Confusing Ingredients in the Gluten-Free Diet KEY POINTS There are some ingredients that you may come across on a food label that need more explanation.

Artificial What are they? Are they Gluten- Artificial Free? Yes. Flavorings flavorings are blended from chemical compounds. Blue Cheese1, 2, 3, 4 What is It? Is it Gluten Free? Take Note. The mold in blue It depends. Past Choose blue cheese labeled cheese may be testing of blue gluten-free. grown on a cheese containing variety of mold spores grown As an extra precaution, until materials on gluten-containing more is known, it may be best including wheat, materials has been to avoid products containing barley, and rye. done by the or using barley enzymes unless Only purified Canadian Celiac the final product is tested for mold spores of Association. Results residual gluten using a Penicillium were < 5 ppm competitive ELISA (a test for roquefortii are gluten. gluten contamination).4 used in the Contact the manufacturer cheese culture. However, more directly to ask these questions. recent testing shows that it is possible For more information, read that barley enzymes “Gluten-free labeling: are may sometimes growth media containing contain enough wheat, barley, and rye falling barley protein to be through the cracks” (See a problem for article below in References) individuals with celiac disease. Caramel/Caramel What is it? Is it Gluten-Free? Take Note: Coloring1 Caramel is a Regardless of the Don’t confuse the ingredient coloring agent starting material, caramel/caramel coloring

that may be made caramel is which is used as a food from a variety of considered gluten- coloring with caramel candy sources including free. Even if made which may contain gluten. malt syrup and from wheat or starch barley it is highly hydrolysates, unlikely that it such as wheat would cause an starch otherwise gluten- hydrolysates. free food to contain However, 20 ppm or more caramel is most gluten. often made from cornstarch.

Color Additives What are they? Are they Gluten- These generally Free? Yes. are derived from chemicals and dyes and are free from food allergens and gluten. Distilled alcohol7 What Is It? Is It Gluten-Free? Take Note: Distilled alcohol Regardless of For more information on is an alcoholic whether distilled Alcohol, visit liquor made from alcohol is made from https://www.bidmc.org/centers- distillation of wheat, barley, or rye and-departments/digestive- wine or other it is considered disease-center/services-and- fermented fruit gluten-free. For programs/celiac-center and or plant juice, or detailed scroll down to Alcohol and the from a starchy information, please Gluten-Free Diet under Patient material (such as see the section on Education Materials. various grains) alcohol. that has first been brewed. Glucose syrup1 What Is It? Is It Gluten-Free? Take Note: Glucose syrup is a Regardless of the Dextrose is simply another starch starting material, word for glucose. It is hydrolysate that glucose syrup is considered gluten-free is sometimes considered gluten- regardless of the starting made from wheat free. Even if wheat material. starch or barley or barley is listed as starch. For the source, it is products sold in highly unlikely that the US, this it would cause an ingredient is otherwise gluten- most likely made free food to contain from cornstarch. 20 ppm or more gluten.

Malt What Is It? Is It Gluten-Free? Take Note: This is a flavoring Any product There have been a few ingredient that is containing malt is instances where products usually made not gluten-free, and labeled gluten-free contain from barley. It must be avoided. malt. These products are may be listed as incorrectly labeled as gluten- malt, malt free and should be avoided. flavoring, malt extract, or malt syrup.

Maltodextrin1,8 What Is It? Is It Gluten-Free? Maltodextrin is a Regardless of the starting starch hydrolysate material, maltodextrin is that may be made considered gluten-free. from wheat starch but Even if wheat or barley is is usually made from listed as the source, it is cornstarch, especially highly unlikely that it in the US. would cause an otherwise gluten-free food to contain 20 ppm or more gluten. Modified Food What Is It? Is It Gluten-Free? Take Note: 1 Most often this On FDA-regulated Food containing Starch ingredient is made products sold in the U.S. if wheat-based from corn. If it is modified food starch is modified food starch derived from wheat derived from wheat, it will may be labeled starch, modified food be clearly listed either in gluten-free as long as starch may not be the ingredients list or in a the final product gluten-free. “Contains” statement (or contains <20ppm. both). If wheat is not listed There should be a in either place, modified statement on the food starch can be package that reads considered gluten-free. “The wheat has been processed to allow In USDA-regulated this food to meet the products containing Food and Drug wheat-based modified Administration (FDA) food starch, wheat may requirements for not be stated on the label. gluten-free foods." If modified food starch is listed, and the product does NOT have a gluten- free label, it may be best to contact the manufacturer to ask about the source of their starch. Monoglycerides What are they? These Are they Gluten-Free? are fats used as Monoglycerides and and Diglycerides chemical binding diglycerides do not agents. contain gluten, though occasionally wheat may be used as a “carrier.” If so, wheat will be listed in the ingredients list or the “Contains” statement (or both) on an FDA-regulated package.

Monosodium What Is It? Is It Gluten-Free? Take Note: MSG is a flavor Various starches and sugars While the FDA has Glutamate enhancing food additive. may be used as starting classified MSG as a (MSG) 9-12 It is the salt of the amino materials but wheat starch food ingredient acid glutamic acid. does not appear to be one of that is "generally them. Even if it was, it is recognized as safe," highly unlikely that the salt it is a controversial of glutamic acid would ingredient. contain traces of gluten. Anecdotal reports of symptoms from sensitivity to MSG include headache, flushing, sweating, nausea, and weakness, etc. However, these reactions do not have anything to do with gluten. Natural flavors What are they? Natural Are they Gluten-Free? 1,13 flavors are products Most likely. Unless wheat, from any one of barley, rye, or malt are numerous sources of included in the ingredients plant material or list or “Contains” statement animals whose primary (or both) of a product function is to flavor containing natural flavor, food. the natural flavor is most likely free of gluten. Rice syrup 1, 3,4 What Is It? Is It Gluten-Free? Take Note: ,14 Rice syrup or brown rice Unclear. Past testing done on For more syrup is a liquid barley enzymes and products information, read sweetener made from made using barley enzymes Gluten-free rice. Enzymes are added found them to contain < labeling: are to the rice to break 5ppm gluten. However, more growth media down the starch into recent testing shows that it is containing wheat, sugar. These enzymes possible that barley enzymes barley, and rye are sometimes derived may sometimes contain falling through the enough barley protein to be a from barley. cracks (See the problem for individuals with article below in celiac disease. Until more is References). known, it may be best to avoid products containing or using barley enzymes unless the final product is tested for residual gluten using a competitive ELISA (a test for gluten contamination). Contact the manufacturer directly to ask these questions. Seasonings1,15,16 What are they? Is It Gluten-Free? In general, seasonings It depends. If the word are blends of flavoring “seasonings” in an agents (e.g. spices, ingredient list does not herbs, hydrolyzed wheat include a sub-ingredient list, protein, smoke it is best to avoid the flavoring) and product because it is likely sometimes an anti- incorrectly labeled. If the caking agent such as words wheat, barley, rye, or (calcium silicate). These malt are not in the sub- are often combined with ingredient list, the a carrier agent (e.g. salt, seasoning probably does not sugar, lactose, whey contain gluten. powder, starch or flour). Wheat starch, wheat flour and malted barley flour are common carrier agents in seasoning blends.16 Any spices, flavoring, or colorings included in the seasoning may be listed collectively but all other ingredients (including the carrier agent) must be named in a sub- ingredient list. Smoke What Is It? Is It Gluten-Free? Take Note: 1 Smoke flavoring is It depends. “When used as Contact the Flavoring flavoring derived from an ingredient in a food manufacturer if burning various types of product, dry smoke you have concerns woods. flavoring may sometimes about this use barley malt flour to ingredient. capture the smoke. It is not known at this time how often this occurs or how much gluten smoke flavoring may contain.”1 This is not a concern if the product is labeled gluten- free.

Sorbitol and What are they? Are they gluten-free? Take Note: Physical symptoms, Sugar alcohols Sugar alcohols are such as gas, bloating, cramping other sugar rarely may be considered gluten-free and loose stool, can occur from alcohols (e.g., derived from regardless of the the ingestion of large amounts of xylitol, glucose syrup starting materials so sugar alcohols. However, these that is derived sorbitol and other sugar reactions do not have anything to mannitol, alcohols are considered 1 from wheat do with gluten. maltitol, etc.) starch or barley gluten-free, too. starch. The single What Is It? Is It Gluten-Free? Take Note: Spices are Usually, yes. “Spice” or Some spices have been found to word “spice” aromatic “spices” are naturally be contaminated with wheat, 1, 17 or “spices” vegetable gluten-free. Spices such barley, or rye. Read Gluten Free substances as basil, oregano, and Watchdog’s report on gluten whose thyme may be listed contamination of spices (See link significant role is collectively in an to the article below in as a seasoning in ingredients list as spice References). food. or spices; the ingredient list does not need to name each spice. If any non-spice ingredients, such as starch, are included in a spice mixture, they must be included in the ingredients list by their common or usual name. If the words wheat, barley, rye, or malt are not in the sub-ingredient list, the spice mix probably does not contain gluten. The single What Is It? Is It Gluten-Free? Take Note: The single word If an FDA-regulated In USDA-regulated foods, the word “starch” in the product contains starch single word “starch” may mean 12, 18 “starch” ingredients list made from wheat, it will cornstarch or wheat starch. If of FDA-regulated be listed as “wheat starch is listed, and the product food product starch.” The does not have a gluten-free label, it means manufacturer is allowed may be best to contact the cornstarch. to label the product manufacturer to ask about the gluten-free if the final source of their starch. product contains < 20ppm gluten.

The single What Is It? Is It Gluten-Free? Take Note: The single word The following kinds of Malt vinegar is NOT gluten-free word “vinegar” in an vinegars are gluten- because it contains barley. 1,19,20 “vinegar” ingredients list free: vinegar, cider Flavored vinegar also may means “vinegar vinegar, apple cider contain malt as an ingredient. made from vinegar, wine vinegar, apples.” grape vinegar, distilled vinegar, white vinegar and balsamic vinegar. Wheat Starch What Is It? Is it Gluten-Free? Take Note: 21, 22, 23 Wheat starch is a It depends. Food For more information on wheat finely processed containing wheat starch, visit powder derived starch that is NOT https://www.bidmc.org/centers- from the labeled gluten-free and-departments/digestive- endosperm should not be eaten disease-center/services-and- (starchy because it can contain programs/celiac-center and portion) of the high levels of gluten. scroll down to Wheat Starch and wheat plant. the Gluten-Free Diet under A food labeled gluten- Patient Education Materials. free may contain wheat starch if the food The FDA has mandated that if a contains <20 ppm of food labeled gluten-free includes gluten. However, it is the word wheat in the difficult to separate ingredients list or “Contains” starch from protein in a statement as required by grain of wheat and FALCPA then the food label must current testing is not include the statement, "The perfect. If a person with wheat has been processed to celiac disease chooses allow this food to meet the Food to eat wheat starch, and Drug Administration Gluten-Free Watchdog requirements for gluten-free recommends only foods." choosing a product:

• IF it is labeled “gluten-free.”

• IF the manufacturer and/or supplier test wheat starch for gluten using both the sandwich and competitive R5 ELISAs. Whey What Is It? Is It Gluten-Free? Whey is a Yes. protein found in milk. Yeast Extract/ What Is It? Is It Gluten-Free? Take Note: Yeast extract It depends. Spent Per Gluten-Free Watchdog: It is Autolyzed and autolyzed brewer’s yeast is a by- not clear at this time how often Yeast yeast extract are product of the beer spent yeast is the source of yeast Extract1,24-26 ingredients that brewing process and, extract in products sold in the may be made thus, can be US. Until we know more, it is best from spent contaminated with to avoid products NOT labeled brewer’s yeast small amounts of gluten-free containing the which is used in gluten-containing grain ingredient “yeast extract” [or food as a and malt. An example autolyzed yeast extract] unless flavoring agent. of a product containing the source is confirmed to be They can also be yeast extract from gluten-free by the manufacturer. grown on sugar barley is Marmite, a beets which are British food spread. Per gluten-free. Gluten Free Watchdog, Marmite tested at ~30 parts per million which is not considered gluten-free.

References:

1. Thompson, T. Academy of Nutrition and Dietetics. Pocket Guide to Gluten-Free Strategies for Clients with Multiple Diet Restrictions. .Academy of Nutrition and Dietetics. . 2nd ed. Chicago, IL, 2016.

2. Gluten-free Dietitian. Blue Cheese. http://www.glutenfreedietitian.com/newsletter/blue- cheese/. Accessed July 12,, 2018.

3. Anca, A. Blue cheese in the gluten-free diet: a research update. Celiac News. 2009;23:1-5. http://www.glutenfreediet.ca/img/bluecheese.pdf.

4. Thompson T, Dennis M, Emerson L. Gluten-free labeling: are growth media containing wheat, barley, and rye falling through the cracks? J Acad Nutr Diet. 2017 Sep 1. https://www.sciencedirect.com/science/article/pii/S2212267217310663

5. Gluten-free Dietitian. Caramel Color. http://www.glutenfreedietitian.com/newsletter/caramel- color/. Accessed July 12, 2018. 6. US Food and Drug Administration. Code of Federal Regulations. Caramel. 21CFR73.85. https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?fr=73.85. Revised April 2017. Accessed July 24,2018.

7. Merriam Webster. Distilled Alcohol. https://www.merriam- webster.com/dictionary/distilled%20liquor. Accessed July 20, 2018.

8. Gluten-free Dietitian. Maltodextrin. http://www.glutenfreedietitian.com/newsletter/maltodextrin/. Accessed July 12, 2018.

9. Gluten-free Dietitian. Monosodium Glutamate. http://www.glutenfreedietitian.com/newsletter/2011/03/03/monosodium-glutamate/. Accessed July 12, 2018.

10. Ault, Addison. The Monosodium Glutamate Story: The Commercial Production of MSG and Other Amino Acids. Journal of Chemical Education. 2004;81:347-355.

11. Sano, Chiaki. History of Glutamate Production. The American Journal of Clinical Nutrition. 2009;90:728S-732S. Available at: http://www.ajcn.org/content/90/3/728S.full.

12. Matheis, Gunter. Flavor Modifiers. In Philip R. Ashurst editor Food Flavorings. Gaithersburg, Maryland: Aspen Publishers. 1999:367-405.

13. Gluten-free Dietitian. Flavorings and Extracts: Are They Gluten Free? http://www.glutenfreedietitian.com/newsletter/flavorings-extracts-are-they-gluten-free/. Accessed July 12, 2018

14. Gluten-free Dietitian. Barley Enzymes in Gluten-Free Products. http://www.glutenfreedietitian.com/newsletter/barley-enzymes-in-gluten-free-products/. Accessed July 12, 2018.

15. US Food and Drug Administration. Labeling of seasonings. Compliance Policy Guide. CPG Sec 525.650. October 1980.

16. Case, S. Gluten-Free: The Definitive Resource Guide. Case Nutrition Consulting. Saskatchewan, Canada, 2016.

17. US Food and Drug Administration. Code of Federal Regulations. Foods; labeling of spices, flavorings, colorings, and chemical preservatives. 21CFR101.22. https://www.gpo.gov/fdsys/pkg/CFR-2012-title21-vol2/pdf/CFR-2012-title21-vol2-sec101- 22.pdf. Revised April 2009. Accessed July 23, 2018.

18. US Food and Drug Administration. Starches—common or usual names. Compliance Policy Guide. CPG Sec.578.100. https://www.fda.gov/ICECI/ComplianceManuals/CompliancePolicyGuidanceManual/ucm0746 05.htm. October 1980. Accessed July 24, 2018. 19. Gluten-free Dietitian. Vinegar! http://www.glutenfreedietitian.com/newsletter/vinegar/. Accessed July 12, 2018.

20. US Food and Drug Administration. Vinegar: definitions. Compliance Policy Guide. CPG Sec. 525.825. https://www.fda.gov/ucm/groups/fdagov-public/@fdagov-afda- ice/documents/webcontent/ucm074471.pdf. April 1977, rev. March 1995. Accessed July 24, 2018.

21. Gluten-Free Watchdog. https://www.glutenfreewatchdog.org/news/does-wheat-starch- belong-in-a-gluten-free-diet/. May 8, 201718. Accessed July 23, 2018.

22. Proceedings of the 27th Meeting Working Group on Prolamin Analysis and Toxicity. Analytical Research Reports. Katharina Konitzer, Herbert Wieser, Peter Koehler. German Research Centre for Food Chemistry, Leibniz Institute, Freising, Germany. Quantitation of gluten in wheat starch by gel permeation chromatography with fluorescence detection Available at: http://www.wgpat.com/proceeding_27th.html. Accessed July 23, 2018.

23. Gluten-Free Watchdog. Using wheat starch in gluten-free foods. https://www.glutenfreewatchdog.org/news/using-wheat-starch-in-gluten-free-foods/. April 2015. Accessed July 23, 2018.

24. Gluten Free Watchdog. Brewer’s Yeast and Gluten. https://www.glutenfreewatchdog.org/news/brewers-yeast-and-gluten/. May 29, 2018. Accessed July 12, 2018.

25. Gluten-Free Watchdog. Ingredient Information: Yeast Extract & Barley. https://www.glutenfreewatchdog.org/news/?s=yeast+extract&post_type=post. May 17, 2017. Accessed July 12, 2018.

26. Gluten-Free Watchdog. Yeast extract and other words to look for in the ingredients list of foods NOT labeled gluten-free. https://www.glutenfreewatchdog.org/news/yeast-extract-and-other- words-to-look-for-in-the-ingredients-list-of-foods-not-labeled-gluten-free/. May 16, 2017. Accessed July 12, 2018.

Revision Date: August 20, 2018 Revised by Melinda Dennis, MS, RDN Editors: Amy Keller, MS, RDN, LD and Daniel Leffler, MD, MS

Original Date: 8-29-12 Author: Tricia Thompson, MS, RD Editors: Melinda Dennis, MS, RD, LDN and Daniel Leffler, MD, MS