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Gluten in “gluten-free” food from food outlets in Melbourne: a cross-sectional study

Emma P Halmos, Catherine A Di Bella, Russell Webster, Minfeng Deng and Jason A Tye-Din
Med J Aust 2018; 209 (1): 42-43. || doi: 10.5694/mja17.00883
Published online: 28 May 2018

Medical treatment of coeliac disease includes a lifelong strictly gluten-free diet and is compromised by exposure to even small (milligram) amounts of gluten.1 Patients often report being accidentally exposed to gluten when dining out, but this has not been formally assessed in Australia. Understanding how often gluten is present in “gluten-free” food offered by food businesses, and the reasons why this occurs, are medically important, with implications for the food industry and its regulation.

We randomly selected 127 food businesses in the City of Melbourne council area that advertised gluten-free options. This was undertaken as part of the City of Melbourne food sampling program, required by the Food Act 1984 (Vic). Environmental health officers (EHOs) conducted unannounced site visits and procured at least one food item declared to be gluten-free. Analysis of gluten content (Ridascreen Gliadin R5 ELISA) identified that 14 of 158 samples (9%) contained detectable gluten (Box), and were therefore not compliant with the Food Standards Australia New Zealand (FSANZ) definition of gluten-free.2 Nine of the 14 samples (6% overall) contained more than 20 parts per million (ppm) gluten, regarded as the upper threshold for safe gluten intake in Europe and the United States. One business provided wheat-based foods (> 80 ppm gluten) despite a gluten-free meal being requested, reflecting the lack of understanding reported by many people with coeliac disease.

Rates of non-compliance had improved since our earlier audits (2014: 28 of 138 [20%]; P = 0.005; 2015: 22 of 151 [15%]; P = 0.12). The improvement may be the result of greater scrutiny by EHOs (one-third of the businesses in this study had previously been audited) and education (Coeliac Australia promoted its Gluten Free Standard for the Food Service Sector3 during 2015). Indeed, four of five venues of one burger chain were non-compliant in 2014, but all were fully compliant in 2015 and 2016. The increasing community demand for gluten-free food4 may also be a driver of increased awareness among food service staff of the importance of avoiding gluten contamination.5

A survey was undertaken at each business by the EHO to determine factors associated with non-compliance. Business details and knowledge and implementation of gluten-free standards (including food labelling, preparation and display, and staff training) were assessed in a multivariate analysis. Only 10% of food service staff had good knowledge of the FSANZ code, and were particularly ignorant about spelt, consistent with European reports.5,6 The odds of compliance were reduced by 75% if the food business did not provide staff training (odds ratio [OR], 0.25; 95% confidence interval [CI], 0.08–0.79) but was sevenfold higher in franchised food outlets (OR, 7.65; 95% CI, 1.21–48.4). Franchise businesses may be more likely to have standardised procedures for food handling and to provide staff training.

Our cross-sectional study found that gluten can be present in “gluten-free” foods offered by Melbourne food businesses, sometimes at clinically significant levels. Improving training and knowledge about appropriate gluten-free food practices is probably the single most important step in ensuring the safe delivery of gluten-free food, particularly for people with coeliac disease, whose health depends upon it.

Box – “Gluten-free” food items found to be non-compliant with guideline for gluten-free foods, Melbourne, 2016, with recent compliance history (2014, 2015) of the supplying businesses

Food item

Gluten content (ppm)

Environmental health officer follow-up

Earlier audits


Chicken burger, BLT burger

each > 80

Telephone call

2014 (compliant)

Roasted vegetable salad

> 80

Letter, re-visit

None

Banana bread*

> 80

Re-visit
(re-tested food compliant)

None

Salt and pepper squid

> 80

Letter

2014 (compliant), 2015 (not compliant: nachos, > 80 ppm)

Rice paper rolls

51

Letter, re-visit

2015 (not compliant: pork noodle salad, > 80 ppm)

Calamari

39

Letter

None

Mixed thali

38

Telephone call

None

Chicken risotto

29

Letter

None

Carrot loaf

9.4

Letter

2014, 2015
(not compliant: dahl pie, > 80 ppm; chocolate brownie, 5.0 ppm)

Banana bread

9.3

Re-visit (business has stopped using outsourced product)

2014 (compliant)

Paella

8.9

Letter

None

Banana bread*

8.3

Re-visit
(re-tested food compliant)

None

Gluten-free pasta

5.2

Letter

None


* Food was from the same chain, but from different venues.

Received 7 September 2017, accepted 21 December 2017

  • Emma P Halmos1,2
  • Catherine A Di Bella3
  • Russell Webster4
  • Minfeng Deng5
  • Jason A Tye-Din1,6

  • 1 Royal Melbourne Hospital, Melbourne, VIC
  • 2 Monash University Central Clinical School, Melbourne, VIC
  • 3 Coeliac Australia, Sydney, NSW
  • 4 Health and Wellbeing Branch, City of Melbourne, Melbourne, VIC
  • 5 Cartovera, Adelaide, SA
  • 6 Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC

Correspondence: tyedin@wehi.EDU.AU

Acknowledgements: 

The City of Melbourne provided funding for the environmental health officer activities and food sampling analysis. Emma Halmos was funded by a research grant from Coeliac Australia.

Competing interests:

Jason Tye-Din is a co-inventor on patents pertaining to applications of gluten peptides in therapeutics, diagnostics, and non-toxic gluten; he is a shareholder in Nexpep and a consultant to ImmusanT (USA).

  • 1. Walker MM, Ludvigsson JF, Sanders DS. Coeliac disease: review of diagnosis and management. Med J Aust 2017; 207: 173-178. <MJA full text>
  • 2. Food Standards Australia New Zealand. Standard 1.2.7. Nutrition, health and related claims. Mar 2016. http://www.foodstandards.gov.au/code/Documents/1.2.7%20Nutrition%20and%20health%20claims%20v157.pdf (viewed Apr 2018).
  • 3. Coeliac Australia. Gluten free standard for the Australian food service sector. July 2015. https://www.coeliac.org.au/gf-standard/ (viewed Apr 2018).
  • 4. Kim HS, Patel KG, Orosz E, et al. Time trends in the prevalence of celiac disease and gluten-free diet in the US population: results from the National Health and Nutrition Examination Surveys 2009–2014. JAMA Intern Med 2016; 176: 1716-1717.
  • 5. Aziz I, Karajeh MA, Zikha J, et al. Change in awareness of gluten-related disorders among chefs and the general public in the UK: a 10-year follow-up study. Eur J Gastroenterol Hepatol 2014; 26: 1228-1233.
  • 6. Sogut A, Kavut AB, Kartal I, et al. Food allergy knowledge and attitude of restaurant personnel in Turkey. Int Forum Allergy Rhinol 2015; 5: 157-161.

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