As trace amounts of gluten can cause intestinal damage, maintaining strict threshold standards for gluten-free products is crucial for the safety of individuals with celiac disease.
Manufactured products that are labelled gluten-free or use the symbol of the ear of wheat with a cross through it must meet the threshold standard of being under 20 ppm gluten.
Through multiple research studies [1,2,3] it was determined that individuals with celiac disease could tolerate up to 10 mg (10 ppm) of gluten per day without intestinal damage. In a typical diet the average individual consumes an average of 15 to 20 g of gluten per day. In household terms, 20 ppm is equivalent to 20 mg of gluten per kg. To clarify: 10 g of gluten is the equivalent of four slices of bread. Therefore, the designation of gluten-free as under 20 ppm provide a safe limit for those on a gluten-free diet.
Lower threshold since 2008
A threshold of 20 ppm, which was adopted in early 2009 and has been the standard since 2012 in Europe. Both Canada and the US have adopted the standard threshold of 20 ppm more recently [1,2,3]. The threshold of under 20 ppm allows patients to consume up to 300 g of carbohydrate per day. The reversal of symptoms and healing benefits of a gluten-free diet are achieved by maintaining strict adherence to the gluten-free diet standard threshold of under
Labelling is crucial for dietary adherence
For individuals with celiac disease maintaining a strict gluten-free diet . Including careful selection of naturally gluten-free foods and labelled manufactured gluten-free products is a necessity for repair and recovery of the gut. Persons with gluten/wheat sensitivity should also maintain a strict gluten-free diet for at least the first year after diagnosis. After the first year and under the guidance of a physician, small amounts of gluten may be tolerated.
- A prospective, double-blind, placebo-controlled trial to establish a safe gluten threshold for patients with celiac disease. Catassi C, Fabiani E, Iacono G, D'Agate C, Francavilla R, Biagi F, Volta U, Accomando S, Picarelli A, De Vitis I, Pianelli G, Gesuita R, Carle F, Mandolesi A, Bearzi I, Fasano A. Am J Clin Nutr. 2007 Jan;85(1):160-6.
- Consumption of gluten-free products: should the threshold value for trace amounts of gluten be at 20, 100 or 200 p.p.m.? Gibert A, Espadaler M, Angel Canela M, Sánchez A, Vaqué C, Rafecas M. Eur J Gastroenterol Hepatol. 2006 Nov;18(11):1187-95.
- The safe threshold for gluten contamination in gluten-free products. Can trace amounts be accepted in the treatment of coeliac disease? Collin P, Thorell L, Kaukinen K, Mäki M. Aliment Pharmacol Ther. 2004 Jun 15;19(12):1277-83