Oats and health benefits

Abstract

The global burden of non-communicable diseases (NCDs) has been an increasing public health concern. Non-communicable diseases (NCDs) account for 60% of the global mortality. Of the 35 million deaths in attributable to NCDs annually, about 80% are in low- and middle-income countries (LMIC). From 2006 to 2015, deaths due to NCDs are expected to increase by 17%. Dietary approaches hold promise as effective and preventive interventions for NCDs. Dietary factors represent the most potent determinants of metabolic health and have been shown to mitigate specific physiological mechanisms in various disease conditions. Recent epidemiological and experimental studies suggest that healthy dietary pattern, including increased consumption of natural products, whole grains, fruits can favorably influence the risk of NCDs. Increase in dietary fiber (DF) intake has been recommended for a healthy life. Cereals and cereal products, particularly from whole grains forms staple diet in most countries. Moreover, in addition to being a source of carbohydrates whole grains especially wheat, rice, and oats, provides protein and essential fatty acids and possesses unique and beneficial combinations of many micronutrients, polyphenolics and DF. Among the whole grains, Oats had gained a unique position, because of its diverse health benefits to the humans. This chapter mainly deals with the health benefits of oats in relation to the prevention of NCDs.

Full text

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Oats and Health benefits
Somasundaram Mathan Kumar*
Abstract:
The global burden of non-communicable diseases (NCDs) has been an increasing public health
concern. Non-communicable diseases (NCDs) account for 60% of the global mortality. Of the 35
million deaths in attributable to NCDs annually, about 80% are in low- and middle-income
countries (LMIC). From 2006 to 2015, deaths due to NCDs are expected to increase by 17%.
Dietary approaches hold promise as effective and preventive interventions for NCDs. Dietary
factors represent the most potent determinants of metabolic health and have been shown to
mitigate specific physiological mechanisms in various disease conditions. Recent
epidemiological and experimental studies suggest that healthy dietary pattern, including
increased consumption of natural products, whole grains, fruits can favorably influence the risk
of NCDs. Increase in dietary fiber (DF) intake has been recommended for a healthy life. Cereals
and cereal products, particularly from whole grains forms staple diet in most countries.
Moreover, in addition to being a source of carbohydrates whole grains especially wheat, rice, and
oats, provides protein and essential fatty acids and possesses unique and beneficial combinations
of many micronutrients, polyphenolics and DF. Among the whole grains, Oats had gained a
unique position, because of its diverse health benefits to the humans. This chapter mainly deals
with the health benefits of oats in relation to the prevention of NCDs.
Keywords: Oats, NCDs, Health benefits, Whole grains, CVDs, Diabetes, Coeliac disease.
*Correspondence: Senior Veterinarian; Department of Animal and Veterinary Sciences,
College of Agricultural and Marine sciences, Sultan Qaboos University, Sultanate of Oman.
Email: Mathan@squ.edu.om

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Introduction:
Cardiovascular diseases, Diabetes (Type-II), and Cancer, and Obesity are major health concerns
in the western nations especially in United States and developing countries around the world. [1]
Cardiovascular diseases (CVDs) is the leading cause of death in the world, accounting for 30%
of deaths globally, and the estimated number of deaths due to CVDs worldwide was 17.5 million
in 2005 and will increase to 20 million in 2015. WHO estimates that between 2000 and 2030, the
world population will increase by 37% and the number of people with diabetes will increase by
114%. [2, 3, 4, 5] Blood cholesterol is a major risk factor for CVDs. In addition, calorie-enriched
diet intake and lack of exercise have been causing a world-wide surge of obesity and insulin
resistance is also identified as the major risk factors. [2, 6]
Today we find ourselves with an epidemic of over nutrition and obesity not only in the western
world but also in the emerging economies with prevalence of “super size” food portions and “all
you can eat” buffets that promotes over eating. [7], causing substantial increases in morbidity
and early mortality in the population with these non communicable diseases. [ 9] While we
derive more than enough calories from food choices, either has lost many of the natural
preventive substances or their inclusion is inadequate such as cereal fibers that are proven to
provide health benefits against these.[2,6, 8, 9]
Since past few decades, prevention of non-communicable diseases has become the top agenda
for every international and national health authorities. Real challenges are in the prevention
strategies for CVDs, diabetes and cancers as these globally burdening the population. Even the
etiologies of these three diseases are complex, yet preventable. Dietary intervention is the first
line of approach against these major health disorders and inclusion of plant based products has
successfully proven to unveil the connection between diet and disease. [1, 2, 10.] Hippocrates-
also called the "Father of Medicine" - stated "Let thy food be thy medicine and thy medicine be
thy food."[11] The statement remains true and need for recollection even after 2500 years.
Dietary consumption of whole-grain foods such as wheat, barley, oats, etc are associated with a
decreased risk of several chronic diseases, with benefits attributed to their content of both macro
and micro nutrients, fiber and phytochemicals. [12]

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The quest for answers continues as science uncovers the mysteries between health and nutrition
for the emerging lifestyle related diseases i.e. NCDs. Even though research on Oats has been
happening for the four decades, as the primary report of the cholesterol reduction by oats
consumption in humans [13] ever since, oats has always been in the top of the order in nutritional
research, clinical trials and constantly fueling the specialty of applied human nutrition,
nevertheless, significant achievements occurred in the past two decades. At presently, research is
finding more and more evidence that explains the relationship between dietary inclusion of oats
and the health benefits attained through physiological responses to prevent or delay the illness
against these NCDs.
Oats- A Background:
Oats are a crop of Mediterranean origin, not as old as wheat and barley but their domestication
dates back to ancient times. Oats rank around sixth in the world cereal production statistics
following wheat, maize, rice, barley and sorghum. [14]. World oat production is generally
concentrated between Latitudes 35-65oN and 20-46o S and Russia, USA, Canada, Germany and
Poland account for about 75 percent of the world’s supply of grain, seed and industrial grade
oats.[15] In 2005, the top five oats producers according to the UN Food and Agriculture
Organization (FAO) were Russia with 5.1 million metric tons, Canada with 3.3 million metric
tons, United States with 1.7 million metric tons, Poland with 1.3 million metric tons, and Finland
with 1.2 million metric tons. Other top producers of oats include Australia, Germany, Belarus,
China and the Ukraine. [14]
In many parts of the world oats are grown for use as grain as well as for forage and fodder either
as green chaff, hay and straw. Livestock grain feed is still the primary use of oat crops,
accounting for an average of around 74 percent of the world’s total usage.[15] Oats for grain and
forage or fodder are grown on over 1.8 million hectares in Canada and 0.8 million hectares in
USA. The food industry in North America uses approximately 1.7 million tons of oats while a
major share goes to livestock feed industries. Oats still remain an important grain crop for people
in marginal ecologies throughout the developing world, and in developed economies for
specialized uses. Oat grains are a good source of protein, fibre, and minerals. [14, 16]

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Table 1: Taxonomic information of Oats (Obtained from [17]
Botanical name
Avena sativa
Kingdom
Plantae: plants
Subkingdom
Tracheobionta: vascular plants
Super division
Spermatophyta: seed plants
Division
Magnoliophyta: flowering plants
Class
Liliopsida: monocotyledons
Subclass
Commelinidae
Order
Cyperales
Family
Poaceae: grass family
Genus
Avena: oat
Species
A. sativa: common oat, A. byzantina,
A. fatua, A. diffusa, A. orientalis
Oats and Health Claim:
The Food and Drug Administration (FDA) had announced its decision on Jan 1997 to authorize
the health claims on the association between soluble fiber from whole oats and a reduced risk of
coronary heart disease (CHD). Further, the agency had concluded that the type of soluble fiber
found in whole oats, i .e. β-glucan is primarily responsible for the claimed association. Their
decision was based on a review of the evidence demonstrating that consumption of whole-oat
sources ( including oat bran, rolled oats, and whole oat flour) decreases total cholesterol (TC)
and low-density lipoprotein cholesterol (LDL-C) concentrations. However in continuation, the
health claim association between oats consumption and reduced risk of CHD was also approved
by The Joint Health Claims Initiative (JHCI) in UK in the year 2004 and Ministry of Health
Malaysia in the year 2006. [18, 21.]
Among the whole grains, oats had gained a unique position because of its diverse health benefits
attained through favorable physiological responses to combat epidemically emerging NCDs.
Dietary inclusion of oats provide beneficial effects to health because of its rich macro nutrients,
micro nutrients, soluble fiber (β-glucans) and the recently discovered oat poly phenolics. This
chapter details out the health benefits of oats in relation with CVDs, diabetes and celiac disease.

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Oats and Cardiovascular Diseases:
The cardiovascular system, which is composed of the heart and blood vessels, is essential for the
distribution of oxygen, nutrients, and other critical components to all organs throughout the
human’s body. As the heart is the sole pump for the cardio vascular system, any disruption of its
function can have critical consequences for the human’s life.
Cardiovascular diseases (CVDs) are the leading cause of death in the world and that includes
coronary or ischemic heart disease, cerebrovascular disease or stroke, hypertension, heart failure,
and rheumatic heart disease. Coronary artery disease due to advanced atherosclerosis is the major
cause of death in the United States and in most Western countries. In contrast, Asian countries
have disproportionately high morbidity and mortality from stroke compared with Western
countries and rise in blood cholesterol is a major risk factor for CVDs. [2, 5].
Hypercholesterolemia is caused by increased concentrations of low-density lipoprotein
cholesterol (LDL-C) and very low-density lipoprotein cholesterol (VLDL-C). Elevated
triglycerides (TGs) result from elevated VLDL. High TG and greater LDL-C are predictors of
increased cardiovascular risk. Oxidation of low density lipoproteins (LDL, the “bad cholesterol”)
is a key biochemical step in the development of cardiovascular diseases. High-density
lipoprotein cholesterol (HDL-C) concentrations provide the opposite relationship, with increased
blood concentrations of HDL-C predicting reduced risk. [19]. Epidemiological evidence
indicates that a higher intake of oats is associated with a reduced risk of coronary heart disease,
and this effect of has been attributed to its cholesterol-lowering effect and improvement of
vascular endothelium through its fiber and antioxidant components.[8,20]
As was seen earlier, FDA had announced its food specific health claim decision on Jan 1997 to
authorize the association between soluble fiber from whole oats and a reduced risk of CHD. The
intent of this benchmark is to provide a high level of confidence in the validity of the
relationship. Although it does not require unanimous and incontrovertible scientific consensus, it
is meant to be a strong standard based on the totality of the science, like the preliminary report
by de Groot et al in the year 1963 from then until the year 1997 with several other studies and
evidence based review to unveil this relation, so, there are little likelihood of chances being this
relation reversed by new data. [21]

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Whole grain foods are known to exhibit positive protection against CVDs through its fiber and
antioxidant components and the commonly consumed ones are: dark bread, whole-grain or bran
breakfast cereals, bran, popcorn, oatmeal, wheat germ and brown rice.[3] Several large
population cohort studies had concluded that higher intakes of whole-grain foods were associated
with lower risks of CHD and this inverse association was independent of known coronary risk
factors and these are detailed out as following, In a southern Californian population-based cohort
of 859 men and women aged 50-79 years with a study design as 24-hour dietary fiber intake
record had concluded that dietary fiber intake of 16 gm/ 24 hours or more provided better
protection against ischemic heart disease than whose intake less than 16 gm/24 hours. Further
the study added that 6 gm increment in daily fiber intake was associated with a 25% reduction in
ischemic heart disease. [22]. In a prospective cohort of 75521 US women aged 38 - 63 years,
who completed detailed food frequency questionnaires (FFQs) and were followed up for 12
years as part of the Nurses’ Health Study concluded that higher intake of whole grain foods was
associated with a lower risk of ischemic stroke among women, and the inverse relation was
continuous throughout the study period and accounted about a 30%-40% lower risk of ischemic
stroke among women.[23]. In1986, a total of 43 757 US male health professionals 40 to 75 years
of age, completed a detailed 131 -item dietary questionnaire to measure usual intake of total
dietary fiber and specific food sources of fiber in a six year follow up study and documented
0.59% (734 cases) of myocardial infarction as a form of fatal coronary heart disease. This study
concluded that within the three main food contributors to total fiber intake (vegetable, fruit, and
cereal), cereal fiber was most strongly associated with a reduced risk of total myocardial
infarction.[24] In the Iowa Women’s Health Study (n= 34 492) post menopausal women
followed for 6 years, concluded that a greater intake of whole grain was associated with a
reduced risk of CHD death.[25] A Meta-analysis of 12 studies that were conducted between
1977 and 1999, shown regular intake of whole grain foods was associated with a 26% reduction
in risk for CVDs. Whole grain foods positively influence a number of other CVD risk factors
such as hypertension, diabetes and obesity through reduction of LDL-C and TGs, in addition
they have favorable effects on fasting and postprandial serum lipoproteins. Higher intakes of
whole grains are associated with increased sensitivity to insulin, and lower plasma insulin
concentrations and these effects are possibly attributed as whole grains are the rich source of

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magnesium, fibers and Vitamin E. Nevertheless, it is highly recommended that consumption of
≥3 servings of whole grains/day, but not the refined sources to decrease the risk of CHD by
≥30%, irrespective of other lifestyle behaviors. [3, 26]
Soluble fiber fraction of oats, in particular to the (1→3, 1→4) β-D-glucan component reduce total
and LDL cholesterol is a sum of several effects. The effect is small within the practical range of
intake. For example, 3 g soluble fiber from oats (3 servings of oatmeal, 28 g each) can decrease
total and LDL -C by <0.13 mmol/L. Such effects include soluble fibers bind bile acids or
cholesterol during the intraluminal formation of micelles and the resulting reduction in the
cholesterol content of liver cells leads to an up-regulation of the LDL receptors and thus
increased clearance of LDL-C. Other suggested mechanisms include inhibition of hepatic fatty
acid synthesis; by products of fermentation (production of short-chain fatty acids (SCFA) such as
acetate, butyrate, and propionate). Both oats and barley contains β- glucan identically in structure
but vary in their quantities, however, did not evince any dissimilarity in the reduction of LDL-C
in the Syrian golden F1B hamsters and the demonstrated mechanism as β-glucan inhibits
absorption of cholesterol from the gut by a significant increase in the excretion of fecal
cholesterol and neutral sterols.[2,27,28]
Physiochemical properties such as molecular weight (MW) and solubility of β- glucan favorably
influence the serum cholesterol reduction; higher the MW promotes increased gut viscosity that
may prevent dietary cholesterol from reaching the intestinal epithelium. In addition, this gives
increased satiety and delayed return of hunger i.e.
“second meal effect” through the lowered postprandial glycemic and insulinemic response.
Soluble fibers may decrease absorption of dietary cholesterol by altering the composition of the
bile acid pool. Oat bran increased the portion of the total bile acid pool that was deoxycholic acid
(DCA) and it has been noted to decrease the absorption of exogenous cholesterol in humans.
Fermentation of fibers in the large intestine may also alter cholesterol metabolism by production
of SCFA, among which butyrate was found to play a major role altering the cholesterol
metabolism. The role other SCFA such as propionate and acetate remain inconclusive.[8,29,30]
It is likely that some food constituents, such as vitamins, trace elements, phenolic compounds,
and phyto estrogens, found in oats also affect CVDs risk and operate via pathways other than the

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lipid-regulating pathway. This conclusive thought is arrived at a study which measured the
Intima media thickness (IMT) of common carotid arteries ultra sonographically and fiber intake
by dietary recall. The study concluded that lowered risk was associated with improved
endothelial function. [31]. The spectrum of health benefits that comes with the consumption of
oat and oat products does not limited to the presence of β- glucans, but also due to the presence
of poly phenolics in the prevention of CVDs, especially with atherosclerosis.
Oat- Avenanthramides (Avn)
Avenanthramides (Avn) are the unique group of low-molecular weight soluble phenolic
compounds found exclusively in oats. Avenanthramides 2c, 2p, and 2f were the most dominant
forms found in the oats. These phytochemicals have a range of biological activities, including
antiatherosclerotic, anti-inflammatory, and antioxidant effects /anti scavenging properties and are
concentrated in the outer layers of oat kernel. Avenanthramide-2c (Avn-c) one of three major
avenanthramides in oats, comprises about one-third of the total avenanthramide concentration in
oat grain, and this avenanthramide has the highest antioxidant activity in vitro. Bioavailability of
avenanthramides has been demonstrated in hamsters and recently in humans.[32, 33, 34,35] The
proliferation of vascular smooth muscle cells (SMC) and impaired nitric oxide (NO) production
are the key patho physiological processes in the initiation and development of atherosclerosis of
arterial walls. Oxidation of LDL-C is a major risk for occurrence of atherosclerosis. Avn-c, one
of the major avenanthramides inhibits the serum induced proliferation of vascular smooth muscle
cells (SMC) and interacts synergistically with vitamin C to protect LDL during oxidation. [19,
20, 36.]
As most phenolics are located in the bran layer of grains, oats, which are normally consumed as
whole-grain cereal, can be a significant dietary source of these compounds [34] clearly
suggesting preferring oats in its natural form for dietary inclusion. Taken together, these data
strongly support the potential health benefits of oat consumption in the prevention of CVDs
beyond the benefits from their soluble fiber content but also through the oat Avns.

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Oats and Diabetes:
Of the world population between the ages of 20 and 79 years, an estimated 285 million people, or
6.6%, have diabetes.[37] World Health Organization (WHO) estimates that between 2000 and
2030, the world population will increase by 37% and the number of people with diabetes will
increase by 114%.[4, 10, 38].The prevalence of type II diabetes is reaching epidemic
proportions, perhaps more alarming, it is estimated that more than 57 million American adults
have pre diabetes, defined by impaired glucose tolerance (IGT) or impaired fasting glucose
(IFG), which places them at substantially in an increased risk for developing diabetes now or in
the near future giving a great need for dietary intervention.[39, 40] A strikingly conservative
estimate in Asia shows that India and China will remain the two countries with the highest
numbers of people with diabetes by 2030.[4,10.] Additionally, among the top ten countries, four
more are in Asian continent—Indonesia, Pakistan, Bangladesh, and the Philippines, justifying
Asia as the major site of a rapidly emerging diabetes epidemic in the world.[10] Type II diabetes,
once virtually unrecognized in adolescence, now emerged as a major health concern and this is
entirely attributable to the child obesity epidemic, of particular concern, a prediabetic state,
seems to be highly prevalent among severely obese children irrespective of ethnic background
worldwide. The increased emergence of type II diabetes in children represents an ominous
development of multisystemic health disorders. [41, 42, 43] Additionally, people with diabetes
are at a significantly higher risk of many forms of cancer and CVDs. [21,44] Finally, the
economic burden due to diabetes at personal, societal, and national levels is huge as type II
diabetes and its associated complications pose major health concern care burden worldwide and
present many challenges to patients and health-care system.[4, 10, 38]
Diabetes is typically divided into 2 major subtypes, as type I and type II. Type II Diabetes is the
most common form (almost 95%) and obviated through complex interaction of genetic, dietary
and lifestyle factors. Diabetes often results in complications such as macro vascular e.g. heart
disease, stroke, limb amputation and micro vascular e.g. kidney failure, blindness. [45] Glucose
intolerance, impaired glucose tolerance and insulin resistance are associated with obesity and
may be preliminary steps in the progression to type II diabetes, and improved glycemic control

10
by diet is the essential element for optimal management and to lessen the above mentioned long
term complications. [46, 47, 48]
Diabetes educators build on the evidence that type II diabetes can be prevented or delayed by
body weight reduction, increased physical activity and/or by the use of selected medications
among the population those with pre diabetes, the improvement of lipid profile or blood glucose
control is a major challenge, as type II diabetes is a major cardiovascular factor. Worldwide
clinical trials and population studies are evident of effective lifestyle interventions to prevent or
delay the development of type II diabetes, among which dietary intervention is the key approach.
Dietary intervention principally aims at low glycemic index foods and low fat/ high fiber diet
and to accomplish this, plant based diets would be the preferred choice as they are nutrient dense
and calorically dilute whilst providing the larger amounts of dietary fibers and therefore blood
glucose levels and improvement of lipid profile of diabetic and pre-diabetic individuals can be
moderated by using dietary fiber rich food such as Oats. [9, 10, 39, 40, 46, 49]
Cereals and cereal products, particularly from whole grains such as wheat, rice and oats, are the
most important source of dietary fiber in the Western diet; Dietary recommendations of health
organizations suggest consumption of three servings a day of whole grain foods; however,
Americans generally fall below this standard. In addition they provide protein, essential fatty
acids and may have unique and beneficial combinations of many micronutrients, antioxidants,
and phytochemicals. The key content, oat soluble fiber -β-Glucan, a non starch polysaccharide
composed of β-(1→4)–linked glucose units separated every 2–3 units by β -(1→3)–linked
glucose is a boon in diabetes control owing to the potentiality of glycemic control and lipid
profile modification. [50, 51, 52]
Prevention of type II diabetes by dietary intervention typically aims at improved glucose
metabolism such as control of postprandial dietary peak of glucose, delaying or preventing the
progression of impaired glucose tolerance to insulin resistance, control of obesity and following
are the research highlights which provide the insights of dietary inclusion of oats and the
benefitting mechanisms by which above mentioned prime concerns are addressed in combating
the diabetes.

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It is urged that consumption of wholegrain rather refined grains substantially improves glucose
tolerance and reduce insulin resistance recorded in a large cohort of 75 521 women aged 38 to
63years in a ten year follow-up study,[50] similar evidence was obtained large cohort of 2286
men and 2030 women aged 40–69 years in a ten year follow-up study[53] and also in a large
cohort of 42898 men in a twelve year follow-up study.[54] Three of these large cohort studies
had concluded that higher intake of whole-grain foods was associated with lower risk of type II
diabetes; whereas higher intake of refined grain was related to increased risk and the inverse
association was independent of known risk factors. The mechanisms attributed by which grains
may improve glucose metabolism and delay or prevent the progression of impaired glucose
tolerance to insulin resistance are related with the physical properties such as particle size,
amount and type of fiber, presence of various individual antioxidants, and phytochemicals, as
well as interactions among them. Whole grains are generally digested and absorbed slowly
because of their physical form and high content of viscous fiber; compared with whole-grain
products, refined grains more than double the glycemic and insulinemic responses and unable to
maintain the glucose homeostasis. In addition magnesium which is found in the whole grains that
can act as calcium antagonist and can promote insulin sensitivity. In the milling process, the
outer bran layer of whole grains is removed and the original physical form is disrupted to make
the remaining starchy endosperm more easily digestible and this typically signifies the
importance of dietary inclusion of whole grains rather the refined.[47, 48, 50,54, 55,]
Peripheral arterial disease (PAD) is a major cause of morbidity, might arise out of complication
of type II diabetes and severe disease can lead to limb amputation, for a possible prevention
increasing amounts cereal fiber in the diet is suggested, as an inverse association between cereal
fiber intake and PAD risk was revealed. This is possibly through food sources of cereal fiber also
contains magnesium and chromium which are associated with improved insulin sensitivity. [56]
Higher the recommendation for the fiber than the American Diabetes Association-ADA
suggested is proven in a clinical study that incorporated a diet containing moderate amounts of
fiber (total, 24 g; 8 g of soluble fiber and 16 g of insoluble fiber), as recommended by the ADA
and a high fiber diet (total, 50 g; 25 g of soluble fiber and 25 g of insoluble fiber) containing
unfortified foods and concluded that high intake of dietary fiber, particularly of the soluble type,
improves glycemic control, decreases hyperinsulinemia, and lowers plasma lipid concentrations

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in patients with type II diabetes. Therefore, dietary guidelines for patients with diabetes should
emphasize an overall increase in dietary fiber through the consumption of unfortified foods such
as whole oats.[57]
Concerning glucose metabolism, the beneficial metabolic effects of oat β-glucan are closely
linked to the β-glucan-induced increased viscosity of the meal bolus, which delays and/or
reduces carbohydrates absorption.[49] .Clinical studies with isolates of oat β-glucan have
demonstrated that the glycemic response is regulated not by the dose of the polysaccharide but
by its molecular weight and concentration in solution (extractability); this is because the
glycemic response is controlled, in relation to the luminal viscosity of the fiber in the gut.
Therefore, increase in intestinal viscosity due to high molecular weight β-glucan is important for
achieving the positive effect of β-glucan on the peak blood glucose. [29, 30, 58] which sheds a
clear thought on the need for understanding the processing technologies that are keen to develop
modern day fiber supplements.
Viscous fibers, including β-glucan in oat bran and its amount can favorably enhance postprandial
sensations of satiety as well as decrease feelings of hunger thereby moderating both postprandial
carbohydrate and lipid metabolism. This is possibly attributed through the increased nutrient-
stimulated postprandial secretion of the anorexigenic hormones and greater suppression of the
orexigenic hormone and also by delaying the gastric emptying rate and intestinal transit time to
increase greater satiety and delay the return of hunger through viscosity of oat β- glucan.[59,60]
Dietary fiber (DF) and resistant starch (RS) from carbohydrates are fermented in the colon by the
bacterial flora releases short chain fatty acids, (SCFA mainly acetic, propionic, and butyric acids)
and gases (e.g. hydrogen) which typically happens after oats ingestion mainly helps in both
reduction of LDL cholesterol and the glycemic response which shall be attributed through the
formation of butyric acid and also at the small intestine by increased level of bile acid excretion
and at large intestine increased level of bile acid concentration.[61]
Any dietary inclusion however possessing the health benefits that shall agreeably palatable for it
to deliver the desired benefits, in that fitting oat bran which is high in insoluble fiber and the
soluble fiber β-glucan has been tested by several studies had concluded long-term acceptance of
oat bran concentrate products was good and use of oat bran concentrate bread/bread products as

13
a dietary staple was feasible,[62,63] however, an increased level of β- glucan in the oat extract
did produce some abdominal discomfort and increased flatulence were noted.[64]
Health benefits of Oats on Celiac disease:
Celiac disease (CD) is a permanent intolerance to specific storage proteins in wheat (gliadin),
barley (hordein) and rye (secalin), which are collectively called ‘gluten’. Ingestion of gluten
causes damage to the small intestinal mucosa by an autoimmune mechanism in genetically
susceptible individuals and its prevalence is 1% in populations of Caucasoid descent. [65,66] In
the United States, National Institute of Health (NIH) estimates more than 2 million people
actually suffer from the disease, which would correspond to 1 in 133 people.[66,67].Coeliac
disease can occur at any age, may peak at 50’s and females are more commonly affected than
males.[68] Affected individuals with celiac disease have genetic markers on chromosome 6p21,
called class II human leukocyte antigen (HLA), specifically HLA-DQ2 and HLA-DQ8. [69]
This gluten sensitive enteropathy (GSE) is clinically characterized by malabsorption and causing
a typical histological lesion in the small intestine. The prototypical signs are oral ulcers, weight
loss, diarrhea, fatigue, and abdominal bloating. Other signs such as iron deficiency anemia, folate
deficiency, and osteopenic bone disease. As sequelae malignancy such as small intestinal
lymphoma may occur. This disease is closely related to dermatitis herpetiformis. [68] The
disease is caused by an inappropriate immune response triggered by dietary gluten proteins and
the response is controlled by CD4+ T cells. These T cells are specific for proline- and glutamine-
rich gluten peptides. T cells may react with tissue transglutaminase (the principal component of
the endomysium auto antigen), and set in motion a series of inflammatory events that result in
the characteristic coeliac mucosal lesion. Histological identification such as finding villous
atrophy of duodenal biopsy and serological evidence of antibodies to endomysium and gliadin
are the definitive clinical diagnostic protocols. [68, 69, 70, 71]. Medical nutrition therapy
(MNT) is the only accepted treatment for celiac disease (CD) and strict adherence of gluten- free
(GF) diet (GFD) for life is the preferred and only available “drug of choice”.[65, 68, 69,70,72,
73]

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Non-gluten containing cereals would be a valuable contribution to the gluten-free human diet.
Among the cereals wheat, rye, and barley are harmful to persons with celiac. In contrast, the
prolamins of corn (zein) and rice (orzenin) are considered harmless. In the past, oats were
considered to be toxic to individuals with celiac disease and were not allowed in a gluten-free
diet. However several studies were undertaken to test the oat prolamin, ave-nin, as a safe diet
inclusion for coeliac patients[70, 72, 73, 74, 75]. In a study involved with ten adult coeliac
disease patients as each patient consumed 50 g of oats (as porridge) daily for 12 weeks, evidence
of immunological stimulation such as serology and biopsy are considered as markers of disease
activation. Such evidence includes lymphocyte infiltration of the surface epithelium and the
production of antibodies to endomysium and gliadin, where as in patients those who had gluten
micro challenge relapsed with signs, clearly suggesting oats cereal is neither toxic nor
immunogenic in coeliac disease. Seven of the patients have continued to take the same quantity
of oats for more than 12 months without adverse effect. [70]. Results from one study indicated
that oats does not induce cellular or humoral immunological responses within 12 months in
adults with CD and continued for a period of five years and the reason for non reactivity possibly
due to the absence of certain amino acid sequences found in wheat gliadin, but not in oat avenin,
and concluded even long term use of moderate amounts of oats included in a gluten free diet in
adult patients with CD is safe. Additionally commented if allowed, most patients with CD
preferred some oats in their diet.[76] By evidence oats appear to be safe for use by most
individuals with celiac disease, but their inclusion in a gluten-free diet is limited by potential
contamination with gluten during milling and processing, as commercial lots of oat flakes and
flour frequently are contaminated with gluten grains, [69, 73, 77] and the contamination levels
of gluten varied between 1.5 ppm and 400 ppm from a single bag and the source was suspected
as barley not wheat.[72,75] The oats that are pure and uncontaminated with other gluten-
containing grains is safe and a quantity for adults, up to 70 g and for children up to 25 g per day
are tolerable.[17, 65] A subset of patient population had gastrointestinal (GI) discomfort as an
exaggerated sensitivity to oats, but not related to CD. However patients with coeliac disease
wishing to consume a diet containing oats should therefore receive regular follow-up, including
small bowel biopsy, and this caution strongly aimed at the potential risk of malignancy and the
risk may even be increased in patients who consume small amounts of gluten (and by extension

15
moderate amounts of oats if contaminated with other gluten grains). [72, 74, 75, 78] To produce
pure, uncontaminated oats, the manufacturer must have a dedicated system, including fields,
harvesting, production, storage, transportation, manufacturing equipment and a production plant.
[17,65] It is essential that people with celiac disease must read all food labels to ensure the
gluten-free status of a food item. This process has become easier since the enactment of the Food
Allergen Labeling and Consumer Protection Act of 2004 in the United States requires that all
food products manufactured after January 1, 2006, be clearly labeled to indicate the presence of
any of the top eight food allergens such one as Wheat but the same does exclude the cereal
barley and rye. Likewise in Canada, the pure oats or the products that are made from these oats
must have passed a Canadian Food Inspection Agency (CFIA) field inspection both visual and
chemical. In Europe, EC-Regulation 41/2009 came into force on the content and labeling of
foods for individuals with CD as oat products containing less than 20 ppm gluten are now
allowed to be sold as gluten-free since January 2009. Nevertheless an additional knowledge of
hidden sources of gluten/prolamins that may be found in the ingredients of many processed foods
in the form of additives, stabilizers, thickeners, flavorings, extracts, emulsifiers, hydrolyzed
textured vegetable proteins, and certain ground spices is needed. This constitutes the most
compelling reason to advocate strict adherence to the diet and possibly need for guidance from
skilled dietician on a regular basis. [65, 66, 79] Despite the arising doubts about inclusion of oats
in the diet of patients of CD, oats add variety, taste, satiety, dietary fiber, and other essential
nutrients to the diets and may help alleviate the relative monotony of strict gluten free diet and
may improve the quality of life.[68,69]
Conclusion:
With strong totality of science, dietary inclusion oats can elicit diversified health benefits
through the favorable physiological responses that keep the check points in prevention of NCDs.
It is highly suggestive with the present knowledge oat nutritional research, that consumption of
oats and oat-based products should be encouraged as part of an overall lifestyle medicine
approach for the prevention of CVDs and diabetes.[21]

16
As mentioned earlier in the chapter, that prevention of NCDs is the prime agenda for every
national and international health authorities and the real challenges are vested in formulating the
prevention strategies. It is urged that, health advocacy groups work closely with national health
authorities to promote the consumption of natural food products and they need to emphasize
diets with increased fibre such as oats as part of a healthy lifestyle. Additionally to promote such
higher consumption they should be able to propagate and publish traditional recipes with slight
modifications [80] i.e. Developing newer oat recipes with (regional and national) traditional diet
choices as an attempt against fast food eating habits.
The major practical translation of nutrition research to public health consists of identifying the
foods that can potentially influence health and defining optimal dietary recommendations aimed
to prevent disease and to promote optimal health.[81] Equating this to oats, that it is been
identified with the bioactive nutrients such as β-glucans and Avns that can potentially influence
the health and optimal dietary recommendations of three grams of soluble fiber advocated in
FDA’s approval of the health claim association between consumption of oats and reduced risk of
CVDs.
However, what lies in the future is the role of biomedical agriculture is to identify the cultivars of
any food crops with an added advantage of providing increased health benefits.[1] In a similar
fitting for oats, such future oat cultivars can possess the increased amounts of bio active
components-(β-glucans and Avns) that can exponentially influence the risk factors associated
with NCDs, whilst retaining the same quantities of oat consumption/dietary inclusion.
Even though the large body of research evidence that is available to elucidate that dietary
inclusion of oats can greatly benefit in combating type II diabetes worldwide, nutritional research
on oats in Asia is limited.
Understandably interventions that work in some societies may not work in others, because social,
economic, and cultural forces influence diet and exercise [39] likewise, both population based
studies and clinical trials involving oats or its bio active components are urgently called for in
Asian population as NCDs are epidemically emerging in this population.

17
To debate, the present era research knowledge clearly suggest the variations in terms of
expression and predisposing factors for NCDs among Asian population, especially the diabetes
associated risk factors such as metabolic syndrome and insulin resistance and occurrence of
higher rates of cerebrovascular disease (stroke) instead of coronary heart disease [5, 10, 43] with
that of rest of the world. Such studies of future will be able to coordinate cross-cultural/ethnic
involvement and will be extremely useful in defining gene-environment interactions.
It is been hypothesized that the emerging morbidity and mortality due to CVDs is that the world
population has been experiencing during recent decade is due in part to the higher frequency of
deleterious alleles that predispose certain ethnic groups sensitive to the influence of
environmental CVD risk factors [81] Therefore, elucidating such ethnic-specific genetic markers
will be a great stride for efficacious prevention of NCDs in countries undergoing Westernization
of lifestyles, specifically to Asian countries needless to say about the weight of the issue, as half
of the world’s population lives in Asia.
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