<<Disclaimer: Verify this information before applying it to your situation.>> Hi I have corresponded with Kemp concerning his recent email regarding wheat starch. Jeff's email on the same topic has now arrived on my screen. List members may be interested in the following: I have a copy of a formal document ( 1993 ) quoting the National Food Authority of Australia stating: `Currently there are foods on the market labelled as "gluten-free". However, some of these "gluten-free" foods contain small amounts of gluten and cause coeliacs who are extremely sensitive to gluten to become ill.' The concern of the Australian Authority included `Codex defined' wheat-starch based products. To repeat. Some coeliacs were becoming ill on such products Australia and New Zealand have now effectively defined `gluten-free' as `containing no detectable gluten'. Codex quality wheat starch products cannot be labelled as `gluten-free' in these two countries. In NZ, the one such product on the market must now be labelled as `low-gluten'. List members may also be interested in the following recent research items which do indicate problems with Codex quality wheat-starch products for at least some coeliacs. Chartrand LJ; Russo PA; Duhaime AG; Seidman EG. Wheat starch intolerance in patients with celiac disease. J Am Diet Assoc, 97(6):612-8 1997 Ju.n Abstract: OBJECTIVE: Evaluate in patients with celiac disease the tolerance of prolonged consumption of small amounts of gliadin contained in products containing wheat starch. DESIGN: Open 1-year trial of the addition of wheat starch to a gluten-free diet in a cohort of adult patients with biopsy-proven celiac disease who had never consumed wheat starch. The control group consisted of patients with celiac disease who tolerated wheat starch. SUBJECTS: Seventeen patients with celiac disease and 14 control patients, all diagnosed according to criteria of the European Society of Pediatric Gastroenterology and Nutrition, were recruited from the Canadian Celiac Association and the Quebec Celiac Foundation. SETTING: The study was conducted in the outpatient clinic of the Gastroenterology and Nutrition Service of Ste Justine Hospital, Montreal,Quebec, Canada. INTERVENTIONS: Patients were asked to consume four to six portions daily of a wheat starch-containing product, mainly bread, for up to 1 year. MAIN OUTCOME MEASURES: The gliadin content of the wheat starch product used in this trial was quantified by enzyme-linked immunosorbent assay. Patient outcome measures included symptoms, nutritional parameters (anthropometric data, complete blood count, serum folate and iron levels), and immunologic parameters (antigliadin antibody and antiendomysiumantibody titers). RESULTS: A quantifiable amount of immunoreactive gliadin (0.75 mg/100 g) was found in the wheat starch. The majority of the patients with celiac disease (11 of 17) who had never consumed wheat starch previously developed symptoms, which resolved within weeks of discontinuing the product. Relapse of skin lesions was seen in two of three patients with coexisting dermatitis herpetiformis. No weight loss or biochemical changes were observed. Despite the presence of symptoms, antigliadin antibody and antiendomysium antibodydeterminations were not useful to detect the clinical intolerance. APPLICATIONS: The innocuousness of the long-term ingestion of "gluten-free" products containing wheat starch is stillunproven, and prolonged use of such products by patients with celiac disease cannot be recommended. Faulkner-Hogg KB; Selby WS; Loblay RH. Dietary analysis in symptomatic patients with coeliac disease on a gluten-free diet: the role of trace amounts of gluten and non-gluten food intolerances. Scand J Gastroenterol, 34(8):784-9 1999 Aug. Abstract: BACKGROUND: Whereas many people with coeliac disease (CD) are asymptomatic when consuming a gluten-free diet (GFD), a proportion continues toexperience symptoms. The reasons for this are unclear. METHODS: Thirty-nine adult members of The Coeliac Society of New South Wales, all of whom had persistent gastrointestinal symptoms despite adhering to a GFD, were evaluated. Dietary analysis indicated that 22 (56%) were consuming a GFD as defined by the WHO/FAO Codex Alimentarius (Codex-GFD), in which foods containing up to 0.3% of protein from gluten-containing grains can be labelled as 'gluten free'. The remaining 17 were following a no detectable gluten diet (NDG)-GFD, as defined by Food Standards Australia. All subjects were required to follow a NDG-GFD during the study. Those in whom symptoms persisted after changing from a Codex-GFD and thosewho entered the study already on a NDG-GFD began an elimination diet followed by open and double-blind challenges to identify specific non-gluten food or food chemical intolerances. RESULTS: Of 22 patients who switched to a NDG-GFD symptoms resolved in 5 (23%) and were reduced in 10 others (45%). Thirty-one subjects commenced the elimination diet. Symptomatic improvement was experienced in 24 (77%). Subsequent food or food chemical challenges resulted in a mean of five positive challenges per individual. Diarrhoea was the most commonly provoked symptom, followed by headache, nausea, and flatulence. Symptoms were especially provoked by amine, salicylate and soy. CONCLUSION: The consumption of trace amounts of gluten, traditionally allowed in a Codex-GFD, may be responsible for the continuing symptoms seen in some patients with CD. Further investigation for non-gluten food intolerances should follow if symptoms persist after adherence to a NDG-GFD. Graeme New Zealand