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Coeliac patients What can we do? Tunde Koltai Association of European Coeliac Societies New phenomene: Gluten sensitivity Gluten related diseases Wheat allergy Classic Non-coeliac gluten sensitivity Non-classic Coeliac disease Symptomatic Gluten ataxia Subclinical Dermatitis herpetiformis Potencial Refracter The gluten-free market is growing France Germany Italy Netherlands Russia Spain Sweden UK 2004 Value Per capita 105.7 1.7 100.6 1.2 145.5 2.5 35.6 2.2 40.0 0.3 77.6 1.8 16.5 1.8 113.8 1.9 2009 Value Per capita 158.4 2.5 191.5 2.3 205.5 3.5 46.7 2.8 57.9 0.4 134.5 3.0 24.6 2.7 228.3 3.7 2014 Value Per capita CAGR 04-09 CAGR 09-14 233.1 3.5 8.4% 8.0% 324.0 3.9 13.7% 11.1% 273.2 4.7 7.1% 5.9% 57.2 3.4 5.6% 4.1% 63.4 0.5 7.7% 1.8% 200.8 4.3 11.6% 8.3% 34.2 3.7 8.3% 6.8% 374.2 6.0 14.9% 10.4% Brazil US 22.3 1,134.0 0.1 3.9 55.5 1,754.3 0.3 5.7 100.7 2,298.5 0.5 7.1 20.0% 9.1% 12.7% 5.6% 38.4 22.0 24.3 21.6 25.1 1.9 0.0 0.0 0.2 0.5 69.9 34.6 47.3 40.1 63.9 3.3 0.0 0.0 0.3 1.3 98.6 44.4 69.1 58.0 114.1 4.4 0.0 0.1 0.5 2.3 12.7% 9.5% 14.2% 13.2% 20.6% 7.1% 5.1% 7.9% 7.7% 12.3% 1,923.3 0.5 3,113.1 0.8 4,343.4 1.1 10.1% 6.9% Australia China India Japan Korea Overall Values in millions US Dollars Source Datamonitor New products launched every day in Europe Number of new GF products launched in 2009 International Coeliac Day Officially supported by WHO Agreement with other continents’ coeliac associations International Coeliac Day Goals: •Create/increas awareness •The disease usually remain undiagnosed and frequently misdiagnosed •Coeliacs have no other therapy only the strict glutenfree diet •Support for diagnosed coeliacs and families •There is a help: AOECS/national coeliac societies give information about ‘glutenfree lifestyle’ International Coeliac Day Target groups: •General public •Potential coeliacs •Diagnosed Coeliacs •Families and friends of coeliacs and potential coeliacs •Medical persons •Politicians •Others: shop owners, hypermarket chaines, food producers, restaurants, caterers, etc. ... Better life for coeliacs Helsinki 6 - 9 September 2012 http://www.confedent.fi/blc2012/venue_site/ What is the Crossed Grain Symbol? • Created in 1969 by a member of Coeliac UK • Today it is the internationally recognised symbol for gluten-free food needed by people with coeliac disease • Registered by coeliac societies at national and European levels The Crossed Grain Symbol The consumers’ friend • An easily recognisable symbol whatever your language • Consumers trust the symbol as a guarantee of safety • The best guide for consumers with coeliac disease in a growing market with ever more choice • Harmonised and equal quality in Europe • Guidelines for the local/small producers The European Licensing System (ELS) - European Charta - License contracts - AOECS Standard II. part Foods for Coeliacs have to be • Safe • Controlled • of Good quality and tasty • of High nutrition value • Cheap • Available • Produced complying valid rules and laws • Easy to recognise Legal background CODEX STAN 118 – 1979 CODEX STANDARD FOR FOODS FOR SPECIAL DIETARY USE FOR PERSONS INTOLERANT TO GLUTEN Was accepted in July 2008 by the Codex Alimentarius Commission Revised Codex Standard for ‘dietetic’ products Glutenfree food: Gluten content < 20 mg/kg ‘Very low gluten’ or ‘suitable for coeliacs’: Gluten content between 20 and 100 mg/kg Foodstuffs suitable for gluten intolerant people Gluten content mg/kg Special dietary foods for gluten intolerant people Foods suitable for gluten intolerant people reduced gluten content substitution of wheat, rye, of wheat, rye, barley, barley and oats oats foods for normal consumption / other special dietary foods max. 20 gluten-free gluten-free gluten-free 20 - 100 "very low gluten" NO NO The Crossed Grain Symbol HACCP guidance FLOUR, FLOUR MIXTURE AND MILL PROCESS PHASE HAZARD PREVENTION Suppliers qualification Gluten Assessment of suppliers (audit, contamination questionnaire, etc.) in raw material CORRECTION INSTRUCTIONS/ CP/CCP To choose another supplier / to make aware the supplier of gluten contamination risk - List of qualified suppliers -Supplier documentation - Audit of supplier report, questionnaire, etc. CCP - List of suitable raw materials - Supplier documentation CCP - Certificate of gluten analysis from the producer and / or - Declaration / documentation by the supplier Quality of raw Gluten material contamination in raw material Hazard analysis of the raw materials To change raw material / supplier and association with a critical level (meaning a risk that the raw material might be contamined) Receiving raw material Inspection at the delivery, control of documents: - Certificate of gluten analysis from the producer and / or other documentation by the supplier - Documents identifying the cargo (product, GF nature, lot number, quantity, source, destination) - Random sampling (analytical plan) Gluten in raw material or surroundings / wrong (not GF) raw material Refuse the acceptance of the materials or Separated storage of the raw material (identified as not-to-beused) waiting: to receive documents from supplier / to receive analytical testing result or Use of the raw material in another with-gluten production PERSON IN CHARGE QM QM Leader of production, QM Foods not to be licensed UNPROCESSED CEREAL GRAINS Rice Maize MEAT, FISH AND EGGS All sorts of fresh or frozen meat and fish not processed Tinned or canned fish with water/vegetable oil and salt, without additives or other substances Eggs MILK AND MILK-DERIVATES Fresh milk, UHT milk, sterilized milk without additives, vitamins or other substances Infant formula Yogurt without additives, vitamins or other substances Fresh milk cream and UHT milk cream Cheese Foods not to be licensed VEGETABLES AND LEGUMES All sorts of plain, fresh, frozen, canned or dried vegetables and legumes NUTS AND SEEDS All sorts of nuts and seeds, with or without shells, not processed FRUITS All sorts of plain, fresh, frozen, canned or dried fruits DRINKS Fruit juices Soft drinks Mineral waters Tea, pure coffee Wine Distillates for spirits Foods not to be licensed SWEETS Honey, sugar Marmalade and jam DRESSINGS AND OTHERS Butter, bacon fat, lard Vegetable Oil Vinegar Spices and aromatic herbs not processed OUR COMMON CHALLANGE