<<Disclaimer: Verify this information before applying it to your situation.>>

It has been rumored that Dr. Fassano was involved in a recent research study
which concluded that celiacs could safely consume up to 50 milligrams (mg)
of gluten per day, in essence, setting a "maximum daily allowance for
gluten."  

 

The study in question was "A prospective, double-blind, placebo-controlled
trial to establish a safe gluten threshold for patients with celiac
disease."  The report, written by Catassi Carlo, et al., was published in
American Journal of Clinical Nutrition, Vol. 85, No. 1, 160-166, January
2007.  An online reprint is available at
http://www.ajcn.org/cgi/reprint/85/1/160.  

 

This study did not establish a safe threshold for gluten exposure at 50
milligrams (mg) per day, as the authors of the study plainly stated in their
report, "The potential toxicity of trace amounts of gluten is still
unclear."  

 

The researchers found that although some study participants did not show
intestinal change after being challenged with 50 mg of gluten daily over a
period of 90 days, other subjects showed intestinal damage from ingesting
only 10 mg of gluten daily.  One patient who was receiving 10 mg of gluten
per day "showed typical signs of relapse (vomiting, diarrhea, and abdominal
distension) after 6-8 wk of microchallenge." 

 

Observing this wide variation in patient sensitivity to trace amounts of
gluten, the researchers reported, "Despite this wide individual variability,
which must be taken into account when implementing a threshold that is safe
for all patients, we showed that 50 mg gluten/[day], if introduced for 3
[months], were sufficient to cause a significant decrease in the [villous
height/crypt depth] index in treated CD patients."  Because of these
findings, the team concluded, "The ingestion of contaminating gluten should
be kept lower than 50 mg/[day] in the treatment of CD."  This did not
establish 50 mg/day as the maximum amount of gluten all celiacs could safely
consume.  Rather, it established the amount of 50 mg/day or more as
definitely unsafe.

 

Establishing a safe threshold of gluten exposure for celiacs is important in
determining a definition for labeling products as "gluten-free," but most
celiacs are more concerned with what an upper limit means in terms of
practical quantities.  The proposed 20 parts per million (ppm) rule, which
sets an upper limit for gluten contained in a food labeled "gluten-free," is
expressed as a ratio, not as a weight or volume per serving.  The specific
quantity of gluten that a person could conceivably ingest from eating a food
would depend not only on the actual (rather than allowed) amount of gluten
in the food product but also on the size of the serving.  For example, if a
slice of gluten free bread weighed 38 grams, it would be required to contain
less than 0.76 mg of gluten.*  During the course of a day, if a person ate a
bowl of cereal, a slice of toast, a hamburger bun, a serving of chips, a
dinner roll, and a couple of cookies, he would be consuming approximately
280 grams of food products potentially containing a total of nearly 5.6 mg
of gluten even if each food item fell within the FDA proposed guidelines.
For the celiac who can tolerate nearly 50 mg gluten per day, 5.6 mg may be a
safe amount, but what about the person in the research study who could not
tolerate as much as 10 mg per day?

 

Until more is known about the effects of ingesting trace amounts of gluten,
celiacs would do well to focus their diet on fresh produce, safe whole
grains, and minimally processed foods.

 

*  How to "do the math" -

 

20 parts per million (ppm) is the same as 20 milligrams per kilogram (20
mg/kg).  If a serving size on a label is expressed in grams, the potential
amount of gluten in a single serving can be calculated by multiplying the
number of grams in one serving of product times 20 and multiplying the
result by 1/1000 (grams /kilograms conversion ratio):

 

(Serving size in grams) x (20 mg/kg) x (1/1000 kg/g).

 

The end result will be in milligrams.  It is important to note that the food
product must contain less milligrams of gluten than the calculated value for
the product to comply with the FDA guideline.  

 

Deborah Holladay

Alamo Celiac GIG Membership Database

http://alamoceliac.org <http://alamoceliac.org/> 

 


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