How safe is food labelled 'gluten free' for the management of coeliac disease in New Zealand? - Dr Kirsten Coppell, Public Health Physician

How safe is food labelled ‘gluten
      free’ for the management of
      coeliac disease in New Zealand?
                     Dr Kirsten Coppell, Public Health Physician
Senior Research Fellow, Department of Medicine, University of Otago; Training Programme Supervisor, NZCPHM

Disclosures

1. No food industry conflicts of interest
2. My husband and both our children have coeliac disease
3. Self-confessed foodie

The New Zealand Coeliac Survey

Methods
          Permission was sought to use the Canadian Celiac Health Survey1
          Study population was members of Coeliac New Zealand Incorporated
           (n=2720)
          Data from 936 (199 men; 737 women) biopsy positive adults aged ≥ 16
           years
          Average age respondents = 54.1 years
          Majority (94%) New Zealand Europeans
          Average time between onset of symptoms and diagnosis = 11.6 years

1Cranney A, Zarkadas M, Graham I, Switzer C. The Canadian celiac health survey - the Ottawa chapter pilot. BMC
Gastroenterology. 2003;3(1):8.

Clinical symptoms prior to diagnosis & recovery rates

Symptom                              Present at     Fully Recovered
                                    diagnosis (%)          (%)
Bloating, gas, abdominal pain            76               52

Extreme weakness or tiredness            67               52

Diarrhoea                                64               57

Anaemia                                  57               68

Weight loss                              49               76

Large, pale, foul-smelling stools        42               67

Clinical symptoms prior to diagnosis & recovery rates
 Symptom                            Present at diagnosis          Fully Recovered
                                            (%)                          (%)
 Mood swings/depression                        40                         41

 Itchy skin                                    36                         31

 Constipation                                  33                         43

 Bone/joint pain                               33                         29

 Mouth ulcers                                  32                         60
 Other symptoms included easy bruising of skin, nausea or vomiting, migraines, muscle
 cramps, eczema, lactose intolerance, swollen hands/feet/ankles, poor growth,
 hypoglycemia

Accidental Consumption of Gluten

• 80% reported always having a reaction after eating gluten, and
  14% were unsure

• most common symptoms were gastrointestinal

• frequency of accidental consumption of gluten
   82% - rarely or occasionally
   13% - monthly
   5% - at least weekly

Impact of GF diet on quality of life

                                         All of    Most of   Some of    Never
                                       the time   the time   the time    (%)
                                          (%)       (%)        (%)
I (we) avoided restaurants because        5         21         53        22
of coeliac disease.
I (we) avoided travelling because of      2          8         27        64
coeliac disease.
I (we) brought gluten-free food          43         28         24         6
when I (we) travelled.
I was (we were) not invited out for       1          6         35        58
meals because of coeliac disease.

Figure 2. Histogram plots of the distribution of
gluten consumption in the different population
groups a measured by GIP in stool.

                       >300mg/day      >600mg/day
      Adult - nonCD        100%            100%
      CD, 0-3 yrs           9%               3%
      CD, 4-12 yrs         15%              6%
      CD, ≥13 yrs          18%              4%

Gluten free food standards in New Zealand
 Food Standards Australia New Zealand (FSANZ) develops
  standards for the food industry in Australia and New
  Zealand.

 the Food Standards Code requires mandatory labelling of
  food products where gluten is present as an ingredient, a
  food additive or a processing aid or a component of any of
  these.

 the standard states ‘a claim that a food is gluten free
  must not be made in relation to a food unless the food
  contains no detectable gluten; and no oats or their
  products; or cereals containing gluten that have been
  malted, or their products.’

Gluten free food standards in NZ
• FSANZ do not enforce the Code, and no regular
  monitoring of adherence to the FSANZ standards.

• reliance on the public making complaints to appropriate
  authorities (public health units or local governments),
  who have the responsibility to enforce the code.

• In contrast to, for example the Canadian Food Inspection
  Agency (CFIA). The CFIA compliance and enforcement
  actions occur all along the supply chain and they involve
  numerous stakeholders and jurisdictions.

The Safe Food for Canadians Act
 makes food as safe as possible for Canadian families;
 protects consumers by targeting unsafe practices;
 implement tougher penalties for activities that put health and
  safety at risk;
 provides better control over imports;
 institutes a more consistent inspection regime across all food
  commodities; and
 strengthens food traceability

Oamaru baker warned over gluten-free mix-up
Wednesday, 21 December 2011                                                                      Otago Daily Times
An Oamaru baker has been warned by the Commerce Commission after selling a gluten-free loaf that contained
gluten. However, Harbour Street Bakery's Ed Balsink said yesterday gluten found in the loaf was an accident, when the
wrong flour was used, and he had stopped producing the loaf because there is "no 100% guarantee" it can be gluten-free.
It no longer makes the loaf nor gluten-free products, because of that, he said.
The bakery used to make about 20 gluten-free loaves a week, but stopped the product about seven months ago, as soon
as the Commerce Commission found they contained gluten.
Earlier this year, the Commerce Commission visited the Harbour Street Bakery and bought three loaves of bread from
three batches described as "gluten-free" on signs and the bakery's website.
Testing can detect any gluten more than 3ppm (parts per million), which would have breached the gluten-free claim
under the provisions of the Fair Trading Act. Initial testing found gluten of more than 50ppm and further testing in
the region of 1000ppm.
The manager of the Christchurch competition-fair trading branch, Stuart Wallace said gluten was harmful to people with
coeliac disease, as the only effective treatment was complete gluten avoidance.
Mr Balsink told the commission he was uncertain how the gluten got into the loaves, suggesting there may have been a
residue from equipment and bread slicer. He also suggested a baker may have added gluten by mistake.
Mr Balsink, when contacted by the Otago Daily Times, said about 99% of the bakery's products were made from wheat
flour, which made it hard to maintain a gluten-free environment.
If prosecuted, the bakery could have been fined up to $200,000 and individuals up to $60,000.
However, the commission had decided to issue a warning letter, advise media and take no further action.
david.bruce@odt.co.nz

Rice wheat crop rotation

Wheat & Rice Reaper

 This product is used for
  reaping wheat and rice that is
  between 0.5- 0.8 meters high.

Cropping systems - India

61 of 640 (9.5%) samples of naturally GF ingredients had gluten levels
>20mg/kg (range 5 - 7995 mg/kg) with soy, millet and buckwheat most
commonly contaminated

3 of 268 samples labelled GF had gluten levels >20mg/kg (range 5 - 141 mg/kg)

•   Gluten contamination was detected in 33 of 173
    (19%) samples, with a range of 2.5 - >80 mg kg−1.
•   In 10 of the 173 samples (6%), the quantity of
    gluten exceeded the upper limit of 20 mg kg−1.
•   Of the 40 brand names tested twice in 2014 and
    2015, 15 (38%) showed significantly (p < .05)
    different gluten content between the 2 years.

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