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Modifying the gluten-free threshold for foods: first do no harm

To the Editor: The gluten-free (GF) diet for people with coeliac disease (CD) is complex, costly, and compliance with the diet is variable. Coeliac Australia, with the Australian Food and Grocery Council, are lobbying to increase the mandated gluten threshold for GF foods.1 The situation in Australia since 1995 has been that there must be “no detectable gluten” in foods labelled “gluten free”. The proposed new standard is “< 20 parts per million (ppm)”. This has been proposed because food testing has become increasingly sensitive over the years, resulting in fewer foods being considered gluten free. The current detection level of food testing is about 3 ppm. Unfortunately, the proposed new GF standard may not be safe for patients with CD.

There are few high-quality studies determining a safe gluten intake for patients with CD, although it is known that tolerable amounts vary between patients.2 In one study, 42 patients with CD who were eating a GF diet received 0, 10 or 50 mg of gluten daily for 3 months (10 mg in 500 g of food represents 20 ppm; 10 mg gluten is ingested in 1/250th of a slice of bread containing 2.5 g gluten). Patients’ duodenal…