not keeping a STRICT diet
© 8-2005
Told At Diagnosis - Celiac Disease/DH
Eliminate all food and medications – containing – made from – derived from
Wheat, Barley, Rye and at this time Oats For the remainder of your life—Be Healthy
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Celiac Patient Prescription
Health maintenance is the RESPONSIBILITY OF THE PATIENT
Individual patient FOOD CHOICES
control the success of the treatment
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Responsibility of Patient:
Design own decision-making process to maintain optimal health - no WBRO
Seek information – coping techniques
Adaptation of information to meet own needs
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Diet Management Guidelines
Beginning Self-Management IntermediateAdvanced
– Three Stage Food Plan for Self-Management Jean Guest, MS RD LMNT CSA Dietitian Advisor
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Voluntary Sharing is Appreciated
Resource information from food companies and retailers
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To Make an Informed Decision
Source information about ingredients that may or may not contain WBRO or derivatives in
Product Processing Packaging
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Information to Make Decisions
•Meaningful
•Verifiable
•Consistent
FOOD LABEL
© 8-2005
No WBRO or Derivatives
CROSS CONTACT PRODUCT INGREDIENTS
– “Identity Preserved”; Transportation and Handling
PROCESSING SYSTEM– Cleaning; Dedicated line; Dedicated Facility?
PACKAGING and STORAGE– Cross contact, Coatings and Wraps?
Full Disclosure
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Crops Co-mingleCross Contact
wheat oats
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Consuming Oats?
CSA Survey 2005
950 Eliminate oats from diet 151 Eat oats 22 No answer
1101 Define as absence of WBRO 77 GF= WBR
P. Collin, Finland 2004
Participants quit eating oats when symptoms appeared
– CD 10% DH 19%
© 8-2005
Gluten-Free Snares
Misleading – (corn and rice gluten – no problem)
Gluten is technically only a prolamin of wheat FDA Dismissed Gluten-free term in 1990
– not able to regulate (Misbranding Regulations)
Current measurement is not applicable to all types of products
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Ingredients from Wheat and Rye
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Ridascreen® ELISA - will not accurately detect hydrolyzed or fermented materials
Gluten-Free In Processing?
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Rye Malt Extract?
Package marked
Gluten-Free
3,640 ppm ELISA test
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Can Confusion Be Avoided?
Wheat products make a good binding agent for coatings.
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Also Found on Labels
Gluten-Free?– Wheat Fiber – Certified gluten-free– Wheat Grass– Hydrolyzed Wheat Protein
– NEED RESEARCH ON PRESENCE or ABSENCE OF AMINO ACID SEQUENCES
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Reasons given for Gluten-Free Label with a WBRO ingredient listed
“Gluten is not present in the oats and barley because we use only the outer portion of the grain kernel that is gluten free.
“Wheat fiber is certified to be gluten-free.” “We adhere to the Codex definition of gluten-
free.” “It tested BLD for gliadin, so it is gluten-free.”
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2004 CSA Member Survey
After WBRO
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Beyond Wheat, Barley, Rye and OatsCSA Member Survey 2005 1,200 Responses
Number of other sensitivies listed
1
2
3
4
5
6
7
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Gluten-Free Challenges
Lack of food labeling Determining ingredient sources Finding medical personnel Avoiding cross-contamination
(tied with) Traveling concerns
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Where People Buy Gluten-Free Food
Health food stores Grocery storesMail order/InternetSuper stores
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Rate Immune ResponseImmune Response
0
200
400
600
800
1000
1200
1 2 3 4 5 6 7
Sensitivity
Nu
mb
er
of
Resp
on
ses
Consuming foods
Medications consumed
Skin contact form medications
Skin contact from hair products
Skin contact from detergent
Skin contact from lotions andsoaps
Sensitivity
Little/No…………………….….Highly
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When information is incomplete – what level of risk will you take?
People Take Minimal Risk
0
200
400
600
800
1000
1200
1 2 3 4 5 6 7
At home
At restaurants
At homes of friends andrelatives
On special occasions
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Does “gluten-free” printed on a product label influence your decision?
IF …. Indicates absence of WBRO
Also …. Price Past experience Reputation of the company
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Recognition Program
Recognized by
© 8-2005
General Terms for Use of Seal
The license is ONLY available for products FREE of wheat, barley, rye and oats (WBRO), and any of their derivatives, in product, processing and packaging.
Companies seeking a license must provide, and CSA will consider confidential, adequate information about their internal operations including dedicated lines, control of cross contact and quality control.
The companies listed in the current CSA Gluten-free Product Listing are encouraged to apply for this designation.
© 8-2005
Communication Agreement
Reserved for the best of the best –
The manufacturer of this product is pleased to be recognized by the Celiac Sprue Association® (CSA®). The use of this seal on an article means that the manufacturer has agreed to adhere to CSA’s standards in representing this article to be “Gluten-free,” that is, free of any wheat, barley, rye and oats and their derivates. Visit CSA at www.csaceliacs.orgor call toll free 877-272-4272.
© 8-2005
References:
CSA Member Survey 2004, Celiac Sprue Association, Summary Reports to Membership
CSA Member Survey 2005, Celiac Sprue Association, Summary Reports to Membership
Diet Management -Three Stage Food Plan – CSA Brochures 2000-2005 Jean Guest, MS RD LMNT
Peräaho M, Collin P, Kaukinen K, Kekkonen L, Miettinen S, Mäki M. Oats can diversify a gluten-free diet in celiac disease and dermatitis herpetiformis. J Am Diet Assoc 2004;104:1148-50.
Murray JA, Watson T, Clearman B, Mitros F, Links Effect of a gluten-free diet on gastrointestinal symptoms in celiac disease.Am J Clin Nutr. 2004 Apr;79(4):669-73.
Murray JA, Van Dyke C, Plevak MF, Dierkhising RA, Zinsmeister AR, Melton LJ 3rd. Trends in the identification and clinical features of celiac disease in a North American community, 1950-2001.Clin Gastroenterology Hematology. 2003 Jan;1(1):19-27.