Reading Food Labels Atlanta Metro Celiacs July 14, 2007

Reading Food Labels Atlanta Metro Celiacs July 14, 2007 1

Caution Ingredients change all the time Read the label every time you purchase a product Call the manufacturer with all questions If in doubt, leave it out 2

Celiac Info on the Internet Don t automatically believe what you read That applies to both good and bad news Question any advice given! Do you have different symptoms and/or added difficulties than the person posting the information? Confirm by going to other websites Does the information make sense to you? 3

Gluten Free Product Lists There are lists of Gluten Free (GF) products out there Some lists are for sale or rent Other lists are for free and are put together by: Food manufacturers Grocery stores Health Food Stores On line support groups Local support groups 4

Gluten Free Product Lists for sale or rent Clan Thompson website http://www.clanthompson.com/index.php3 PC, MAC & PDA Food & Drug lists (1 time or yearly subscription) Printed Pocket Guides Free info on website Newsletter Look in old copies for free GF food & drug mini-lists List of food manufacturer s phone # or website Ingredients list & more Good website for new celiacs 5

Gluten Free Product Lists Food manufacturers for Free Check if they are a company that clearly lists gluten On website, look under Nutritional info Sometimes under FAQs If no list call or email Sometimes info posted on listserv or local support group websites Companies that don t list all gluten 6

Gluten Free Product Lists for Free Whole Foods http://www.wholefoodsmarket.com/ Under menu items: Whole Body -> Special Diets (as of 7/5/07) Ingles http://www.ingles-markets.com/ask_leah/gluten_free.php Publix Call 1-800-242-1227 or send message thru www.publix.com to request a list of gluten free products be mailed to you Sarasota, Fl support group has a PDF of 8/2006 list on their website http://www.sarasotamanateeceliacs.com/publixglutenfr eeproducts.html 7

Kroger Gluten Free Product Lists for Free call 1-866-632-6900 and ask to speak to a nutritionist (Mon-Fri only) Kroger now has a printed GF list, call & they will mail one to you Trader Joe s http://www.traderjoes.com/ Under menu items: Products -> Reading Room (as of 7/5/07) Return To Eden http://www.return2eden.com/ Under menu items: Gluten&Wheat Free (as of 7/5/07) 8

Walmart Gluten Free Product Lists Does not publish a list of GF products Many of the Great Value & Equate (Walmart store brands) products that are GF will say Gluten-Free on the package This includes grocery and over the counter(otc) drugs 9

Delphi On-line Forum GF Food & Product Lists Lists compiled by volunteer forum members Lists cover Food (adult and baby food) Food ingredients ie baking supplies, spices, meats, etc Health_And_Beauty_Products Household_Products Vitamins_and_Supplements Medications_Rx_and_OTC Alcohol and other beverages Can be downloaded for free as either Word or PDF files http://forums.delphiforums.com/n/mb/list.asp?webtag=celia c&ctx=1048576&cachetag=x46-0 Files are compressed (zipped) files and must be uncompressed (unzipped) before use. A copy is also posted at http://celiacdisease.meetup.com/11/files/ 10

Celiac Listserv Grand daddy of celiac forums Don t have to join to view or search Have to join (no cost) to post messages The archive of messages is great, but the other celiac reference material/files on the site tends to be old Use the search function to look up info on products http://listserv.icors.org/archives/celiac.html 11

US vs Canada Be careful when on line A product by the same manufacturer with the same name can be GF in US and have gluten in it in Canada & vice versa Know the source/location of the information 12

What is gluten "Gluten" is the proteins encompassing the prolamins and the glutenins. The prolamins in wheat are called "gliadins". Prolamins from other cereals are also considered to be gluten and are named according to their source (secalins from rye, hordeins from barley, avenins from oats, and zeins from nontoxic corn) Celiacs are only concerned about gluten from Wheat, Barley, and Rye Oats will be discussed in a minute 13

Are there other Glutens Prolamins from other cereals are also considered to be gluten zeins from corn is a gluten, but not the kind that is a problem for celiacs Corn gluten is okay for celiacs 14

What about Oats? Are oats okay for celiacs? Opinions differ Some current research shows small amounts of uncontaminated oats are okay for most celiacs However Mainstream oats (Quaker, etc) are too contaminated with wheat for celiacs Only a few specialty oat growers have oats suitable for celiacs to try A list of the specialty oat growers is in the AMC June/July newsletter & on RTE website 15

What about Oats? Why are mainstream oats likely to be contaminated In a given field many farmers grow wheat 1 year and oats the next Seeds dropped during harvest, grow the next year, so wheat ends up growing among the oats Same equipment used to harvest, transport, and store both wheat & oats Wheat & oats have similar shape, size, weight & color, making separation before milling difficult 16

Are all products covered by the same rules No, different rules apply to different types of products Foods - FDA Prescription Drugs - (FDA but different rules) Over the Counter (OTC) Drugs-(FDA but different rules) Meat, Poultry & Eggs (USDA, also different rules) Today s topic is Food Labeling The other product types will be touched on 17

Gluten Free on food Labels Currently no US regulations on what gluten free means Gluten Free on a label is/will be voluntary FDA is set to publish standards on gluten free by August 2008 Gluten Free will probably be defined as less than 20 ppm (parts per million) Oats must also be < 20ppm to be labeled GF Will probably allow wheat based products if processed to < 20 ppm (i.e.all the wheat protein has been removed) 18

Labeling Law for Food Food Allergen Labeling and Consumer Protection Act of 2004 Abbreviated FALCPA 19

Labeling Law Requires that by January, 2006 all food product labels show when one of the 8 major allergens is contained in an ingredient Also requires that these allergens be listed when contained as a secondary ingredient in spices, natural or artificial flavorings, additives and colorings 20

Labeling Law What allergens does the 2004 labeling law cover? Milk Egg Peanuts Tree Nuts Fish Shell fish Soy Wheat The law does not cover barley, rye or oats 21

Labeling Law - Food What isn t covered? Any thing considered protein free, does not have to be listed Specifically oil derived products, i.e. wheat germ oil Incidental ingredients However the FDA has ruled incidental ingredients containing wheat must be labeled But barley is a different story raw agricultural commodities (generally fresh fruits and vegetables) Prescription drugs, OTC drugs, meats, poultry & eggs 22

Labeling Law FALCPA requires the 8 allergens be shown in one of two ways. 1) Include the name of the food source in parenthesis following the common or usual name of the major food allergen in the list of ingredients in instances when the name of the food source of the major allergen does not appear elsewhere in the ingredient statement. 23

Labeling Law One way to show 8 major allergens Ingredients: Enriched flour (wheat flour, malt flavoring, niacin, reduced iron, thiamin mononitrate, riboflavin, folic acid), sugar, partially hydrogenated soybean oil, and/or cottonseed oil, high fructose corn syrup, whey (milk), eggs, vanilla, natural and artificial flavoring) salt, leavening (sodium acid pyrophosphate, monocalcium phosphate), lecithin (soy), mono-and diglycerides (emulsifier) Beware the malt flavoring is probably made from barley 24

Labeling Law Other way to show 8 major allergens 2.) Use a contains statement Ingredients: Enriched flour (wheat flour, malt flavoring, niacin, reduced iron, thiamin mononitrate, riboflavin, folic acid), sugar, partially hydrogenated soybean oil, and/or cottonseed oil, high fructose corn syrup, whey (milk), eggs, vanilla, natural and artificial flavoring) salt, leavening (sodium acid pyrophosphate, monocalcium phosphate), lecithin (soy), mono-and diglycerides (emulsifier) Contains Wheat, Milk, Egg, and Soy Beware the malt flavoring is probably made from barley 25

Labeling Law - Food 2 challenges for celiacs Knowing the other names for wheat Determining which foods have Barley Rye Oats 26

Other names for Wheat Atta Graham Flour Spelt (aka dinkel Bulgar Hydrolyzed Wheat Protein & farro or faro) Club wheat Kamut Triticale Couscous Matzo Meal wheat bran Durum Modified Wheat Starch wheat germ Einkorn Mir wheat starch Emmer Orzo - is not a grain, but a White flour Farina Fu pasta that looks like rice Seitan - also known as 'wheat meat' Semolina unbleached wheat flour And there are probably more names I missed 27

Rye, Oats & Barley Rye Other than rye bread, rye is not used very commonly in the food industry rye bread should be easy to avoid Oats are usually on the label and not hidden Barley is our main concern Since wheat must be called out 28

Barley -Malt Malt (below is from Gluten Free Living) Although there is a slight chance that malt is made from corn, it is almost always derived from barley so it contains gluten. Malt extract, malt syrup and malt flour are made from barley. So is malt vinegar and it is not distilled, so it could contain gluten. 29

Malt Flavoring almost always from Barley 30

Natural Flavor - (Barley??) Natural flavor (below is from Gluten Free Living magazine) Flavors are tricky. It is often difficult to find out what is in a flavoring. But according to the Flavor Extract Manufacturers Association, gluten-containing grains are rarely used in flavoring except in meat products and products that contain meat. 31

Natural Flavor - (Barley??) Natural flavor (below is from Shelley Case's book "Gluten-Free Diet pg 44 ) "It would be rare to find a natural or artificial flavoring containing gluten because :(a) hydrolyzed wheat protein cannot be hidden under the term "flavor", and (b) barley malt extract or barley malt flavoring is almost always declared as "barley malt extract" or "barley malt flavoring". For this reason, most experts do not restrict natural and artificial flavorings in the gluten-free diet." 32

Caramel Color (Barley??) Caramel color (below is from the Clan Thompson website) The FDA allows barley malt - starch hydrolysates - lactose or other ingredients to be used, but we could not find any US manufacturers who use gluten containing ingredients in caramel color. 33

Starch For Foodin US & Canada The single word starch means cornstarch For OTC or prescription drugs The single word starch can mean wheat starch (or other types of starch) modified food starch in Food is okay FALCPA says if made from wheat then it must state on the label Modified wheat starch or Modified food starch (wheat) or Have a Contains wheat statement 34

Wheat Free is seldom Gluten Free Both are Crispy Brown Rice 35

Wheat Free But not Gluten Free (malt) Gluten Free 36

Hormel Chili with Beans Beware of Similar Products Make No Assumptions INGREDIENTS: WATER, BEEF, BEANS, TOMATOES (WATER, TOMATO PASTE), CORN FLOUR, FLAVORING, CHILI POWDER (CHILI PEPPERS, FLAVORINGS), SUGAR, MODIFIED FOOD STARCH, GREEN CHILES, ONIONS, JALAPENO PEPPERS GF Hormel Chili - No Beans INGREDIENTS: WATER, BEEF, CEREAL NOT (OATMEAL, YELLOW CORN FLOUR), CHILI POWDER (CHILI PEPPERS, FLAVORING), GF TOMATOES (WATER, TOMATO PASTE), SUGAR, SALT, HYDROLYZED CORN, SOY, AND WHEAT PROTEIN, MODIFIED FOOD STARCH, FLAVORING, AUTOLYZED YEAST, MONOSODIUM GLUTAMATE, SPICE 37

Vinegar Distilled vinegar is GF Distilling removes gluten (if any to begin with) from the vinegar Most flavored vinegars are okay, but some add non gf flavoring after distilling This is a rare occurrence Not GF Malt Vinegar The occasional flavored vinegar Look at label to see if non GF ingredient was added NP 38

Vinegar Balsamic vinegar, apple cider vinegar, etc are GF Do not believe the old Celiac myth that vinegar is not GF Malt Vinegar is not GF If just vinegar is listed, it is okay 39

Potential for Cross Contamination Eating an otherwise GF product with a statement like the above is a personal decision Factors to consider: Company reputation and is the possible cross contamination from liquid or dust 40

molasses maltodextrin Ingredients list 41

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??? NO OK??? 43

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OK??? No Wheat listed Looking for barley, 45

GF prescription drug list sources Purchase The Clan Thompson website has downloadable GF drugs database ( www.clanthompson.com ) Purchase a printed book of GF meds http://www.celiacmeds.com/ Free List by Columbus, OH pharmacist http://www.glutenfreedrugs.com/ Clan Thompson also has a section with free info on prescription & OTC drugs List by Wheaton, IL support group http://homepage.mac.com/sholland/celiac/gfmedlist.pdf 46

Prescription Drugs To get list of ingredients www.rxlist.com Inactive ingredients should be on the page with medicine s description Since ingredients change, check with drug manufacturer to be sure Ask does your product have wheat, rye, barley or oats in it Generic version probably has different inactive ingredients than name brand drug Good article on deciphering drug ingredients http://healthsystem.virginia.edu/internet/digestivehealth/nutritionarticles/plogstedarticle.pdf Print a copy to give to your pharmacist 47

OTC Drugs & Vitamins (Over The Counter) To determine GF status use GF product lists already discussed Drug & vitamin manufacturers website/call Some drug store chains have lists Some vitamins & supplements have Gluten Free on the bottle Remember food rules on starch do not apply 48

Meat & Poultry What substances or ingredients can be listed as "natural flavor," "flavor," or "flavorings" rather than by a specific common or usual name? Ingredients such as ginger, black pepper, onion powder, garlic powder, celery powder, and garlic oil may be listed as one of the three categories mentioned above. They may be designated as "natural flavors" because they are substances used chiefly for flavor. They do not make a nutritional contribution, are not derived from an animal species, and there are no health concerns linked to them. 49

Meat & Poultry Can hydrolyzed animal or vegetable protein be identified as "natural flavoring" on the label? No. FSIS regulation requires that animal or vegetable proteins must be specifically identified in the ingredient statement on the labels. The source of the protein must also be disclosed. On the label, you will read "hydrolyzed wheat protein" or "hydrolyzed milk protein," not just hydrolyzed protein. 50

Government Websites FDA - Questions and Answers Regarding the Food Allergen Labeling Act of 2004 http://www.cfsan.fda.gov/~dms/alrguid4.html FDA Questions and Answers regarding the proposed Gluten Free Labeling Rules http://www.cfsan.fda.gov/~dms/glutqa.html FDA - great discussion on cross contamination of grain from the celiac perspective http://www.cfsan.fda.gov/~dms/glutran.html USDA - Natural Flavorings on Meat and Poultry Labels http://www.fsis.usda.gov/help/faqs_flavorings/index.asp NIH celiac webpage http://digestive.niddk.nih.gov/ddiseases/pubs/celiac/ 51

Questions 52

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Official Definition of Wheat The term "wheat" in section 201(qq) means any species in the genus Triticum. Thus, for the purposes of section 201(qq), wheat would include grains such as common wheat (Triticum aestivum L.), durum wheat (Triticum durum Desf.), club wheat (Triticum compactum Host.), spelt (Triticum spelta L.), semolina (Triticum durum Desf.), Einkorn (Triticum monococcum L. subsp. monococcum ), emmer (Triticum turgidum L. subsp. dicoccon (Schrank) Thell.), kamut (Triticum polonicum L.), and triticale ( x Triticosecale ssp. Wittm.). 54

Meat & Poultry What Federal regulation defines what can be listed as a natural flavoring on the meat and poultry label? On March 1, 1990, FSIS published the final rule, Ingredients That May Be Designated as Natural Flavors, Natural Flavorings, Flavors, or Flavorings When Used in Meat or Poultry Products. The rule did the following: Defined the ingredients, i.e., spices, spice extractives, and essential oils, that may be declared as "natural flavors" or "flavors" on meat and poultry labels. Required more specific listing of certain ingredients. Substances such as dried beef stock, autolyzed yeast, and hydrolyzed proteins must be listed on the label by their common or usual names because their purpose is not just for flavor. They are flavor enhancers, emulsifiers, stabilizers, and binders. Required that the specific source of hydrolyzed protein be indicated on the label, for example, "hydrolyzed soy protein" or "hydrolyzed whey protein." 55

Maltodextrin Gluten-Free Diet A Comprehensive Resource Guide by Shelley Case (Expanded Edition April 2006), Pg. 52 MALTODEXTRIN -It is used as an anti-caking and free-flowing agent, formulation aid, processing aid, carrier agent for flavors, bulking agent, stabilizer and thickener, or surface-finishing agent in a wide variety of foods. -Maltodextrin is a purified, concentrated, non-sweet nutritive mixture of saccharide polymers obtained by hydrolysis of edible starch. -Can be derived from different starches such as corn, waxy maize, potato, rice or wheat. -Corn, waxy maize or potato are the most commons sources in North America. -Wheat-based maltodextrin is used more frequently in Europe and is now being used in a few North American products. Although maltodextrin may be derived from wheat, it is highly processed and purified (significantly more than modified food starches), and rendered gluten-free. North American and European scientist using the most sensitive, scientifically validated R5 ELISA Tests have not detected gluten in wheat-based maltodextrin. back 56

Molasses Per Gluten-Free Diet A Comprehensive Resource Guide by Shelley Case (Expanded Edition April 2006), Pg. 33 Per Canadian Celiac Association Pocket Dictionary 2 nd Edition 2005 Molasses is an allowed food back 57

"...January 1, 2006, mandates that foods containing milk, eggs, fish, crustacean shellfish, peanuts, tree nuts, wheat, and soy must declare the food in plain language on the ingredient list or via: the word Contains followed by the name of the major food allergen (milk, wheat, or eggs for example); or a parenthetical statement in the list of ingredients, e.g., albumin (egg). " 58