More and more people are choosing gluten-free foods and the number of gluten-free foods available in grocery stores and restaurants is growing steadily. Yet it’s still difficult for consumers to accurately identify gluten-free foods when eating in restaurants where we have far less control over the ingredients in the meal and how it’s prepared. What is gluten?Gluten is a type of protein that's present naturally in wheat, barley, rye, spelt, farro, kamut, and emmer. It’s the substance that gives breads, muffins, and biscuits their shape, strength, and texture. Why do some people need to avoid gluten?There are two reasons to avoid gluten: celiac disease and non-celiac gluten sensitivity.Celiac disease is a genetic condition in which gluten causes an immune system reaction that leads to inflammation of the inner lining of the digestive tract, resulting in nutrient malabsorption. Celiac disease has been known since the mid-1800s, and in 1941 research identified a link between gluten and celiac disease. There is no cure for celiac disease, and the only treatment is to avoid gluten completely. A description of non-celiac gluten-sensitivity was first published in a 1980 paper in the journal Gastroenterology. This paper described patients who had symptoms similar to celiac disease, but no clinical evidence of celiac disease. Further, their symptoms went away while they adhered to a gluten-free diet. The causes of this sensitivity are not yet fully understood.Is a gluten-free diet healthy for everybody?Contrary to what your friends may tell you, there are no current scientific research studies that indicate that consuming a gluten-free diet has benefits for everyone. A gluten-free diet isn’t always a healthy diet. Many gluten-free products like breads, muffins, and crackers are made from processed white rice flour and can be low in fiber, iron, and B vitamins. Often gluten-free foods contain more sugar and fat to improve taste as well. How are gluten-free foods labeled?Beginning in 2014, the U.S. Food and Drug Administration (FDA) has required that claims that a food contains no gluten meet a clear standard that assures consumers that said claims will be truthful and consistent. Any foods with the label “gluten-free,” “no gluten,” “free of gluten,” or “without gluten” must contain less than 20 parts per million (ppm) of gluten, the lowest level that can be reliably detected in foods using scientifically validated analytical methods. Besides the limit of gluten to 20 ppm, the rule permits labeling a food “gluten-free," if the food does not contain:

• An ingredient that is any type of wheat, rye, barley, or crossbreeds of these grains
• An ingredient derived from these grains that has not been processed to remove gluten
• An ingredient derived from these grains that has been processed to remove gluten, but results in the food containing more than 20 ppm of gluten

Avoiding gluten when eating out in restaurantsAccording to the FDA, restaurants’ use of gluten-free labeling should be consistent with the federal definition. Many restaurants now offer gluten-free breads, pizza crusts, pasta, and desserts. However, a major issue that often isn’t addressed is cross-contamination, where foods containing gluten come into contact with gluten-free foods. Examples of cross-contamination include: gluten-free pizza crust cooked on the same pans or cut with the same knife as regular pizza, one toaster used for both gluten-free and regular breads, using the same fryer for gluten-free and traditional foods, prepping gluten-free foods in the same area as traditional foods, or using the same cleaning supplies in both areas.Lindsey Yeakle, Program Manager for the Gluten-Free Food Service Certification Program within the Gluten Intolerance Group, works with restaurants, hospitals, and college cafeterias to review their policies and procedures to safely provide gluten-free foods and avoid cross-contamination. Yeakle also helps participating restaurants develop staff training programs to make sure that everyone understands the reasons for the policies and procedures and knows how to implement them. The Gluten Intolerance Group has a list of participating restaurants at https://gffoodservice.org/certified-directory/certified-food-services/. Consumers can feel confident that restaurants certified by the Gluten Intolerance Group meet the highest standards for gluten-free foods.Questions to ask in restaurants about gluten-free foodsYeakle suggests that consumers who are looking for gluten-free foods not be afraid to ask questions before ordering. Consider the following...

• Where is the gluten-free food prepared and cooked in comparison to other foods?
• What type of thickener is used for soups, sauces, and desserts?
• Does the salad come with anything that might be crispy or fried? Does it contain croutons?
• Do you have a dedicated gluten-free fryer?
• Do you make your own veggie burgers? Do they contain wheat or any other source of gluten?
• Could I review the ingredients label for purchased gluten-free foods such as pizza crust, breads, crackers, cakes, or muffins?

By Lynn Grieger RDN, CDE, CPT, CHWCReferences:

1. CeliAct. A Brief History of the Gluten-Free Diet. https://celiact.com/blogs/the-celiact-blog/a-brief-history-of-the-gluten-free-diet-where-do-we-stand published 4-30-17; accessed 3-11-19
2. Medical News Today. All About Celiac Disease. Christian Nordqvist. https://www.medicalnewstoday.com/articles/38085.php?utm_source=TrendMD&utm_medium=cpc&utm_campaign=Medical_News_Today_TrendMD_1 last updated 12-15-17; accessed 3-11-19
3. U.S. Department of Health and Human Services. National Institute of Diabetes and Digestive and Kidney Diseases. Eating, Diet and Nutrition for Celiac Disease. https://www.niddk.nih.gov/health-information/digestive-diseases/celiac-disease/eating-diet-nutrition published June 2016; accessed 3-11-19.
4. U.S. Department of Health and Human Services. U.S. Food and Drug Administration. Gluten and Food Labeling, https://www.fda.gov/food/guidanceregulation/guidancedocumentsregulatoryinformation/allergens/ucm367654.htm last updated 7-16-18; accessed 3-11-19.
5. The Gluten Intolerance Group. Gluten-Free Food Service. https://gffoodservice.org/ accessed 3-11-19
6. Lindsey Yeakle, GFFS Quality Control and Program Manager. t: 253-204-2699 | e: Lindsey.Yeakle@gluten.org. 730C Commerce Center Dr. Sebastian, FL 32958. Phone conversation 2-27-19.