For individuals with celiac disease, wheat allergy, or other gluten-related disorders, the simple act of eating can be fraught with challenges. The key to managing these conditions and preventing long-term health consequences lies in strict adherence to a gluten-free diet. However, this is easier said than done, largely due to the complexities of food labeling regulations in the United States.

In the USA, food labeling laws can be confusing, especially for those with celiac disease. If a manufacturer chooses to voluntarily label their product as “gluten-free”, the manufacturer must be able to confirm that the gluten content is below the legally defined “<20 PPM” threshold set by the FDA.

However, unless a product is explicitly marked “gluten-free,” there is no assurance that a manufacturer is complying with gluten-free food labeling laws or that it has been tested to verify the absence of gluten. Manufacturers aren’t required to call out gluten in the ingredient list, only the top 9 allergens. While wheat is considered one of the top 9 allergens, the other sources of gluten (namely barley and rye) are not and can be a hidden source of gluten.

Additionally, manufacturers are not required to inform if the ingredients used or the final product were cross-contaminated during harvesting, transportation, manufacturing, or storage. This lack of transparency can leave individuals with celiac disease vulnerable to inadvertent gluten exposure.

ZERO For Life does not recommend individuals with celiac disease consume products containing any gluten-containing ingredient (i.e., Wheat, Barley, or Rye) in amounts above 0.01 ppm (i.e., 0.011 mg of gluten per day) which was determined by the FDA as “the lowest gluten and most conservative [Level of Concern] (LOC) value associated with a [Tolerable Daily Intake Level] (TDI) that was estimated to (1) Be protective of the vast majority of individuals with celiac disease ages 1 year and older, including those most sensitive to gluten and (2) not cause clinical, morphological, and/or physiological adverse health effects.”

Despite the FDA’s determinations, the Agency set the legal gluten threshold at approximately 2,000 times higher – citing a number of factors influencing their decisions “such as ‘‘ease of compliance and enforcement, stakeholder concerns (i.e., industry, consumers, and other interested parties), economics (e.g., cost/benefit analysis), trade issues, and legal authorities’’ (Ref. 1 at p. 45 and 72 FR 2795 at 2800).”

Those thresholds, however, have not been proven to be safe for individuals with celiac disease.  Authors of studies like one used to determine the current legal gluten threshold (Catassi, et al., 2007) have even been quoted as stating, “These results confirm that an abnormal small-bowel morphology persists in a significant proportion of CD patients treated with a GFD, despite full resolution of their symptoms. This finding has been shown to be related to the ongoing ingestion of gluten, either deliberate or inadvertent, causing persistent inflammation in the small-intestinal mucosa… Because of the limited number of patients, we were not able to reach firm conclusions about the potential toxicity of 10 mg gluten/d, which remained a “gray” area.”

The damage caused by the continual ingestion of gluten can lead to a range of long-term health consequences.  Failure to adhere strictly to a truly gluten-free diet, containing approximately zero parts per million, can result in complications such as nutrient deficiencies, osteoporosis, infertility, neurological problems, and an increased risk of certain cancers. Some studies have even shown that individuals with celiac disease are not living longer lives despite adhering to a “gluten-free” diet.  These facts underscore the belief that trace amounts of gluten, which are currently permitted by the US government in foods labeled “gluten-free,” are still too much.

In conclusion, the importance of reading food labels cannot be overstated for individuals with celiac disease. The potential long-term consequences of not strictly adhering to a genuinely gluten-free diet are significant, making it crucial for those with celiac disease to stay well-informed, vigilant, and proactive in managing their condition. The best way to do so is to familiarize oneself with the food labeling laws, use tools such as ZERO For Life’s Gluten-Free Food Label Interpreter, and when in doubt, throw it out!