COMMISSION REGULATION (EC) No 41/2009 of 20 January 2009 concerning the composition and labelling of foodstuffs suitable for people intolerant to gluten
The EC regulation of 20 January 2009 established new gluten thresholds for dietary foodstuffs and foods for general consumption. From 1 January 2012, only foods which contain less than 20 ppm gluten will be allowed to be advertised as gluten-free. Advertising a product as gluten-free will no longer be permitted if the gluten content is between 21 and 100 ppm. The individual countries of the EU can decide whether products in this category may be labelled as “low gluten” or “with reduced gluten content”.

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Codex Standard for Foods for Special Dietary Use for Persons Intolerant to Gluten
The Codex Alimentarius Commission, which was established by the WHO and FAO, determines Codex Standards. These serve as international trade directives and are generally adopted by all world governments as part of their national food legislation. The Codex Standards are drawn up by various expert committees and, following agreement in committee, are presented to the Commission for approval.
Current Codex Standard for gluten-free foods
Several Codex committees have a role to play in the development and advancement of the different aspects of the standard for gluten-free foods: they are the Codex Committee on Nutrition and Foods for Special Dietary Uses (CCNFSDU), the Codex Committee on Methods and Analysis (CCMAS) and the Codex Committee on Food Labelling (CCFL).

The first Codex Standard for gluten-free foods came into force in 1981. According to this standard, "gluten-free" means that the total nitrogen content of the gluten-containing cereal grains used in the food product does not exceed 0.05 g per 100 g of these grains on a dry matter basis.

Throughout the year, the different Codex committees sit to discuss matters relating to new and existing standards. Between 1992 and 2006, the standard for gluten-free foods was on the agenda at half of these Codex sessions. Renewed discussions about the standard began in 1991 and a large proportion of the debate between the negotiators focused on the gluten threshold for gluten-free foods. A 200 ppm threshold was introduced in 1998.

After years of discussions about the threshold value, several delegations present at a session of the CCNFSDU suggested that a comprehensive revision of the entire draft standard was required. At its 31st session, which took place in Geneva between 30 June and 4 July 2008, the Commission adopted new thresholds for gluten-free foods. The “Draft Revised Standard for Foods for Special Dietary Use for Persons Intolerant to Gluten” specifies that only foods which contain less than 20 ppm gluten may be advertised as gluten-free. Advertising a product as gluten-free will no longer be permitted if the gluten content is between 21 and 100 ppm. The new agreed standard entitled the ‘"Draft Revised Standard for Foods for Special Dietary Uses for Persons Intolerant to Gluten" was also adopted as an EU regulation in 2009 and must now be implemented in national legislation by 2012.

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of 27 November 2007
amending Annex IIIa to Directive 2000/13/EC of the European Parliament and of the Council as regards certain food ingredients

In November 2005, a labelling regulation was introduced to make it easier for allergy sufferers to select products with a low allergen content.
This regulation is valid across Europe but only applies to packaged foods. Food allergy sufferers can find the following fourteen most common triggers of allergies and other intolerances in the ingredients list or the product name:
• Cereals containing gluten (wheat, rye, barley, oats, spelt, kamut or their hybridised strains) and products thereof,
• Milk and products thereof (including lactose),
• Eggs and products thereof,
• Soybeans and products thereof,
• Peanuts and products thereof,
• Nuts, i.e. almonds, hazelnuts, walnuts, cashews, pecan nuts, Brazil nuts, pistachio nuts, macadamia nuts and Queensland nuts, and products thereof,
• Celery and products thereof,
• Mustard and products thereof,
• Crustaceans and products thereof,
• Fish and products thereof,
• Sesame seeds and products thereof,
• Sulphur dioxide (SO2) and sulphites at concentrations of more than 10 mg/kg or 10 mg/litre expressed as SO2,
• Lupin and products thereof since the end of 2008,
• Molluscs and products thereof since the end of 2008.

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Scientific advisory board for the Italian Coeliac Association

A patient should not switch to a gluten-free diet until they have been given a reliable and definitive diagnosis. But which are the right methods of diagnosis? The scientific advisory board for the Italian Coeliac Association (AIC) has compiled a set of guidelines for the diagnosis and follow up of coeliac condition.

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Complimentary Feeding: A Commentary by the ESPGHAN Committee on Nutrition
2008
Coeliac condition is a complex pathology which is caused by the interaction of various genetic, immunological and exogenic factors. One of the exogenic factors that has been discussed is infant nutrition. Various studies have shown an correlation between the duration of breastfeeding and a reduced risk of developing coeliac condition. Based on the results of these studies, it can be surmised that the ideal time to introduce gluten into the diet is between the 17th week and the 7th complete month. Introducing a very low amount of gluten and continuing breastfeeding for at least a further two months after the introduction of gluten also both seem to have a protective effect.
In 2008, the ESPGHAN Committee (European Society for Paediatric Gastroenterology, Hepatology and Nutrition) gave its recommendations for the introduction of supplementary food into an infant's diet.

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A European scientific research project for the prevention of coeliac condition.

New study results point to the fact that the time of introduction of gluten into the diet of a child with a genetic predisposition to coeliac condition plays a large role in possibly preventing the onset of coeliac condition through targeted prevention. A large-scale, pan-European intervention study on the prevention of coeliac condition now intends to look into this hypothesis.

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The American Dietetic Association has developed guidelines for the care and management of celiac disease and non-celiac gluten sensitivity through the Evidence Analysis Library Project (EAL). The EAL guidelines are now available through the American Dietetic Association web site.

http://www.adaevidencelibrary.com/topic.cfm?cat=3726

The EAL protocol for guideline development involves extensive review of the most current research in the topic area. Each study is reviewed for relevancy of findings, rigor of the research, and transferability to the subject population. Each study is then graded on a scale from one to three, with five reflecting the least amount of study strength.

The questions covered in the project included the effectiveness of the gluten free dietary pattern on bone density, hematological variables, pregnancy outcomes, quality of life, the inclusion of oats, and adequacy of the nutritional intake.

The statements and guidelines can be summarized as follows:


• Adherence to a gluten free dietary pattern has positive impact on bone density, hematological values, villous atrophy, neurological and gastrointestinal symptoms.
• Inclusion of oats and supplementation of the gluten free dietary pattern need to be addressed on an individual basis.
• Individuals with celiac disease are negatively impacted by the gluten-free diet
• Treatment should include a dietitian specialist and be individualized
• Multifaceted – multidisciplinary team
• Include support or social network – referrals to local or national groups
• Reinforcement – repeat labs
• Education – quality
• Need for empowerment
• Need for empathy


The details of the process are defined in the following chart:

EAL Project
1. Select topic and appoint expert work group
2. Define questions and determine inclusion and exclusion criteria
3. Conduct literature review for each question
4. Analyze articles and critical appraisal
5. Evidence summary and overview
6. Develop conclusion statements and assign each a grade
7. Develop algorithms based on nutrition care process
8. Formulate guideline recommendations
9. Internal and external review and revision accordingly
10. Publish conclusion statements and guidelines on EAL