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Can trace amounts be accepted in the treatment of coeliac disease?

http://www.ncbi.nlm.nih.gov/entrez/q...arch&DB=pubmed

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Gluten contamination in gluten-free products cannot totally be avoided. The safe threshold for gluten remains obscure.

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purpose was to estimate a reasonable limit for residual gluten

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CONCLUSIONS: The threshold for gluten-contamination can safely be set at 100 ppm. Provided that the daily flour intake is even 300 g, a level of 100 ppm results in 30 mg of gluten intake. This has been shown to be safe, when correlated to histology, in clinical and challenge studies. The level can be achieved by the industry, and does not make the diet too cumbersome.

Hey, I'm not saying I agree with the conclusion... I'm just posting what I found this morning... don't shoot the messenger. :D

This just backs up my reasons for learning to bake with cooked rice rather than the contaminated rice flour that is traditionally accepted as being gf.

Small doses (10 mg/body mass/day) hurt adults

Wiad Lek. 2002;55(9-10):554-60. Links
[Individual sensitivity of jejunal mucosa to small doses of gluten in coeliac disease ]
[Article in Polish]

* Rujner J,
* Socha J,
* Romanczuk W,
* Stolarczyk A,
* Wozniewicz B,
* Gregorek H,
* Madalinski K,
* Syczewska M.

Instytutu Pomnik-Centrum Zdrowia Dziecka w Warszawie.

In coeliac patients the age of development of symptoms, clinical picture of the disease and complications depend on the dose of ingested gluten. The aim of the study was the evaluation of individual sensitivity to small doses of gluten in the group of 60 patients aged 2.65 to 17.92 (mean age 7.49) treated with gluten-free diet for at least 12 months due to coeliac disease diagnosed according to ESPGAN criteria (food allergy to gluten excluded). Gluten challenge with dose of 10 mg/kg body mass/day was controlled with serological tests (IgAEmA, IgAAGA, and IgGAGA antibodies) carried out every 3 to 6 months. Jejunal biopsy was performed before gluten challenge (normal mucosa), and after positive EmA/AGA antibodies tests to confirm diagnosis (flat mucosa). After 35 months of observation 53.7% of all patients presented of jejunal villious atrophy, and positive IgAEmA. In this group 3.7% presented symptoms after 3 months of gluten challenge, 5.5% after 6 months, 3.7% after 9 months, and 3.7% after 12 months. In some coeliac patients ingestion of small amounts of gluten (10 mg/kg/day) can lead to small intestinal villious atrophy.

PMID: 12607410 [PubMed - indexed for MEDLINE]

You've taken it farther than me. Guess I'll have to get a grinder for Christmas. You don't worry about contamination in the rice as well as contamination in the rice flour?
Leslie

If it is contaminated, it is not to the same degree as rice flour (because of the gluten in the commercial mills). We know this because ds will get car sick (throws up) if we feed him a flour based rice product and then go for about a 45 minute ride (he throws up about 1/2 an hour into the journey). However, he can eat a whole bowl of rice and not be sick at all. (Also, it says 'may contain trace amounts of wheat' on the bag of rice flour.)

I don't grind my rice up, I just cook it and reduce the liquids used. I'm still working on a lot of stuff but am not being too impatient because we don't really need a whole lot of grain in our diets.

Kim, your link http://www.ncbi.nlm.nih.gov/entrez/q...arch&DB=pubmed takes me to the Pubmed homepage :confused: I have had that problem recently too. Can you post the PubMed # and then we can put that into the search. Is there another way to get there that is easier?

At Dr. Fine's meeting this past spring there was a physician who spoke and said that all grains are cross contaminated. He even included quinoa and teff - I would think that these would have very little chance of coming in contact with wheat but what do I know :confused:
Anne

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Originally Posted by KimS (Post 12194)

This just backs up my reasons for learning to bake with cooked rice rather than the contaminated rice flour that is traditionally accepted as being gf.

You might want to consider ALL foods as suspect then. There are some naturally GF food that test out at 2-3 ppm. This was discussed during the labeling law/GF status meetings. They did not specify what it was.

I think this is the link:

http://www.ncbi.nlm.nih.gov/entrez/q...=pubmed_docsum

Quote:

1: Aliment Pharmacol Ther. 2004 Jun 15;19(12):1277-83. Links
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,
Maki M.
Department of Medicine, Tampere University Hospital, and Medical School, University of Tampere, Tampere, Finland. pekka.collin@uta.fi

BACKGROUND: Gluten contamination in gluten-free products cannot totally be avoided. The safe threshold for gluten remains obscure.

AIM: The purpose was to estimate a reasonable limit for residual gluten, based on current literature and measurement of gluten in gluten-free products on the market.

METHODS: The gluten content of 59 naturally gluten-free and 24 wheat starch-based gluten-free products were analysed by enzyme-linked immunosorbent assay. The daily intake of flours was calculated in 76 adults on gluten-free diet, and the intake compared with mucosal histology.

RESULTS: A number of both naturally gluten-free (13 of 59) and wheat starch-based gluten-free (11 of 24) products contained gluten from 20 to 200 ppm (=mg/kg). The median daily flour consumption was 80 g (range: 10-300). Within these limits, the long-term mucosal recovery was good. CONCLUSIONS: The threshold for gluten-contamination can safely be set at 100 ppm. Provided that the daily flour intake is even 300 g, a level of 100 ppm results in 30 mg of gluten intake. This has been shown to be safe, when correlated to histology, in clinical and challenge studies. The level can be achieved by the industry, and does not make the diet too cumbersome.

PMID: 15191509 [PubMed - indexed for MEDLINE]

Thanks Al... that's the one. Sorry about that link, Anne.

I think the thing is that there are so many different levels of 'sensitivity'. In our family dd and I don't react to commercial rice flour (or I should say, don't seem to) but dh and ds do react...

So, the trick is to cook toward to the most sensitive person in the house, thereby protecting everyone from illness. (There's no way I'm baking one batch of cookies from comm. rice flour and another batch from rice!)

I know that there are many people who can't tolerate any grain at all. Sometimes I suspect my son of being one of them... but if I can figure out how to, reasonably safely, give him cookies once a week, that he enjoys so much... then I will do it. :)

Sometimes I think it's actually an allergy that he has (besides?) celiac. I've heard that people with gluten allergies have to be 'more' careful. :confused: