If you're among the millions of men who can't eat gluten – a protein in wheat, barley, and rye – then you know it's a major pain to find foods that won't make you sick. Whether you have a gluten sensitivity or celiac disease, you have it hard at most restaurants and even the grocery store, where you must meticulously scan food labels in order to avoid gluten.
The headache doesn't end there. The labels themselves can be deceiving. Just because a package says "gluten-free" doesn't mean the food inside contains zero gluten. In fact, many products bearing this claim contain enough to make you sick, because ingredients have been cross-contaminated with gluten-containing grains on the farm or during processing, says Alice Bast, founder and president of the National Foundation for Celiac Awareness.
That's all about to change. After years of fielding gluten complaints, the Food and Drug Administration (FDA) officially defined "gluten-free" in August. According to a new rule that takes effect August 2014, for a label to say "gluten free," "no gluten," "free of gluten," or "without gluten," the food must be free of wheat, barley, rye, and crossbreeds of those grains (unless the gluten has been removed) and contain less than 20 parts per million of gluten.
Why 20 ppm and not zero? Two reasons: First, the FDA felt 20 ppm was an easily measurable standard. Currently, no test exists that can measure gluten content down to zero; the most precise test can confirm 3 ppm. Second, the FDA says most people with celiac disease and gluten sensitivities can safely consume 20 ppm – that it isn't enough gluten to cause stomach cramps, joint pain, fatigue, or, for celiacs specifically, more serious intestinal damage.
Many health experts agree with the 20 ppm threshold. "Ample evidence-based research shows that less than 20 ppm of gluten is appropriate and safe for people with celiac disease and gluten sensitivity," says Bast.
However, while 20 ppm may be okay for most folks, not everyone can safely tolerate that much gluten. And it may not be clear whether you can or can't. Although people with gluten sensitivities can usually tell how the protein affects them – they get cramps, bloating, stiffness, – celiacs especially don't always know. They may not experience outright symptoms, even though damage is occurring inside. That's why 83 percent of Americans with celiac disease are undiagnosed, says Bast.
But even diagnosed celiacs' tolerance can seesaw, depending on age, stress levels, and other health conditions, says Mary Schluckebier, executive director of the Celiac Sprue Association. "There is no way to know how much gluten is too much for any one person at any one point in his life," she says.
Also, some experts say chronic exposure to even low levels of gluten can add up over a lifetime and cause long-term trouble. "The 'celiac disease' damage is cumulative, so every small amount counts," Schluckebier says. "For years, much of Europe has allowed more gluten in gluten-free products than the U.S. has, and they report a much higher incidence of refractory celiac disease and related illnesses."
If you are one of the most gluten sensitive, be diligent when shopping for foods. Keep combing ingredients lists for potential gluten-containing grains, including oats, which aren't covered by the rule. "Oats are naturally gluten free, but not necessarily safe for celiacs," says Bast. "They can come into cross-contact with wheat, barley, and rye during growing, harvesting, and manufacturing, so only purchase oats specifically labeled gluten-free," she says.
Also, don't get tricked by similar gluten claims not covered by the gluten-free rule. "Food labels bearing the claims 'made with no gluten-containing ingredients' and 'not made with gluten-containing ingredients' do not have to comply with the FDA's rule," Bast says. Finally, if you want to make sure to get as little gluten as possible, look for third-party certifications. The Gluten Intolerance Group awards its Certified Gluten-Free seal only to products proven to contain less than 10 ppm of gluten. Celiac Sprue's seal is even tougher, allowing just 5 ppm in approved products.