Hello, my name is XXX and I am a Registered Dietitian from XXX hospital. I am going to be conducting the Coeliac UK Store Tour here today.

So, what is a Store Tour? At the end of this Tour you should hopefully know a bit more about the gluten-free diet, have learnt about food labelling and picked up a few healthy eating tips along the way So these are the topics we’ll be looking at: What makes up the gluten-free diet food labelling healthy eating The Tour should take about an hour and we will have time for questions at the end. The toilets and fire exits are situated XXX. Please feel free to ask questions as we go around the store [THIS IS UP TO YOU – IF YOU PREFER TO ONLY HAVE QUESTIONS AT THE END, PLEASE DO]. We will be going through lots of examples on the tour around the store so this is a brief introduction on food labelling to get you all in the mood!

These foods make up the gluten-free diet. As you will see we have split this list into two colours using a traffic light scheme – green for those that do not contain gluten and yellow for those that can be tricky. So, at the top we have our naturally gluten-free foods and these include cereals such as rice and maize, fruit, vegetables, animal products and pulses. This also includes pure oats. We know oats can be a confusing point, so we’re highlighting it now and will refer to it in more detail later. The gluten-free diet is also made up of processed foods. These are the foods which can be difficult to identify, so we’ve highlighted these in yellow and the presentation will focus on how to identify those that can be eaten and those that can’t. And then finally we have the specialist substitute products that include those you find on prescription and those in the Free From aisle of the supermarket. To summarise these foods make up the base of the gluten-free diet and as such….

…..You can put them in your shopping trolley

What you can’t eat are foods containing gluten. Using our traffic light system those you can’t eat are highlighted in red. Gluten is found in the cereals wheat, barley and rye and the pictures show common examples of products made from these grains including bread, pizza bases, pasta, cakes etc. Gluten can also be found in processed foods. As with the previous slide we have highlighted these in amber and the remainder of the presentation will focus on identifying these. To summarise, all of the foods here contain gluten and therefore….

…You need to keep them out of your shopping trolley

Now let’s go back to those yellow products – the processed foods Now let’s go back to those yellow products – the processed foods. How are you going to know if they can be put in your shopping trolley? Now we have the basics of the diet, how can we tell by looking at a product if it is ok for you to eat? We are going to start by looking at the information you can find on the packet, focusing on: the ‘gluten-free’ label the ingredients list allergy advice boxes ‘may contain’ statements. You go into the supermarket, you pick up a packet, the first thing you probably look for is….

…the gluten-free label You may have noticed that some foods that used to have a gluten-free label on them no longer do. This is because a new law came into effect in January 2012 which means that if a product states ‘gluten-free’ on it, it must contain 20ppm of gluten or less. This is the first time there has been a law, and before this the generally accepted level was 200ppm. Some research showed that some people with coeliac disease were reacting to this level and so the safe level was lowered. Products that you may see labelled as gluten-free include: naturally gluten-free products, specialist, substitute products which may or may not contain Codex wheat starch, and pure uncontaminated oats.

The gluten-free label will only be used on products that contain 20ppm or less, and are ok for everybody with CD There is another term, ‘very low gluten’ which can be used on some products but we do not know of any products in the UK using this term. The statement ‘no gluten containing ingredients’ does not come under the law and can be used on products where the manufacturer has reviewed the ingredients and the processing and are confident that the product doesn’t contain gluten based on guidance from the Food Standards Agency (FSA).

The allergy advice box… Is being phased out with the introduction of the Food Information Regulation in December 2014. Allergens present will be emphasised in the ingredients list instead. You may still see them until current packaging is used up. Different manufacturers use these differently and some don’t use them at all Sometimes they can appear as contradictory This example shows a product that has been labelled as containing barley but actually, when you look at the ingredients list or in the Food and Drink Directory you will see that it is actually safe for you to eat Coeliac UK’s advice is to always check the ingredients list.

That’s the allergy advice box, now what about the ‘may contain statements’? Let’s have a show of hands: How many of you think these statements are a useful guide? How many of you think that this is just manufacturers covering their backs? May contain statements focus on the risk of cross contamination These are based on guidelines given by the Food Standards Agency Therefore, we see again that these are not backed by law and therefore can be used differently by different manufacturers. Can I eat it? Essential point is that some are okay and some are not. Check your Food and Drink Directory. The Food and Drink Directory does list some products that have ‘may contain’ written on the package. However, this is because we have spoken directly with the manufacturer and the product is safe for you to eat. If it isn’t in the Food and Drink Directory then call the Coeliac UK Helpline – as we are in constant discussion with the manufacturers and may be able to provide you with more information. You can also call the manufacturer and ask them to give you more information on the measures they have to prevent cross contamination.

We’ve picked up our product, checked for the gluten-free label, may or may not have looked for the allergy advice box and may contain statement and now we turn to the ingredients list. The ingredients list is required by law. Manufacturers are required by law to: List all ingredients and identify any allergens present in the product regardless of how much they have used. For foods manufactured after 13 December 2014 allergens will be emphasised in the ingredients list. The words wheat, rye, barley and oats will be most likely emphasised in bold lettering. There will be a mixture of packaging for a few years. As we know from our previous slides looking at the basics of the diet, what you need to keep your eyes peeled for are the words: Wheat Rye Barley Oats.

There are a number of ingredients that are common sources of confusion: Oats Gluten-free (Codex) wheat starch Modified starch Barley malt extract Glucose syrups, maltodextrin and dextrose. We’re now going to look at these ingredients to see if they should or shouldn’t be included in our shopping basket and we’ll see some examples on the Tour.

The majority of people with coeliac disease can tolerate pure oats The reason why oats can be difficult is because of the issue of cross-contamination The way that they are processed and handled means that they are very easy to contaminate with wheat, rye and barley It is only with pure oats that we can be sure no cross contamination has occurred. This isn’t the same as the ‘100% oats’ label you may see on the front of a package of porridge To identify if oats are suitable for you to eat, look for the ‘gluten-free’ label or look at the oats section in the Food and Drink Directory.

What is it? This is a specially manufactured wheat starch that has a level of gluten within the Codex standard The gluten-free wheat starch ingredient was first introduced as a basis for substitute products like flour and bread to improve the quality and texture of the products It must always appear in an ingredients list if it has been used If 20 ppm or less, the product can be labelled gluten-free Suitable for all people with coeliac disease If 21-100 ppm, can be labelled very low gluten Suitable for most people with coeliac disease.

Modified starch is used widely in the food industry as a thickener and to increase the shelf-life of products It can come from a variety of sources including wheat, maize and potato The important thing for you to remember is that if it comes from wheat it must appear on the ingredients list as “modified wheat starch”. If you see: “modified corn starch” “modified potato starch” Or just “modified starch” it is safe for you to eat. The products shown here are all made from modified maize starch and therefore are safe to eat.

Another ingredient that many people find confusing is barley malt extract. At the beginning of the presentation we highlighted where gluten could be found – wheat, rye and barley. Barley flour is used as a thickener in baking and is also commonly seen in barley waters. Barley malt is used in malted drinks and beer. These products, seen pictured here, are not suitable if you are following a gluten-free diet. Barley malt vinegar and barley malt extract are a little different. Barley malt vinegar In line with the law, if a vinegar is made from barley, then it must be declared on the ingredients list. So, if you pick up a bottle of malt vinegar, look at the ingredients list and see the word ‘barley’ – can you eat it? Yes. Whilst normally the word barley would be a clear sign that you cannot eat it, the fermentation process for making vinegar means that the end product has gluten that is at a safe level for people with coeliac disease and is therefore gluten-free.

Barley malt extract Malt extract is widely used in very small amounts by the food industry as a flavour enhancer. It can be found in foods such as breakfast cereals, vinegar, sauces and pickles, ready meals and chocolate. The law states that barley malt extract must be stated on the ingredients list regardless of how little or how much is used. This is the one case where reading the label doesn’t give you a definitive answer. In some cases the levels of barley malt extract are so small that it is safe to eat. But sometimes they use a higher level and it is not safe to eat. If you want to know if it is safe, check the Food and Drink Directory. We will see examples of these labels as we go round the store – [AN EXAMPLE IS KELLOGGS CORN FLAKES V. SUPERMARKET OWN BRAND CORN FLAKES – BOTH PRODUCTS INGREDIENTS LISTS LOOK VERY SIMILAR – OWN BRAND IS OK, KELLOGG’S IS NOT].

There are four other ingredients that come from gluten-containing sources i.e. wheat or barley, but which undertake such rigorous processing that they themselves are gluten-free. The four ingredients are: Maltodextrin Glucose syrups Dextrose Distillates for spirits. Because the processing renders them gluten-free, they are exempt from the 2005 allergen labelling legislation and therefore manufacturers do not have to declare the source of the ingredient in the ingredients list. Some still do though, which is confusing, so glucose syrup and glucose syrup from wheat are both safe.

We will now start the Tour!