Why do caterers need to take gluten free meals seriously?
Gluten free options on the menu is important for many reasons. People with coeliac disease are not fussy eaters. There is no cure for the disease and the only treatment is strict avoidance of gluten. Providing inclusive options on the menu also makes financial sense with an estimated 1.3 million in the UK on a gluten free diet due to coeliac disease and other medical conditions1. These people want to spend money when eating out, but caterers are missing out on an estimated £100 million pound in additional sales because there is not enough choice1. Food businesses that offer gluten free choices produced in a safe environment gain loyal customers who spend money.
What is Coeliac disease?
Coeliac disease is an autoimmune reaction to gluten in food and affects 1% of the population in the UK. This serious digestive condition disrupts the absorption of nutrients into the body by damaging the tissue lining of the small intestine. This reaction happens when the immune system wrongly mistakes a substance found in gluten, called gliadin, as a threat 2. Antibodies are produced and cause damage and inflammation to millions of villi that cover the surface of the gut. These finger-like projections are flattened, and the body is not able to digest important nutrients found in food.
What are the symptoms?
Symptoms of coeliac disease can be difficult to detect and often mistaken for irritable bowel syndrome (IBS). Coeliac UK estimate there are 500,000 people in the UK with undiagnosed coeliac disease1. There are over 200 different symptoms of coeliac disease, but the most common is diarrhoea. Other gastrointestinal symptoms include: abdominal pain, flatulence, indigestion and constipation. Coeliac disease can also lead to fatigue, weight loss, mouth ulcers anaemia and itchy skin (dermatitis herpetiformis)2. Serious conditions, such as osteoporosis and bowel cancer, can arise if the disease if not treated.
What are the risk factors?
Coeliac disease can happen at any age, but most commonly diagnosed between the ages of 40 and 60 years with reported cases twice as high in men than women3. Factors that may increase the risk of developing coeliac disease include: genetics and existing autoimmune conditions. Coeliac disease is genetically linked and family history of the disease can increase the risk by 10% -75% (identical twins)1. People with other autoimmune conditions, such as Type 1 diabetes and thyroid disease are also more likely to have coeliac disease. Diabetes UK estimate that 10% of people with coeliac also have type 1 diabetes4.
What are the legal requirements?
The EU Food information for Consumers Regulation (1169/2011) outlines legal requirements for food manufacturers and caterers in the provision of information on gluten as allergenic ingredient and making a gluten free claim. These legal requirements are enforced in UK under the Food Information Regulations 2014.
Food businesses must provide accurate, visible and verifiable information on 14 allergenic ingredients, including gluten. This information is clearly communicated within the ingredients list on prepacked foods or provided written or verbally for food sold loose or direct sale. Caterers must also clearly signpost information where information is not written and upfront.
Under legislation, the phrase ‘gluten-free’ can only be applied to food which contains less than 20 parts per million or 20 mg/kg. Manufacturers and Caterers must demonstrate when tested that products do not exceed this set limit. Due to the high risk of gluten cross contamination it may not be possible for caterers to claim foods are ‘gluten-free’. This risk can be significantly reduced when appropriate controls and training are in place. This viewpoint is validated by a project commission by Coeliac UK5. They concluded that 95% of samples taken from catering establishments producing gluten free meals were in-line with the legal threshold.
Caterers must also not include contradictory disclaimers on menus, such as ‘no gluten-containing ingredients’ (NGCI) or ‘may contain gluten due to cross contamination’. Although, food businesses can NGCI in a menu where all items listed do not contain gluten containing ingredients6.
What are the hazards?
A hazard is anything with the potential to cause harm. Hazards can occur due to presence of undeclared gluten in prepacked and loose products, cross contamination and poor communication between the customer and persons preparing and serving food or drink.
Undeclared gluten in meals produced on site can happen when substitute prepacked products are not checked during delivery or if a recipe specification is not followed correctly. The allergenic matrix may also be misleading due to a failure to verify its accuracy.
There are five ways in which cross contamination can occur: spillages, ineffective cleaning procedures, shared equipment, airborne contaminants and poor personal hygiene. Shared equipment that has not been cleaned effectively can transfer gluten residue to gluten free foods. Airborne contamination can arise when dust particles containing gluten travel through the air and contaminate gluten free foods. This can occur during cooking in a convector oven or close proximity to where flour is being handled. Contamination can occur when using the same oil or water used previously to cook foods containing gluten. The hands are the most common vehicle for transferring contaminants onto food. Food handlers not washing hands before preparing gluten free food is a significant risk.
Poor communication between the customer and persons preparing and serving the meal is a real problem. A well-known high street restaurant chain was fined £8,000 and ordered to pay £9,000 in legal costs when a customer with coeliac disease fell ill, after unknowingly eating pasta containing gluten. The customer had asked restaurant staff three times if the pasta contained gluten, but still there was a mistake in the order.
Practical control measures
A control measure is activity or action designed to prevent, eliminate or reduce a hazard to an acceptable level. Coeliac UK and Food Standards Agency have produced an excellent guide with practical controls to reduce the risk of undeclared gluten in food throughout the food chain. The guide can be downloaded from the Coeliac UK website7. Testing for gluten in gluten free meals will provide evidence that controls in place are effective and meet legal requirements. But control measures will only work in practice when food handlers understand the procedures and follow them. Compliance with procedures can be verified through risk-based auditing.
1. Coeliac UK (2017. Caterers and Restaurants: Facts at glance [Online]. Available at: https://www.coeliac.org.uk/food-industry-professionals/caterers-and-restaurateurs/
2. NHS (2016). Coeliac Disease. [Online]. Available at: https://www.nhs.uk/conditions/coeliac-disease/
3. NHS Scotland (2018). Coeliac Disease [Online]. Available at: https://www.nhsinform.scot/illnesses-and-conditions/stomach-liver-and-gastrointestinal-tract/coeliac-disease
4. Diabetes UK (2018). Diabetes and Coeliac Disease [online]. Available at: https://www.diabetes.org.uk/Guide-to-diabetes/Enjoy-food/Eating-with-diabetes/Managing-other-medical-conditions/Coeliac-disease-diabetes
5. Coeliac UK (2013). Developing a gluten-free risk assessment ‘toolkit’ for the catering sector. [Online]. Available at: https://www.coeliac.org.uk/campaigns-and-research/previous-research/catering-research--providing-information-for-caterers-to/
6. Coeliac UK (2016). Gluten Free and No Gluten Free Ingredients From July 2016 [online]. Available at: https://www.coeliac.org.uk/food-industry-professionals/gluten-free-and-the-law/gluten-free-and-no-gluten-containing-ingredients-from-july-2016/
7. Coeliac UK (2017). Guidance documents. [online]. Available at: https://www.coeliac.org.uk/healthcare-professionals/resources/guidance-documents/