Jump to content
  • Sign Up
  • Welcome to Celiac.com

  • Member Statistics

    84,311
    Total Members
    4,125
    Most Online
    pegalilly
    Newest Member
    pegalilly
    Joined
  • 0

    The Celiac Disease Oat Conundrum


    Jefferson Adams

    Celiac.com 06/30/2008 - According to the latest European research, pure oats are safe for most people with celiac disease, and contamination is the main problem facing people with celiac disease who wish to eat oats. The question of whether oats are safe to consume for all people with celiac disease has yet to be adequately resolved. Doubts remain as to whether pure oats are safe for all people with celiac disease, and if so, which oats.

    Some studies show that most people with celiac disease can tolerate oats, while some studies show sensitivity. Some people with celiac disease seem to be sensitive to oats, whether they are contaminated or not, but recent studies suggest that contamination is the main problem for most people with celiac disease who wish to eat oats. Anecdotal evidence is equally divided, with some folks reporting no problem with oats, while others report adverse reactions.

    A recent editorial by doctors Heather Julia Ellis and Paul J. Ciclitira in the European Journal of Gastroenterology and Hepatology notes that oats could be an important component in a gluten-free diet. They point out that a small segment of the population with celiac disease seem to have adverse T cell responses to oats that can not be explained by contamination. The doctors also point out that only one of the two commercially available kits for testing for the presence of gluten in foods is sensitive to barley. Another problem with oat consumption among people with celiac disease is that some may seem to tolerate oats well, and show no symptoms, but still be suffering damage.

    Doctors Ellis and Ciclitira note that people with celiac disease who wish to consume oats need sound advice and regular monitoring for telltale antibodies, and reliable, comprehensive assay techniques, which means access to reliably tested, uncontaminated oats. To that, I would add clear labeling. An article by the Irish gastroenterologist William Dickey in the European Journal of Gastroenterology and Hepatology seems to echo that point. According to Dickey, research supports the idea that most people with celiac disease can tolerate pure oats well, and that only in rare cases do pure oats elicit an adverse reaction. Dickey notes that contamination of commercially viable oats is the cause of most adverse reactions in people with celiac disease. He points out that R5 ELISA accurately detects and measures gluten contamination in oat products. Dickey calls for R5 ELISA testing of all oats, and of all “gluten-free” products containing oats. He points out that contamination levels of all such products should be clearly labeled to help people with celiac disease to avoid products with unacceptable contamination levels.

    A recent study made by a team of doctors in Spain set out to measure the levels of wheat and barley contamination of oats from Europe, the United States, and Canada. The research team was made up of doctors Alberto Hernando, Jorge R. Mujico, Mara C. Mena, Manuel Lombardía, and Enrique Méndez. The team used Sandwich R5 ELISA (using either gliadins or hordeins as standards), western blot, matrix-assisted laser desorption/ionization time-of-flight mass spectrometric and quantitative real-time PCR (Q-PCR) techniques to evaluate 134 varieties of “pure,” “uncontaminated” oats from Europe, the United States, and Canada.

    Results showed that just 25 of the samples were actually pure, and contained no detectable levels of contamination. The other 109 samples all showed wheat, barley and/or rye contamination. The results also showed that contamination levels vary among oats from the same source.

    European Journal of Gastroenterology and Hepatology 20: 492–493; 494–495; 545–554.

    0


    User Feedback

    Recommended Comments



    Guest Melia Haywood

    Posted

    Are you able to reference the 25 sources that were indeed found to be 'pure' when tested for gluten contamination? I have been purchasing 'gluten free' oats as I had been told that both Irish and Scottish Oats were absolutely sure to NOT be cross contaminated as the USA sources were. You make the same references but what do I do to find oats that will be safe for myself?

    Share this comment


    Link to comment
    Share on other sites
    Guest Sarah

    Posted

    We have had very good luck with the Bob's Red Mill Gluten Free Oats. I'm now using them for oatmeal, granola, granola bars etc. My kids love them and my younger one who has a very sensitive tummy that hurts after even the possibility of cross-contamination, seems fine eating them on a regular basis.

    They are expensive, but so nutritious, I really wanted to include them in our gluten-free diet.

    Share this comment


    Link to comment
    Share on other sites
    Guest Phyllis Morrow

    Posted

    What's the reference for the Spanish study? I'd like to know if Chateau Cream Hill Estates 'Lara's Rolled Oats' were tested. The package claims no cross-contamination (using R5-ELISA batch testing).

    Share this comment


    Link to comment
    Share on other sites
    Guest Luann Brown

    Posted

    Interesting, but I still would not consider eating oats at this point.

    Share this comment


    Link to comment
    Share on other sites

    I do tolerate gluten free oats well, whereas I react to even the tiniest amounts of gluten, and the codex wheat starch. What is interesting is that some get problems from oats without symptoms.

    Share this comment


    Link to comment
    Share on other sites

    I haven't had any issues with eating oats. I wish people would stop having knee jerk reactions to informative articles such as this. So much misinformation that so many people just cannot let go of even when articles such as this point out the safety of oats.

    Share this comment


    Link to comment
    Share on other sites
    Guest Gloria Brown

    Posted

    After reading much about the gluten/oat controversy, I dared to try 'Gluten Free Oats' on the hope that the producers (a family of three generations of celiacs) would ensure no contamination. The consequence rated among the most frightening of any food I've eaten, with blood being drawn from my intestine. I have wondered since if damage from oats is related more to the severity of one's sensitivity, and that those reporting no response may be in earlier phases of the disease?

    Share this comment


    Link to comment
    Share on other sites
    Guest Julie

    Posted

    I recently have tried gluten-free Oats and have had no adverse reactions. I am excited to have a new grain in my diet!

    Share this comment


    Link to comment
    Share on other sites
    Guest Axel Feldmann

    Posted

    I was told by my gastroenterologist that tolerance of oats varies from person to person according to their level of gluten sensitivity. I for one, do not eat oats, because of the risk.

    Share this comment


    Link to comment
    Share on other sites
    Guest kristine

    Posted

    My daughter is 13 and was told 4 years ago that she has celiac. She happens to be one that can not tolerate oats of any kind. We were taught the phrase: "WHEN IN DOUBT, DO WITH OUT". We still live by this motto. Thank you for a very well written article.

    Share this comment


    Link to comment
    Share on other sites



    Your content will need to be approved by a moderator

    Guest
    You are commenting as a guest. If you have an account, please sign in.
    Add a comment...

    ×   Pasted as rich text.   Paste as plain text instead

      Only 75 emoji are allowed.

    ×   Your link has been automatically embedded.   Display as a link instead

    ×   Your previous content has been restored.   Clear editor

    ×   You cannot paste images directly. Upload or insert images from URL.


  • About Me

    Jefferson Adams earned his B.A. and M.F.A. at Arizona State University, and has authored more than 2,000 articles on celiac disease. His coursework includes studies in biology, anatomy, medicine, and science. He previously served as Health News Examiner for Examiner.com, and provided health and medical content for Sharecare.com.

    Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of the book Dangerous Grains by James Braly, MD and Ron Hoggan, MA.

  • Popular Contributors

  • Related Articles

    Scott Adams
    The Journal of Pediatric Gastroenterology and Nutrition (1996;22:414) published the abstracts of the forthcoming ESPGAN Meeting (June 4-8, 1996 in Munich, Germany). Troncone et al will present their work:
    Oat prolamines activate mucosal immune response in the in vitro cultured treated coeliac mucosa
    The conclusion is that oat prolamines are able to activate the T-cell mediated mucosal immune response in the coeliac jejunum, and represent a warning against the inclusion of oats in the diet of coeliac patients.

    Scott Adams
    Celiac.com 10/28/2004 – The obvious problem with this study is that it is so small—only nine people. It does, however, bring up valid concerns about the safety of oats for all celiacs. There may exist a sub-set of celiacs who also have avenin-reactive mucosal T-cells, avenin being the oat counterpart to wheats gliadin. It is important to conduct future studies that are designed to determine just how many celiacs also have avenin intolerance. Most patients with celiac disease can eliminate their symptoms--at a price: life-long adherence to a gluten-free diet. This means no wheat, rye, barley, and, until recently, no oats. Then some recent studies suggested that oats did not cause the intestinal inflammation characteristic of the disease, and thus oats are now often included in the celiac disease diet. This is good news for patients coping with severe restrictions on what they can and must not eat, but a study by Ludvig Sollid and colleagues in this issue of PLoS Medicine suggests that oats are not safe in all cases.
    Like other chronic inflammatory diseases, celiac disease is caused by a complex interplay between genetic and environmental factors, but it is better understood than most. Long believed to be a relatively rare disorder, it is now thought to affect about one in 250 people worldwide. Clinical symptoms are present in less than half of patients and vary considerably. Genetically, almost all patients have one of two predisposing HLA molecules, which determine the context in which their immune system encounters foreign antigens, including gluten proteins found in wheat and other cereals. In individuals with celiac disease, the immune system mounts an abnormal response to gluten, which is characterized by gluten-reactive intestinal T cells and by inflammation and compromised function of the small intestine.
    Ludvig Sollid and colleagues applied the current understanding of celiac disease and a range of molecular pathology tools to studying the response to oats of nine patients with celiac disease. The nine patients were not a random sample: all of them had been eating oats, and four of them had shown clinical symptoms after oats ingestion. The goal of the study was to characterize the intestinal T cell response to oats in these patients, and to relate it to clinical symptoms and intestinal biopsy results. All patients were on a gluten-free diet and ate oats that were free of contamination by other cereals.
    Three of the four patients who had reported problems after eating oats showed intestinal inflammation typical of celiac disease, and Sollid and colleagues studied intestinal T cells from these three patients. Two of the five patients who seemed to tolerate oats also had oats-reactive intestinal T cells. Functional study of these T cells showed that they were restricted to celiac-disease-associated HLA molecules and that they recognized two peptides derived from oat avenin that are very similar to peptides of gluten.
    Taken together, the findings show that intolerance to oats exists at least in some patients with celiac disease, and that those patients have the same molecular reaction to oats that other patients have to wheat, barley, or rye. However, identical reactions were also seen in two of the patients who were clinically tolerant to oats. The authors suggest that these reactions could develop into symptomatic disease after some time delay, but there is no proof that the presence of oats-reactive T cells is an indicator of future symptoms or even of enhanced susceptibility to clinical oats intolerance.
    Oats are not safe for all patients with celiac disease, but future studies are needed to determine the frequency of oats intolerance.
    Abstract of Study:
    Background
    Celiac disease is a small intestinal inflammatory disorder characterized by malabsorption, nutrient deficiency, and a range of clinical manifestations. It is caused by an inappropriate immune response to dietary gluten and is treated with a gluten-free diet. Recent feeding studies have indicated oats to be safe for celiac disease patients, and oats are now often included in the celiac disease diet. This study aimed to investigate whether oat intolerance exists in celiac disease and to characterize the cells and processes underlying this intolerance.
    Methods and Findings
    We selected for study nine adults with celiac disease who had a history of oats exposure. Four of the patients had clinical symptoms on an oats-containing diet, and three of these four patients had intestinal inflammation typical of celiac disease at the time of oats exposure. We established oats-avenin-specific and -reactive intestinal T-cell lines from these three patients, as well as from two other patients who appeared to tolerate oats. The avenin-reactive T-cell lines recognized avenin peptides in the context of HLA-DQ2. These peptides have sequences rich in proline and glutamine residues closely resembling wheat gluten epitopes. Deamidation (glutamine?glutamic acid conversion) by tissue transglutaminase was involved in the avenin epitope formation.
    Conclusions
    We conclude that some celiac disease patients have avenin-reactive mucosal T-cells that can cause mucosal inflammation. Oat intolerance may be a reason for villous atrophy and inflammation in patients with celiac disease who are eating oats but otherwise are adhering to a strict gluten-free diet. Clinical follow-up of celiac disease patients eating oats is advisable.
    Copyright: © 2004 Public Library of Science.

    Scott Adams
    Thompson T. NEJM. 2004;351:2021-2022 (Nov. 4, 2004, Number 19)
    Celiac.com 11/09/2004 - While oats do not appear to naturally contain gluten, like other grains they can become contaminated during harvesting, transporting, milling and processing. Many studies have shown that moderate amounts of uncontaminated oats are safe for most adults with celiac disease. There may, however, also exist a sub-set of celiacs who also have avenin-reactive mucosal T-cells, avenin being the oat counterpart to wheats gliadin.
    To summarize the study—12 containers of oats representing 4 different lots of 3 brands (Quaker, Country Choice, and McCanns) were tested for gluten contamination using the R5 ELISA developed by Mendez. Contamination levels ranged from below the limit of detection (3 ppm gluten) to 1807 ppm gluten. Three of the 12 oat samples contained gluten levels of less than 20 ppm, and the other nine had levels that ranged from 23 to 1,807 ppm. All brands of oats tested had at least 1 container of oats that tested above 200 ppm gluten. It is interesting to note that Country Choice oats ranged from below the limit of detection to 210 ppm—an amount that is nearly at the level allowed by the Codex Alimentarius for products that normally contain gluten but have had their gluten removed—and of the three brands had the least amount of cross-contamination. We must caution, however, that the sampling done in the study was much to small to make any firm conclusions about the average level of gluten-contamination of each of these brands.
    This study shows that cross-contamination is indeed a concern for celiacs who want to try oats. Celiac patients should contact oat millers directly and talk to them about their clean-out procedures, and whether they have done any testing of their own for gluten cross-contamination.


    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).


    Jefferson Adams
    Celiac.com 03/26/2008 - According to the results of a recent study,adults with diet-treated celiac disease show no elevation inanti-avenin IgA by oats. Celiac disease is effectively treated with agluten-free diet that is free of wheat, rye, barley and related grains. Whileit is well known that wheat, rye and barley trigger the disease, fordecades there has been controversy about the safety of oats.
    Recentevidence from a number of studies has supported the idea that oats aresafe for people with celiac disease. In several countries, oats are nowon the list of safe foods for people with celiac disease. The studieson oats and celiac disease have had various designs, but most have beensmall, and often with high patient drop-out rates. To date, there hasonly been a single randomized and double-blinded study measuring the effects of oats on celiac patients. The studies have been nearly unanimous in concluding that consumption of oats is safe to celiac disease patients.
    Mostof these clinical studies have assessed blood histology in reaction tooats, or measured normalization after patients had been diagnosed withceliac disease and were already following gluten-free diets. Threelarge studies from Finland have investigated the effect of dietary oatsand their influence on antibody levels to wheat gluten and to tissuetransglutaminase. Previous studies have shown that people withuntreated celiac disease show elevated IgA antibodies in reaction oatavenins. However, only one study on treated celiac disease patients hasinvestigated IgA antibodies to oats.
    Researchers know of justthree confirmed cases of active celiac disease flaring up again inadults after these people ingested oats, which indicates thatintolerance to oats among celiacs may be rare, but also may in facthave some role to play in celiac disease. It also points to the need for clinical monitoring of celiac disease patients who eat oats.
    Aresearch team made up of Vigdis Guttormsen, Astrid Løvik, Asta Bye;Jorunn Bratlie, Lars Mørkrid, and Knut E. A. Lundin recently conducteda small study to determine whether treated adult celiac diseasepatients who ate oats showed elevated levels if IgA. The research team compared blood samples of 136 adult patients with treated celiac disease against 139 controls. The team used ELISA to test the blood samples to measure IgA against oats avenin, wheat gliadin and tissue trans-glutaminase.
    Eighty-two of the celiac disease patients had been eating oats as part of their gluten-free diet for 6 months or more.  Both the oats-eating and non-oats-eating celiac disease patients showed no significant differences in IgA against oats. However, both groups did show elevated levels of IgA against wheat, oats and tissue tTG compared to healthy controls. Thegroups also showed a significant positive correlation betweenanti-avenin and antigliadin IgA (pB0.0001), and between anti-avenin andanti-tissue transglutaminase IgA (p 0.0012).
    The researchersconcluded that eating oats does not cause increased levels of IgA inadult celiac disease patients on a gluten-free diet. The findings support the notion that most adult celiac disease patients can tolerate oats.
    Scandinavian Journal of Gastroenterology, 43:2, 161 - 165.


×