Unmasking Hidden Gluten: Evaluating the Compliance of Gluten-Free Products and Consumer Exposure in Lebanon

Our study aims to determine gluten levels in gluten-free products marketed in Lebanon and to assess the consumption frequency of noncompliant products among gluten-free shoppers. Following a thorough market screening, a cross-sectional analysis was conducted on identified gluten-free (n = 115) stock-keeping units (SKUs) marketed in the country, including 54 local and 61 imported products. Gluten was quantified with the RIDASCREEN® R5 ELISA; levels >20 ppm were deemed noncompliant. A qualitative food-frequency questionnaire (FFQ) was administered to a sample of 66 gluten-free shoppers for the intake frequency of each noncompliant SKU. Eleven SKUs (9.6%) exceeded 20 ppm, while another 15 (13%) fell between the 1 ppm quantification limit of the kit and 20 ppm. Noncompliance was markedly higher in local products (18.5%) than in imports (1.6%). Forty percent of the contaminated local SKUs and the sole contaminated import bore an FSMS logo, indicating implementation gaps. Bread (6/43) and snack/bars (4/30) accounted for most infractions; a single oat-based "other grain" also tested positive. Although 87% of products were analytically compliant, the FFQ revealed 8 daily and 11 weekly consumption events involving contaminated SKUs. Notably, 65% of respondents were celiac, and 27% purchased for celiac relatives, increasing clinical risk. Lebanon's retail gluten-free sector is largely compliant, yet a substantial risk persists in domestically produced breads and snack items. Strengthened regulatory surveillance, dedicated production lines for high-risk categories, and targeted consumer education must be enforced to safeguard medically vulnerable populations and uphold ethical standards.