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    Should Celiacs Eat Oats? Depends on the Oat


    Diana Gitig Ph.D.
    Image Caption: New study indicates that the type of oats matters for celiacs.

    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.


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    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.

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    Guest Angie Halten

    Posted

    I thought most oats were the same but after reading your article I discovered that some oats are more toxic than others. This sheds a bit more light on the whole controversy concerning eating oats. Thanks!

     

    Angie.

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    The article may answer the question, but as a non-scientific person, I'd prefer a straight, non-scientific answer. So.....specifically what oats are safe and which are not? Just tell me, so I don't have to try and understand the science.

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    Guest Donna

    Posted

    A good start. Now we celiacs need a list of which oats we can try eating, and which to avoid, by brand or at least by some consumer-visible guideline. Looking forward to seeing that, sooner than later. Oats generally can be so good for people, I'd like to resume eating them.

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    This study just confirmed why I have reactions to oatmeal. The oats I purchased from a reputable store were guaranteed gluten free. I tried 2 different manufacturer's of oats and had the same gut reaction. Since I am not willing to keep trying other oat types, oats are out of my diet.

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    Guest Nikki

    Posted

    I too had a terrible reaction to a reputable brand of gluten free oats. If there are specific oats which are less likely to cause a reaction, I'd like to know and would give it one last try. BTW, I get the same reactions from corn and soy.

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    Guest Robin

    Posted

    The researchers in the study cited in the article used an antibody called G12. It is in the Glutentox Kit, now on the market in the United States.

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    Guest Karen

    Posted

    Okay, so some oats are bad and some oats are good. That's great, but what type of oats fall under what category? I guess I don't like wasting my time on something that really doesn't give me any information.

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    Guest Jared

    Posted

    This study may have confirmed why I seem to have no trouble eating all varieties of Nature Valley granola bars. Like Lisa stated, I want to see a list distinguishing between safe and unsafe oats/brands.

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    Guest dappycharlie

    Posted

    nothing said specifically about what defines bad oats even if pure - so of little to no help.

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    She did not say which specific brands of oats are okay to consume- what are we guinea pigs ???

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    Guest Emily Kaufman

    Posted

    The science is still really new, so information about which oats are/are not safe is just not available yet.

     

    For now, the takeaway is still pretty significant -- First, that CC isn't the sole problem with oats / that some are inherently safer than others.

     

    Second, that there's a mistake in the commonly-held belief that some celiacs are just more sensitive to oats than others (even oats labeled gluten-free). This may be true, but it's also likely that some of them are eating oats that aren't gluten-free despite labeling to the contrary. Many of the antibodies used in testing/certifying are only able to recognize CC in oats, not the gluten inside some oats -- these scientists used a different, new antibody (G12) that is so far the only one proven to detect CC-gluten and inherent-gluten.

     

    This is a preliminary study, it paves the way for future studies that will identify safe oats and lead to better testing and labeling.

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    Okay, so some oats are bad and some oats are good. That's great, but what type of oats fall under what category? I guess I don't like wasting my time on something that really doesn't give me any information.

    That is pretty much what I thought. If it doesn't explain the difference in which oat is which, why bother explaining the science behind it. I'm more interested in the bottom line I guess.

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    Guest Robert H. Gibbs MD

    Posted

    It would be good to know just what manufacturers are using when they say they use an 'Elisa' assay for that does not define the epitrope that the testing antibodies have been formed against. Also the author should have noted that the people who did the study treated the proteins prior to assay with enzymes (gut enzymes like we have) and that could make their data more meaningful than the simple testing of an oat slurry.

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    Guest Nicketti

    Posted

    A promising study. However, What's missing is, including the names of the different types of oats that were in the study. Then people can actually use this information.

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    I tried gluten-free oats and had the same symptoms as with wheat. I think that no matter what the general consensus is or what the science says, if there's any question for you personally, oats should be skipped.

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    Guest Brian

    Posted

    Finish with the info on the good oats!

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    Guest Kristin Jordan

    Posted

    Very informative! It's good to see the oat topic and celiac disease still being scientifically explored. I appreciate this article because it informs us that the oats "debate" in the celiac community is not resolved. I had a severe reaction to Bob's Red Mill certified gluten-free oats, two years after my celiac diagnosis and going gluten free. (It was my first time to try gluten-free oats, and I will never get near any type of oats again!) I had tried the oats at this time because the "consensus" out there (what I was reading about celiac disease) was that the gluten-free oats were safe for celiacs, and gluten-free oats are now in so many "gluten-free" products. Now I know better and read more comprehensive studies before attempting anything that might be dangerous to my health.

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    Guest woodchuck64

    Posted

    How much oats can you safely eat per day?

     

    "Catassi et al demonstrated that the ingestion of contaminated gluten should be kept lower than 50 mg/day in the treatment of celiac disease. Based on the reactivity of the G12 antibody against the different oat varieties and gliadin and on the results published by Catassi et al, the tolerance to the most toxic oats might be in the range of 2–20 g/day."

     

    Answer: 2g if you want to be safe, 20g if you're feeling lucky, according to the authors.

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    This study just confirmed why I have reactions to oatmeal. The oats I purchased from a reputable store were guaranteed gluten free. I tried 2 different manufacturer's of oats and had the same gut reaction. Since I am not willing to keep trying other oat types, oats are out of my diet.

    I have such a terrible reaction to regular oats that I am afraid to try the certified gluten-free kind.

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    I feel like I just watched a season ending cliff hanger... Was there something of usable value here that I missed? Why post this article: for people to waste their time? It serves no use.

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    Guest Chris Samuel

    Posted

    To quote from the original paper (linked to above):

     

    "Therefore, three groups of oat varieties could be clearly distinguished depending on their recognition by the moAb G12: a group with high affinity towards the antibody (OM719, OA729 and OE717), a group with intermediate recognition (OH727, OL715 and OC723) and another group comprising oats that were not recognised by moAb G12 (OF720, OR721 and OP722). The alternative anti-33mer moAb A1 also provided equivalent results (data not shown)."

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  • About Me

    Diana received her B.A. in Biochemistry from the University of Pennsylvania, and then a Ph.D. in Cell Biology and Genetics from Cornell. Now she is a freelance science writer and editor in White Plains, New York.  Her son was diagnosed with celiac disease in 2006, at the age of five, and she has been keeping her family healthy by feeding them gluten free treats ever since.

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  • Related Articles

    Scott Adams
    New England Journal of Medicine
    October 19, 1995 -- Volume 333, Number 16
    Celiac.com 10/25/1995 - According to an article published for the week of October 19, 1995 (Vol. 333, No. 16) in the New England Journal of Medicine, it is not a problem for celiacs to eat oats (non-contaminated, of course!). The article is based on a study conducted in Finland by a group of doctors who did very rigorous testing on adult celiacs and concluded that oats can, and should be included on the celiac diet (The lead doctor for the study is also a celiac).
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    The study DID NOT test people who had severe cases of celiac disease, and therefore cannot make recommendations with regard to them. Also, three people with dermatitis herpetiformis withdrew from the study because of an increase of itching, but none of them showed any signs of dermatitis. One person withdrew because of abdominal symptoms, but they did not exhibit damaged villi.
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    There is also an editorial from England which cites positive research which has been done there regarding oats. The NEJM is the Bible of medical research, with extensive peer reviews before publication.

    Scott Adams
    The following was written by Donald D. Kasarda who is a research chemist in the Crop Improvement and Utilization Research Unit of the United States Department of Agriculture. If you have any questions or comments regarding the piece, please address them to Don at: kasarda@pw.usda.gov
    The work from Prof. Auricchios laboratory (Troncone et al.) in Naples is certainly of interest and I shall look forward to seeing the details, but I will just point out for the sake of balance that studies with patients who ingest, or have instilled into their intestines, the substance to be tested represent the gold standard and in vitro testing (that is, in glass, or in the test-tube), while valuable, does not carry as much weight. The results from the Finnish group and from Dr. Feigherys group (not yet published), Dublin, Ireland, are very impressive. The results based on in vitro testing would have to be truly exceptional to undermine the excellent work that has been done on the safety of oats. So, we shall have to wait and see, but I doubt there is reason to be overly concerned just yet.

    Jefferson Adams
    Celiac.com 05/30/2007 - The results of a study recently published in the Scandinavian Journal of Gastroenterology shows that patients with celiac disease can consume oats with no risk of adverse immunological effects.
    An international research team made up of doctors Tarja Kemppainen (1); Esko Janatuinen (2); Kati Holm (3); Veli-Matti Kosma (4); Markku Heikkinen (5); Markku Mäki (3); Kaija Laurila (3); Matti Uusitupa (1); Risto Julkunen (5), set out to evaluate local cellular immune response after 5 years of oat consumption by adult celiac patients.
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    The results showed no differences in the densities of CD3, IEL and IEL T cells between the oat and the control groups. The researchers concluded that the mucosa of the small intestine show no immunological response in celiac patients who consume oats over a long period of time.
    Scandinavian Journal of Gastroenterology, Volume 42, Issue 1 2007 , pages 54 - 59

    Participating Institutions:
    Department of Clinical Nutrition, University of Kuopio and Kuopio University Hospital. Kuopio. Finland Department of General Medicine, Al Mafraq Hospital. Abu Dhabi, U.A.E. Medical School, University of Tampere and Tampere University Hospital. Tampere. Finland Department of Pathology and Forensic Medicine, University of Kuopio and Kuopio University Hospital. Gastroenterological Unit, Department of Medicine, Kuopio University Hospital. Finland About the Author: Jefferson Adams is a freelance health writer who lives in San Francisco and is a frequent author of articles for Celiac.com.

    Dr. Ron Hoggan, Ed.D.
    This article originally appeared in the Winter 2004 edition of Celiac.com's Journal of Gluten-Sensitivity.
    Celiac.com 09/19/2014 - Experts have decreed that pure oats are safe for people with celiac disease(1,2,3).  The definition of this disease is based on a very specific type of injury to the intestinal wall that heals following the removal of gluten from the diet.  This intestinal damage, called villous atrophy, is caused by the interaction between the immune system and certain proteins found in wheat, rye, and barley.  Identical proteins are not found in oats (although there is also some variation between the protein groups found in wheat, rye, and barley).  Further, many newly diagnosed celiac patients have been shown to recover from their celiac symptoms while eating significant quantities of oats and their intestinal biopsies do not show signs of villous atrophy1 (Admittedly, the quantity of oats consumed by these study subjects does not rival the grain protein consumption in a regular, gluten-laden diet, but the quantity is significant).  Therefore, this food is considered safe for celiac consumption.
    Given these facts, it is not surprising that many gastroenterologists are now recommending that their patients eat oats.  Some claim that patients are more likely to follow a gluten-free diet if that diet allows oats.  Others point to the definition of celiac disease, which clearly requires gluten-induced villous atrophy.  Still others insist that since we now know which proteins cause the villous atrophy, oats must be safe for celiac patients to consume.
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    A similar debate arose regarding the inclusion of wheat starch.  It was long held to be a safe nutrient in the gluten-free diet in many European countries.  In fact, the studies that showed a reduced risk of cancer and a variety of celiac-associated conditions were often conducted among patient groups living where wheat starch was deemed acceptable(12, 13).  Yet when wheat starch consumption was studied in Canada, against a back-drop of zero tolerance, most of the subjects developed signs and symptoms of celiac disease(14).
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    Given the facts, we have several hurdles to overcome before we can, in my opinion, render an informed judgment about the safety of oats.  We need a much better understanding of gluten-induced disease in all of its manifestations.  We also need a definition of celiac disease that is more useful to the patient who is experiencing symptoms of gluten sensitivity/celiac disease.  As part of this, we also need a test that is more accurate, and can identify celiac disease after beginning the diet––a challenge that many of us face.  Until we have overcome these hurdles, any pronouncement regarding the safety of oats is premature.
    Further research is, in my opinion, the greatest need of the celiac community.  We need to know more, not just about celiac disease, but about the whole range of nutritional and pathological impacts of eating grains. In my own quest, I have learned from the experiences of other celiac patients.  Each new facet of my own experience has been illuminated by someone else’s story.  I have come to understand ADHD as a frequent companion of celiac disease.  Learning disabilities are also common among celiacs.  Behavioral disturbances are the norm, and speech problems are common.  My understanding continues to grow as I hear from others who struggle with gluten sensitivity.
    Despite its usefulness, this patient-to-patient network of information sharing is not enough.  We need well designed, well executed research.  We need a better understanding of our disease and how to protect future generations from the current, inaccurate assumptions about grains.  The oats question is only one facet of a much larger need for more information and better testing methods.
    Sources:
    Storsrud S, Olsson M, Arvidsson Lenner R, Nilsson LA, Nilsson O, Kilander A.    Adult coeliac patients do tolerate large amounts of oats. Eur J Clin Nutr. 2003 Jan;57(1):163-9. Kilmartin C, Lynch S, Abuzakouk M, Wieser H, Feighery C.  Avenin fails to induce a Th1 response in coeliac tissue following in vitro culture. Gut. 2003 Jan;52(1):47-52. Janatuinen EK, Kemppainen TA, Julkunen RJ, Kosma VM, Maki M, Heikkinen M, Uusitupa MI.  No harm from five year ingestion of oats in coeliac disease. Gut. 2002 Mar;50(3):332-5. Teschemacher H.  Opioid receptor ligands derived from food proteins. Curr Pharm Des. 2003;9(16):1331-44. Review. Yoshikawa M, Takahashi M, Yang S. Delta opioid peptides derived from plant proteins. Curr Pharm Des. 2003;9(16):1325-30. Review. Horvath K, Graf L, Walcz E, Bodanszky H, Schuler D. Naloxone antagonises effect of alpha-gliadin on leucocyte migration in patients with coeliac disease. Lancet. 1985 Jul 27;2(8448):184-5. Zioudrou C, Streaty RA, Klee WA. Opioid peptides derived from food proteins. The exorphins. J Biol Chem. 1979 Apr 10;254(7):2446-9. Hoggan R.  Considering wheat, rye, and barley proteins as aids to carcinogens. Med Hypotheses. 1997 Sep;49(3):285-8. Fukudome S, Yoshikawa M.   Opioid peptides derived from wheat gluten: their isolation and characterization. FEBS Lett. 1992 Jan 13;296(1):107-11. Kuitunen P, Savilahti E, Verkasalo M.  Late mucosal relapse in a boy with coeliac disease and cow's milk allergy. Acta Paediatr Scand. 1986 Mar;75(2):340-2. Holmes, et. al. "Malignancy in coeliac disease - effect of a gluten free diet" Gut 1989; 30: 333-338 Holmes GK.  Coeliac disease and malignancy.Dig Liver Dis. 2002 Mar;34(3):229-37 Collin P, Pukkala E, Reunala T.  Malignancy and survival in dermatitis herpetiformis: a comparison with coeliac disease. Gut. 1996 Apr;38(4):528-30. Chartrand LJ, Russo PA, Duhaime AG, Seidman EG.  Wheat starch intolerance in patients with celiac disease. J Am Diet Assoc. 1997 Jun;97(6):612-8.

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    Those scientists recently gathered some of the first evidence to show that cheap, over-the-counter antacids can prompt the spleen to promote an anti-inflammatory environment that could be helpful in combating inflammatory disease.
    A type of cell called mesothelial cells line our body cavities, like the digestive tract. They have little fingers, called microvilli, that sense the environment, and warn the organs they cover that there is an invader and an immune response is needed.
    The team’s data shows that when rats or healthy people drink a solution of baking soda, the stomach makes more acid, which causes mesothelial cells on the outside of the spleen to tell the spleen to go easy on the immune response.  "It's most likely a hamburger not a bacterial infection," is basically the message, says Dr. Paul O'Connor, renal physiologist in the MCG Department of Physiology at Augusta University and the study's corresponding author.
    That message, which is transmitted with help from a chemical messenger called acetylcholine, seems to encourage the gut to shift against inflammation, say the scientists.
    In patients who drank water with baking soda for two weeks, immune cells called macrophages, shifted from primarily those that promote inflammation, called M1, to those that reduce it, called M2. "The shift from inflammatory to an anti-inflammatory profile is happening everywhere," O'Connor says. "We saw it in the kidneys, we saw it in the spleen, now we see it in the peripheral blood."
    O'Connor hopes drinking baking soda can one day produce similar results for people with autoimmune disease. "You are not really turning anything off or on, you are just pushing it toward one side by giving an anti-inflammatory stimulus," he says, in this case, away from harmful inflammation. "It's potentially a really safe way to treat inflammatory disease."
    The research was funded by the National Institutes of Health.
    Read more at: Sciencedaily.com

    Jefferson Adams
    Celiac.com 06/18/2018 - Celiac disease has been mainly associated with Caucasian populations in Northern Europe, and their descendants in other countries, but new scientific evidence is beginning to challenge that view. Still, the exact global prevalence of celiac disease remains unknown.  To get better data on that issue, a team of researchers recently conducted a comprehensive review and meta-analysis to get a reasonably accurate estimate the global prevalence of celiac disease. 
    The research team included P Singh, A Arora, TA Strand, DA Leffler, C Catassi, PH Green, CP Kelly, V Ahuja, and GK Makharia. They are variously affiliated with the Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Lady Hardinge Medical College, New Delhi, India; Innlandet Hospital Trust, Lillehammer, Norway; Centre for International Health, University of Bergen, Bergen, Norway; Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Gastroenterology Research and Development, Takeda Pharmaceuticals Inc, Cambridge, MA; Department of Pediatrics, Università Politecnica delle Marche, Ancona, Italy; Department of Medicine, Columbia University Medical Center, New York, New York; USA Celiac Disease Center, Columbia University Medical Center, New York, New York; and the Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India.
    For their review, the team searched Medline, PubMed, and EMBASE for the keywords ‘celiac disease,’ ‘celiac,’ ‘tissue transglutaminase antibody,’ ‘anti-endomysium antibody,’ ‘endomysial antibody,’ and ‘prevalence’ for studies published from January 1991 through March 2016. 
    The team cross-referenced each article with the words ‘Asia,’ ‘Europe,’ ‘Africa,’ ‘South America,’ ‘North America,’ and ‘Australia.’ They defined celiac diagnosis based on European Society of Pediatric Gastroenterology, Hepatology, and Nutrition guidelines. The team used 96 articles of 3,843 articles in their final analysis.
    Overall global prevalence of celiac disease was 1.4% in 275,818 individuals, based on positive blood tests for anti-tissue transglutaminase and/or anti-endomysial antibodies. The pooled global prevalence of biopsy-confirmed celiac disease was 0.7% in 138,792 individuals. That means that numerous people with celiac disease potentially remain undiagnosed.
    Rates of celiac disease were 0.4% in South America, 0.5% in Africa and North America, 0.6% in Asia, and 0.8% in Europe and Oceania; the prevalence was 0.6% in female vs 0.4% males. Celiac disease was significantly more common in children than adults.
    This systematic review and meta-analysis showed celiac disease to be reported worldwide. Blood test data shows celiac disease rate of 1.4%, while biopsy data shows 0.7%. The prevalence of celiac disease varies with sex, age, and location. 
    This review demonstrates a need for more comprehensive population-based studies of celiac disease in numerous countries.  The 1.4% rate indicates that there are 91.2 million people worldwide with celiac disease, and 3.9 million are in the U.S.A.
    Source:
    Clin Gastroenterol Hepatol. 2018 Jun;16(6):823-836.e2. doi: 10.1016/j.cgh.2017.06.037.