Individuals with
celiac disease generally are advised to follow a lifelong
gluten-free diet and avoid consumption of the
prolamins gliadin (wheat),
secalin (rye), and
hordein (barley). Although the designation of the diet as glutenfree may imply that the diet contains zero
gluten, this is not necessarily true. In some countries (eg, United States, Canada), the
gluten-free diet is completely devoid of
gluten and is based on foods such as rice and corn that are naturally
gluten free. In others (eg, Scandinavia, United Kingdom), the
gluten-free diet may include foods such as wheat
starch that have been rendered
gluten free but nonetheless contain small amounts of toxic
prolamins. The discrepancy in the use of foods rendered
gluten free exists because the amount of toxic
prolamins that individuals with
celiac disease may consume without damaging the mucosa of the small intestine is unknown. Minimal research has been conducted on the toxicity of foods rendered
gluten free, and there are no definitive data about whether the small amount of
prolamin found in these products is safe to consume. Nonetheless, the Codex Alimentarius Standard for
gluten-free foods allows a certain amount of
prolamin in foods designated
gluten free, and these products have been used in many countries for several decades. Well-designed, scientifically sound studies are needed to help determine the amount of toxic
prolamins, if any, that may be safely consumed by individuals with
celiac disease. Until this research is conducted, dietitians in the United States should continue to advise their patients against the use of wheat
starch and other foods rendered
gluten free.