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      Frequently Asked Questions About Celiac Disease   04/24/2018

      This Celiac.com FAQ on celiac disease will guide you to all of the basic information you will need to know about the disease, its diagnosis, testing methods, a gluten-free diet, etc.   Subscribe to Celiac.com's FREE weekly eNewsletter   What is Celiac Disease and the Gluten-Free Diet? What are the major symptoms of celiac disease? Celiac Disease Symptoms What testing is available for celiac disease?  Celiac Disease Screening Interpretation of Celiac Disease Blood Test Results Can I be tested even though I am eating gluten free? How long must gluten be taken for the serological tests to be meaningful? The Gluten-Free Diet 101 - A Beginner's Guide to Going Gluten-Free Is celiac inherited? Should my children be tested? Ten Facts About Celiac Disease Genetic Testing Is there a link between celiac and other autoimmune diseases? Celiac Disease Research: Associated Diseases and Disorders Is there a list of gluten foods to avoid? Unsafe Gluten-Free Food List (Unsafe Ingredients) Is there a list of gluten free foods? Safe Gluten-Free Food List (Safe Ingredients) Gluten-Free Alcoholic Beverages Distilled Spirits (Grain Alcohols) and Vinegar: Are they Gluten-Free? Where does gluten hide? Additional Things to Beware of to Maintain a 100% Gluten-Free Diet What if my doctor won't listen to me? An Open Letter to Skeptical Health Care Practitioners Gluten-Free recipes: Gluten-Free Recipes
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    LETTER FROM TREVOR PIZZEY, VICE PRESIDENT OF OPERATIONS FOR CAN-OAT MILLING (OCTOBER 30, 1998)


    admin

    I was reading with interest the postings on your board with respect to the above study and the follow-up and comments. One item that seemed to remain uncertain was the contamination potential of oat products with other cereal grains, in particular wheat, barley, and rye. If we can be of any assistance in providing information to answer this question, we would be glad to offer our data.


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    My name is Trevor Pizzey, and I am currently the Executive Vice President - Operations for Can-Oat Milling, the largest industrial supplier of oat ingredients in North America. Part of the quality control that is incorporated in our operation is a monitoring of the foreign grain admixture of both our raw material and finished goods. Steve Martins comments that cross contamination of grains in North America is almost a given is indeed accurate. There are a number of points of contamination during the production and manufacturing processes. The first point of contamination is usually in the field. Crop rotation in the US and Canada means that oats are often grown on fields that have previously produced wheat, barley or rye. Volunteer grain is the term used to refer to these grains growing the following year from seed that missed being harvested the previous year. A secondary point of contamination is often the grain handling system.

    Most grain handling facilities receive, store, and ship multiple grains. Usually the systems are not cleaned out between receipts or shipments, so one residues of one grain are often in equipment when the next batch of grain passes through, resulting in contamination. This contaminated grain then moves to a processor for manufacturing into a food product. If you are interested in some data related to wheat and barley (we dont see much rye and as a result have no data) content in both our raw material and finished products, please contact me at any time, and we can put together a package for you. My phone number is (204) 857-9700, and fax number is (204) 857-9500. I would suggest that oat flour is more likely to be contaminated with wheat and barley than are oat flakes, although most oat flakes do have a trace of wheat and barley present in them as well. The reasons for the difference are related to mill flows and maximizing efficiencies, but Im sure are not of much interest to celiacs other than knowing what does and does not contain the offending proteins. Im glad to see that in general terms oats are an acceptable grain based nutrition source for celiacs. I realize that we as processors need to make further progress to be able to provide the assurance necessary for celiacs that oat products are not contaminated with other grains. We would like to be able to reach the point that celiacs could rely on oat products in their diet.

    Regards,
    Trevor Pizzey

    November 2, 1998 Response by Mr. Pizzey to my Request for More Information:

    I have reviewed our QA data, and based on the analysis of approximately 50,000 tons of groat production (Note: Groats are the oats with the hull removed, and this production is the primary stage of processing prior to grinding into flour or rolling into flakes. It is at the groat stage that we can most easily detect and monitor wheat and barley admixture.) from our two facilities during the last 6 months. Average wheat and barley contents have been 2.1 and 4.1 kernels per 100 g respectively. It takes approximately 40 kernels to equal 1 gram, so this admixture level equates to 0.0525% and 0.1025% respectively. This level can be expected to fluctuate with crop year and raw material sourcing region.

    Our specifications for finished food products are a maximum of 10 kernels per 100 g, or 0.25% each of wheat and barley. As you can see, average production levels are significantly below our maximum specification, but celiacs would need to be concerned about the maximum specification level, as this concentration is on occasion present in oat products we manufacture. Most of our competitors do not carry wheat and barley as specification items, so I can not comment on the industry average or maximum concentration.

    With respect to your question about the ability of smaller organic producers and processors to guarantee admix free oat products, I would have to say that they are unlikely to be any better than the larger, more conventional operations. In fact, organic producers have somewhat more limited means of controlling volunteer cereals, so admixture levels can be even more elevated than in conventional production. We have previously been a certified organic oat processing facility, and have dealt with significant volumes of organic oats. In general terms, we saw both wheat and barley levels to be higher in organic oats than in conventional products. As with the conventional producers, there is a range of quality that can be expected from organic growers, and some take more care in crop rotations to ensure low cereal admix than others.


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    Guest Victoria

    Posted

    So, has anyone eaten oats? Regular, not milled separately oats? Do they cause a reaction. I'm thinking it might be ok to eat oats occasionally if oat flakes contain only trace amounts, however, no one wants to be the guniea pig on a theory. Still, if someone already knows, it would be great.

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    Guest Majetta

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    I have tried oats, and as a fast reactive celiac, most of the time, I have no reaction. There are other times, however that I have. I really think it's not the oat grain itself, just contamination. But then, everyone is very different in their reactions. I also do dairy and corn while others can't!

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    Guest Bridget

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    Thanks so much for having this information available to us on the Internet! You've helped me since day 1 of my diagnosis in October 2008. I can't ever express my gratitude for your web site!

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    admin

    CEL-PRO on Oats
    The following is an edited version of some of the opinions of the CEL-PRO, which is a group of doctors who regularly discuss issues concerning celiac disease. Disclaimer - this is NOT medical advise, it is a general discussion of the oats issue. See your own doctor for application to your particular situation.
    Doctor #1:
    I will start off the oats discussion by commenting that this is probably the single most comprehensive study of the effects of a grain on celiacs. The earlier evidence for oats as a deleterious agent in celiac disease was based on a very small number of patients or case studies. Reading the report in the NEJM this week would suggest that oats are safe for most uncomplicated celiacs. There are however some reservations about the study. Severe celiac disease was an exclusion, there were some drop outs in both the oats and the control groups and patients with complications were excluded. If the findings are general to the whole population of celiacs then it would certainly make life a lot easier.
    I have a concern about whether oat flour is reliably free of contamination with barley/ wheat. Also what would happen if we challenged a celiac with high doses of oat flour, greater than the 50g used in this study. Also would oat flour protein produce any of the subtle changes seen in the rectum with enema challenge.
    Doctor #2:
    Here in Finland [where the NEJM study was done] there are mixed feelings about oats. Our colleagues from Kuopio have done a very good study, and in fact the study is on-going. Five year follow-up results will tell us more, the authors are this autumn re-biopsing the coeliacs eating oats. Within our Celiac Disease Study Group we have discussed this, and we are going to discuss the item within the expert team of the Finnish Coeliac Society. At this point I want to say some words regarding children.
    Today we are not going to allow coeliac children to eat oats. We are first going to perform a study, our ethical committee has accepted our protocol. We are also going to look at minor jejunal changes in the normal mucosa revealed by immunohistochemistry. Again, the oats producer will provide us the oats for the study (same deep-frozen tested batch through the whole study). If no harm is seen, oats will be accepted also for children and this is important in our country, we by tradition consume oats. Then another story is whether all oat flour products at our market are clean. This is a real practical problem and we will study this. As you probably know, in Ireland the oats was contaminated, Dr. Conleth Feighery and colleagues used in their study oats from a German producer, tested not to be wheat contaminated (from the fields and mills). The Irish study pointed at the same direction as the Finnish one (9 adult coeliacs challenged with 50 g of oats for 3 months), oats was tolerated. The authors also looked for immunological activation in the mucosa, no changes were seen (paper presented at the 8th International Congress of Mucosal Immunology, San Diego, July 1995, abstract Srinivasan et al. Oats cereal is not immunogenic in coeliac disease. Clin Immunol Immunopathol 1995;76 (part 2):S72).
    Doctor #3:
    The results of Kuopio group published in NEJM are probably changing our dietary recommendations. [The author of #1] has recently discussed the situation in children. The study has been carried out in adults, and in adults the demand to change dietary recommendations is strong, as we have noticed during the last days.
    I think adult celiac patients can switch to oats containing diet under strict follow-up. The amount of oats tolerated, the long-term effect of oats, and the importance of gliadin contamination has to be investigated, however.
    I recommend to my celiac disease patients that they should undergo gastroscopic examination 1-2 years after starting oats-containing diet. Some antecedent information of the mucosal architecture should be available as well. If not, a duodenal biopsy should be taken even before starting of oats. By this way we also can observe possible minor inflammatory changes such as an increase in IEL or alpha-beta T-cell receptor bearing lymphocytes.
    If this arrangement sounds too laborious, at least a strict follow-up by physicians and dietitians are essential. The follow-up comprises general well-being, signs of malabsorption and EmA or AGA analysis.

    admin

    The following is a post by Steve Martin (Lucaya@AOL.COM) who has a B.S. in Milling Science, and 10+ years of experience in real world milling, and another 7+ in grain moving and storage.
    I have been reading with some interest the discussion about oats and cross contamination. The grain storage/transporting infrastructure in the US virtually promises cross contamination of grains. Cleaning processes can separate grains with large size and shape differences. For instance, at the flourmill I use to work at, the wheat would come in with about 0.5% corn and soybeans mixed in, but because of the size difference, they were easy to remove. Oats and wheat, on the other hand, are close to the same size, and much more difficult to remove. I have not worked directly at an oat processing facility, and do not know how well they clean the grains before processing. Some mills I have worked at had the equipment to separate wheat and oats and some did not. I would think that oat mills would be the same. I do know that we will not eat any oat products.

    admin
    Scand J Gastroenterol. 2003 Jul;38(7):742-6
    Celiac.com 08/25/2003 – A recent study published in the July edition of the Scandinavian Journal of Gastroenterology demonstrates that avenin oat prolamines can be detected at higher levels in children with celiac disease compared to those without celiac disease. The researchers prepared a crude avenin extract using an ethanol and salt solution, and used it as an antigen in a three step ELISA test. The blood of 81 children, including 34 with celiac disease, were analyzed for both IgA and IgG antibodies to avenin and gliadin. The researchers found that: Children with coeliac disease on a normal diet had significantly higher levels of antibodies to avenin, both IgG and IgA, than reference children (P
    The researchers conclude: Children with coeliac disease have antibodies to oat proteins at significantly higher levels than reference children. The absorption test did not indicate a cross-reactivity between the prolamines of wheat and oats. The method will be employed for repeated sampling of anti-avenin antibodies during a prospective interventional study with a gluten-free diet supplemented with oats. An emphasis should be added to the last sentence, as it appears that they will now perform a study on celiac children who actually eat oats, and most other major studies of this type have shown no intestinal damage caused by the avenin oat prolamines in people with celiac disease. It is interesting that this study shows a different response to oats in those with celiac disease, but it remains to be seen if this response is actually harmful to celiacs.

    Diana Gitig Ph.D.
    Celiac.com 03/14/2011 - It is still a matter of controversy whether or not oats are safe for people with celiac disease. The general consensus at this point seems to be that pure oats are safe for most, but not all, people with celiac. Since oats can easily be contaminated with wheat during harvest, storage, or other stages of processing, it has been stressed that the oats be certified as pure. Although the classic 33-amino acid long oligopeptide that acts as the immunogenic stimulus in gliadin had not yet been found in oats, other peptides isolated from oats do activate T-cells isolated from celiac patients. A new study performed in Spain by Isabel Comino et al. suggests that it is not that some celiac patients can’t tolerate all oats, but rather that all celiac patients can’t tolerate some oats. Their results are reported in the January 2011 issue of GUT: An International Journal of Gastroenterology and Hepatology.
    Dr. Comina and her colleagues examined nine different cultivars of oats. They exposed each of them to a sensitive monoclonal antibody generated to recognize the toxic 33-mer from gliadin, and also measured if each of the oat varieties could elicit an immune response in peripheral blood mononuclear cells from celiac patients. They wanted to see if they could correlate recognition by the monoclonal antibody to induction of a T-cell response, and found that they certainly could.
    The nine varieties of oats segregated neatly into three groups of three varieties each: those for which the antibody had high affinity, low affinity, and no affinity. This affinity was validated by two different experimental methods, so was not an artifact of the technique chosen. When T cells from patients with celiac were exposed to extracts of the oat variety the antibody bound to strongest, they proliferated the most and released interferon-gamma, an immunostimulatory cytokine whose aberrant expression is associated with autoinflammatory disease. In contrast, the oats that didn’t react with the antibody did not elicit these immune responses. The authors note that the avenin – the storage protein in oats – from even the most immunogenic oats they saw bound to this antibody with 40-400 fold less affinity than gliadin (from gluten – the storage protein in wheat).
    This study thus leaves us with two valuable conclusions. One is that some oats are more toxic than others, regardless of their purity. And the other is that reactivity with this antibody can be correlated to toxicity, making it a potential tool for evaluating the toxic gluten content of other food.
    Source:

    Gut doi:10.1136/gut.2010.225268

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