Celiac disease is all about living gluten-free. However, this requires knowledge when selecting the appropriate foods for consumption. All people with celiac disease know which grains to avoid i.e. wheat, barley and rye. However, when it comes to buying ingredients for cooking or purchasing packaged foods, the matter gets complicated. There are many processed food products used in cooking which contains hidden sources of gluten. This can pose a serious threat to the health of those with celiac disease. Unlike industrialized countries, people of Pakistan are more challenged by the problem of label reading due to lack of adequate laws regarding proper labelling. Also, in other countries there is better level of awareness among the manufacturers and consumers when it comes to gluten-free foods. The problem is further compounded in Pakistan by the fact that almost all labelling of food products is in English and not in Urdu language. Many people in Pakistan cannot read English.
Why is label reading so important for people on a gluten-free diet? The answer to this question is manifold, and can be illustrated with some examples.
This product says Corn Flakes. The first impression by any consumer is that the product is made from corn, a grain that should be safe for those on a gluten-free diet. However, the story becomes quite different when one reads all the ingredients. The product contains malt which is made from barley. Therefore, the product is not gluten-free and not safe for consumption by individuals with celiac disease. The same is true of many other brands of locally manufactured Corn Flakes.
Let us take another example:
The product is named Rice Flakes. Rice is a gluten-free grain and should be safe for those consuming a gluten-free diet. However, the ingredient list of the product reads, “Rice flur, malt, sugar and salt”. Malt is made from barley, which contains gluten. Therefore, this product would not be suitable for those on a gluten-fre diet.
Many items used in foreign countries are gluten-free but they are not in Pakistan even if the same name is used for them. For example, in the USA, Modified Food Starch is considered to be gluten-free as it is derived from corn, rice, or potato. However, in Pakistan there is a strong possibility that Modified Food Starch is made from wheat.
Label reading can be quite frustrating in the beginning but if learned properly it becomes easier. Whenever buying food products, make sure the following points become part of your buying habits:
Always read the label first, even if the product is a candy or a cold drink.
Make sure that you understand each and every ingredient. If an ingredient is unfamiliar, try to research and if unsure, it is best (and safe) to leave the product.
Read the label every time while buying a product even if you have checked the ingredients previously. The manufacturers keep changing the ingredients of the product without warnings.
While going through the list of ingredients on the label, some will be familiar to you while others may not be. Try to memorize some of the common ingredients so that it is easy to recall them the next time you read the label. A mobile phone app called Gluten Free 24/7 is a useful resource to get instant information on the gluten-free status of ingredients.
Any product containing the following grains or flours should NOT be consumed as they contain gluten:
Derivatives of these grains e.g. “malt” or “organic malt” are made from barley. Malt is sometimes also called barley malt. (“Rice malt” is safe but one should check it out to make sure it is in fact rice malt. If it says just malt, do not consume)
Some of the items are considered to be gluten-free in UK and North America as the manufacturers use gluten-free ingredients while making them but in other parts of the world especially in Pakistan, these items are doubtful. If all the ingredients are not clearly mentioned there is a good chance that it will contain gluten and therefore should be avoided.
Hydrolyzed vegetable protein can be derived from different protein sources. If they are derived from wheat they are obviously not safe. However, if they are derived from corn or soy they should be fine. If the source of the Plant or Vegetable is stated, for example, "Hydrolyzed Corn Protein", then it is gluten-free. If the source is not stated, it is best to avoid it.
Soy sauce is usually made from wheat or roasted barley, but there are many foreign brands which make it only from soya beans. Unless the ingredients are mentioned clearly, it should not be used.
Not all food starch contains gluten but, unless you know what kind of starch it is, i.e. corn starch or wheat starch, it is best to avoid it
Sometimes starch fillers are added to yogurt and soft cheeses.
Most cereals contain some form of gluten, especillay in the form of malt.
Look for starch fillers, soy sauce, hydrolyzed vegetable protein and pasta.
It is also used as a thickener or binding agent and is usually made from corn, potato, tapioca or rice. In some cases it is made from wheat. Therefore, unless the source is clearly mentioned, it should be avoided.
Maltodextrin is derived from various starches like rice, potatoes and corn. The vast majority of maltodextrin is derived from corn and is safe. In North America, maltodextrin is usually made from corn; however, it may be derived from wheat in some cases. This is important for people with celiac disease, since the wheat-derived maltodextrin may contain traces of gluten. Wheat-based maltodextrin is used in Europe and North America. However, it is highly processed and purified (more than modified food starch). When tested, wheat-based maltodextrin was found to contain very low levels or no gluten, therefore, it is allowed on a gluten-free diet. If wheat is used to make maltodextrin, it will appear on the label. Even so, the maltodextrin will be essentially gluten-free.
Following items are gluten-free. However, when buying products containing the following ingredients it is still possible that there could be gluten contamination. Caution should be exercised in this case.
Agar is obtained from algae and can be used as an alternative to gelatin for making jellies and desserts. It is unlikely to be cross contaminated with gluten.
Almond is often ground and used as an alternative to flour in bakery products.
Amaranth is a plant used to make cereal alternatives.
Basin or Gram flour is made from chick peas.
Buckwheat is used to make flour and noodles. Although there is word “wheat” in the name, buckwheat is gluten-free.
Carageenan is used as thickener, stabilizer, or emulsifier.
Cassava/Manioc/Tapioca is a plant/vegetable used as a cereal product. Tapioca is the beady starch extracted from the root of the cassava (manioc) – used for puddings or as a thickener
Chestnut is also ground and used as flour
Corn or maize (called makai in Urdu) is a grain from which flour/starch and other products are made.
Flax/Linseed are seeds that can be added to muesli.
Hemp – flour and seeds used in bakery products and muesli
Millet (called bajra in Urdu) is a cereal or grain often used in gluten-free muesli
Mustard can be in the form of flour, powder, seeds and oil
Polenta is made from boiled cornmeal
Potato – can be used to thicken sauces and soups – flour/starch used in baking
Pulses (Beans, Lentils) can be ground to Make flours, and can be used in a variety of dishes.
Quinoa is a pseudo cereal – it’s seeds are used in muesli and baking.
Rice – all types, e.g. wild, Arborio, aromatic, basmati, black and red.
Sago is a powdery starch extracted from sago palms, can be used as thickener or cereal product.
Sesame are available as oil and seeds.
Sorghum is a grain which can be used as a source of syrup.
Soya flour used in gluten-free bakery products.
Tapioca – see Cassava.
Teff is a grass with very small seeds – its flour can be used in baking.
Urd/Urid/Urad is flour made from lentils.
People on gluten-free diet sometimes feel that reading labels restricts their choices of foods. On the contrary, becoming knowledgeable about label reading will, in fact, improve choices as people can select products more easily and reduce the risk of eating foods that are cross contaminated.
Reading labels can sometimes be quite challenging. There is a product called Chinese Chili. The ingredients on the back of this product are:
“Corn flour, sugar, salt, monosodium glutamate, onion, yeast extract, dehydrated vegetables, spices, garlic, hydrogenated palm fat, tomato powder, artificial flavors, malic acid, sodium inosinate and guanylate, soya sauce powder, sodium acetate, citric acid and maltodextrin”
Such products are available in a variety or flavors and packages in the market, but many individuals with celiac disease might avoid the product as the list of ingredients is complicated. Some items listed are rare and, therefore, without proper knowledge it is difficult to judge whether the product is truly gluten-free or not. How many of the above mentioned items are known to you? Even after learning about many of the ingredients used commonly there are still some items which will be unfamiliar. Examples of such items in the above ingredient list would include “guanylate” and “malic acid”.
Guanylate is produced from dried fish or dried seaweed and is often added to instant noodle, potato chips,and other snacks, savoury rice, tinned vegetables, cured meats and packaged soup. Good to know that the item is gluten-free.
“Malic acid” sounds like malt but actually malic acid is found mostly in unripe fruits. It is used to bring sourness in food and is gluten-free.
Many products presumed to be containing gluten may actually be free from it. Knowledge about such products can improve food choices.
There is an urgent need to deal with the issue of food labelling in Pakistan. The celiac community should work towards improving awareness on this problem and lobby the government agencies to mandate detailed and accurate labelling of food products.
Learn to read labels. There is no other way out.
Do not buy or consume anything that is made from or contains any amount of wheat, barley or rye, no matter what the product package says.
If you are not sure whether a product is gluten-free or not, it is best to leave it.
Pakistani Celiac Society is dedicated to provide information on proper reading of food labels so that individuals on gluten-free diet can enjoy a safe living.