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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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    Oats and the Issue of Cross-Contamination with Wheat


    Scott Adams


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    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.


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    Scott Adams

    I am always amused by the argument that one grain or another is more likely to be contaminated than another, as I believe the real source of danger for contamination is found at mills and processing plants, and is more or less spread out equally for most gluten-free grains. Oats are often cited as having a higher chance of cross-contamination with wheat than other grains because it is often a rotational crop with wheat or barley, and kernels of these gluten-containing grains occasionally get mixed with the non-gluten grains. I do not understand why the same people who make this claim do no also include soy in this category, as it is one of the crops that is most commonly rotated with wheat.
    In any case, from the knowledge that I have gathered over the years about farming and processing grains, I must say that with most grains there is little likelihood of contamination due to the mixing of two different whole grains (i.e., the rotational crop hypothesis). This is due to the different sizes and shapes of different grains, and the machines which sort them after a harvest. If any grains do get mixed together the amount of actual contamination would likely be extremely low.
    In Trevor Pizzeys (Vice President of Operations for Can-Oat Milling) October 30, 1998 letter he expresses his belief that celiacs should avoid oats because he finds between 2.1 and 4.1 kernels of barley or wheat in every 4,000 (0.0525% and 0.1025% respectively). He says that this level can legally go up to a maximum level of 10 kernels per 4,000 (0.25%). In either of these scenarios we are talking about very low amounts. Even at these amounts the likelihood that a celiac eating these grains would eat 1 or 2 kernels of wheat or barley on a given day would be very, very low. Also, since most people who eat oatmeal tend to eat the whole oatmeal as a hot cereal, which means they can take very simple additional precautions to make their chances of eating any kernels of wheat or barley practically zero. The obvious way to do this is to look at the oats before you eat them or mill them and pull out any kernels that are of non-oat type.
    Now we turn to the other part of the argument to scare people away from grains that, taken by themselves, do not cause harm to people with celiac disease. This is the wheat dust in the mill (or during transport, or somewhere else) argument. There are many reasons, both health and safety, why mills take steps to keep dust levels down. Dust contamination is still possible, but I think we are also talking about even lower amounts that we were with the occasional kernel of wheat that pops up in oats, although there is no data that I know of to back this up. I think with whole oats (i.e., oatmeal) people can reduce any possible risk of wheat-dust contamination to almost zero by rinsing off their oats well with water before cooking or milling them.
    The famous oat study that was done in Finland and published in the NEJM used a source of non-contaminated oats to eliminate any possible factors that could ruin the results of their long and expensive study. It is possible that they could have used regular, uncontrolled Quaker oats for their study and gotten the same results, but again, the reasons for not doing so were to eliminate any possible factors that might affect the results of their study. This is the scientific process, and it is important with any study to eliminate any possible factors which could affect the outcome of the study.
    Last, there is a danger of contamination which comes from unclean equipment at mills, and at processing plants. This danger is present with any gluten-free grain, bean, etc., that is milled using the same equipment as is used to mill a gluten-containing grain. In other words we cannot speak of only oats with regard to this issue, as rice flour, soy flour, etc., could be contaminated equally in this way. Aside from legislation to require cleaning between milling runs, those who are worried about this need to buy flours from mills which they have researched and found to be gluten-free, or ones that adequately clean their equipment between runs.
    I think contamination issues are real, but need to be put in perspective with regard to other, perhaps more important issues, like labeling laws and getting agreement between the major celiac organizations in this country with regard to which grains are safe.
    See Also:
    Journal of the American Dietetic Association, Dec. 1997 v97n12p1413(4). Do oats belong in a gluten-free diet? by Tricia Thompson.

    Scott Adams
    Celiac.com 3/14/2003 - After conducting an extensive review of the medical literature concerning the safety of oats for people with celiac disease, the American Dietetic Association recently concluded that even though oats are not yet endorsed as safe for people with celiac disease by doctors and support groups in the USA, they should, however, be safe for celiacs who choose to consume them if they limit their consumption to amounts found to be safe in several studies (approximately one-half cup of dry whole-grain rolled oats per day). Ideally, they also should be advised to consume only those products tested and found to be free of contamination. If this is not possible, patients should be counseled on steps they can take to help reduce their chances of consuming contaminated oat products (e.g., avoiding oats sold in bulk from bins, determining from manufacturers whether a dedicated line or facility is used for processing). In addition, patients should be advised to discuss any dietary changes with their physicians.
    The American Dietetic Associations conditional acceptance of oats as safe for people with celiac disease is another big step forward for celiacs in the USA.
    For more information see:
    Oats and the gluten-free diet
    Journal of the American Dietetic Association
    March 2003 - Volume 103 - Number 3


    Jefferson Adams
    Celiac.com 01/08/2008 - Our recent article on oats brought a number of comments calling our attention to another recent study in which certain types of oats were found to be more beneficial, while others were more likely to be problematical.  There still isn’t any official definitive evidence one-way or the other as to just how safe oats are for folks on a gluten-free diet, though there are more studies of this nature being undertaken, and data collection and genetic mapping and testing help us to build a better picture.
    A team of Italian and Australian doctors conduced in vitro tests on three different kinds of oats. They wanted to see if certain kinds of oats showed any kind of toxicity in people with celiac disease. These tests showed that the Avenins of the Italian variety Astra and the Australian variety Mortlook showed a much higher activity than those of the Australian Lampton variety, while Rice of the Roma variety showed no activity. Gliadin which is found in wheat and rye showed the expectedly high levels of activity.
    Of the oat types tested in this study, the Lampton variety seems to be safer than either the Astra or the Mortlock. However, even oats that are “safer” must still be processed in a dedicated facility that is free of contamination and routinely tested to make sure they meet the minimum levels to be gluten-free. For oat products to be considered gluten-free, they must show less than 20ppm of gliadin.
    A study published in the New England Journal of Medicine by Trisha Thompson, M.S., R.D.,* showed that no commercial brand of oats were reliably gluten-free. In fact, nine of the twelve samples from three major brands of oats showed gluten levels ranging from 1,807 to 23 ppm.
    There are several companies who now sell "certified gluten-free oats," which are oats that are farmed, harvested, processed and packed using special methods to avoid cross-contamination with gluten during every step of the way. Gluten-free oats currently sell for around $4 to $5 a pound. These type of oats are typically tested for gliadin to less than 3ppm, and are thus considered safe for celiacs who are not sensitive to Avenins.
    As far as certain types of oats being better than others, it’s worth some checking, but I’m unsure of the availability of, say, the Lampton strain in America. Also, given the results of commercially available oat brands, the question of the conditions under which the oats were processed becomes very important. Previous studies have shown children with celiac produce significantly greater numbers on antibodies to oat protein than non-celiac children (Scand J Gastroenterol. 2003 Jul; 38(7):742-6).
    Many folks with celiac disease are looking to avoid contamination, as no one wants to suffer the unpleasant symptoms of a gluten reaction. Basically, people just want to know what’s safe and to be able to enjoy those items without worrying about getting sick. Since cross-contamination is such a problem of particular importance to celiacs, and since oats grown and processed commercially are likely not gluten-free, it would seem wise to start with gluten-free oats just to be on the safe side.
    But anyone looking for a definitive answer will just have to wait. And remember, as with so much with the gluten-free diet, you are the best judge of your own body.
    *Thompson T. Gluten Contamination of Commercial Oat Products in the United States. N Engl J Med 2004; 351:2021-2022
    Main article:
    Journal of Gastroenterology and Hepatology 22 (4), 528–531, 2007.
    Marco Silano, Mariarita Dessì, Massimo De Vincenzi, Hugh Cornell (2007).


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    Ingredients:
    1 cup red quinoa, rinsed well ½ cup water ½ cup chicken broth 2 radishes, thinly sliced 1 small bunch fresh pea sprouts 1 small Persian cucumber, diced 1 small avocado, ripe, sliced into chunks Cherry or grape tomatoes Fresh sunflower seeds 2 tablespoons red wine vinegar  Kosher salt, freshly ground pepper Directions:
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    Jefferson Adams
    Celiac.com 05/18/2018 - Across the country, colleges and universities are rethinking the way they provide food services for students with food allergies and food intolerance. In some cases, that means major renovations. In other cases, it means creating completely new dining and food halls. To document both their commitment and execution of gluten-free and allergen-free dining, these new food halls are frequently turning to auditing and accreditation firms, such as Kitchens with Confidence.
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    Zyana Morris
    Celiac.com 05/17/2018 - Celiac disease is not one of the most deadly diseases out there, but it can put you through a lot of misery. Also known as coeliac, celiac disease is an inherited immune disorder. What happens is that your body’s immune system overreacts to gluten and damages the small intestine. People who suffer from the disease cannot digest gluten, a protein found in grain such as rye, barley, and wheat. 
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    Sources:
    ncbi.nlm.nih.gov  Celiac.com ncbi.nlm.nih.gov  mendfamily.com