ArticlePDF Available

Consumption of Pure Oats by Individuals with Celiac Disease: A Position Statement by the Canadian Celiac Association

Authors:
  • Canadian Celiac Association

Abstract

The treatment of celiac disease is a strict adherence to a gluten-free diet for life. In the past, oats were considered to be toxic to individuals with celiac disease and were not allowed in a gluten-free diet. However, recent evidence suggests that oats that are pure and uncontaminated with other gluten-containing grains, if taken in limited quantities, are safe for most individuals with celiac disease. For adults, up to 70 g (1/2 to 3/4 cup) of oats per day and for children, up to 25 g (1/4 cup) per day are safe to consume. These oats and oat products must fulfill the standards for a gluten-free diet set by the Canadian Food Inspection Agency and Health Canada. The Canadian Celiac Association, in consultation with Health Canada, Agriculture & Agri-Food Canada and the Canadian Food Inspection Agency, has established requirements for growing, processing, and purity testing and labelling of pure oats. These strategies have led to the production of pure, uncontaminated oats for the first time in Canada. Oats and oat products that are safe for consumption by individuals with celiac disease and dermatitis herpetiformis are now commercially available in Canada.
Can J Gastroenterol Vol 21 No 10 October 2007 649
Consumption of pure oats by individuals with celiac
disease: A position statement by the Canadian Celiac
Association
Mohsin Rashid FRCPC1,2, Decker Butzner FRCPC1,3, Vernon Burrows PhD1,4, Marion Zarkadas MSc1,
Shelley Case BSc1,5, Mavis Molloy BSc1,6, Ralph Warren FRCPC1,7, Olga Pulido MD8, Connie Switzer FRCPC1,9
1Professional Advisory Board, Canadian Celiac Association; 2Division of Gastroenterology and Nutrition, Department of Pediatrics, Dalhousie
University, Halifax, Nova Scotia; 3Division of Gastroenterology, Department of Pediatrics, University of Calgary, Calgary, Alberta;
4Department of Agriculture and Agri-Food, Ottawa, Ontario; 5Consulting Dietitian, Regina, Saskatchewan; 6Kelowna General Hospital,
Kelowna, British Columbia; 7Division of Gastroenterology, Department of Medicine, St Michael’s Hospital, University of Toronto, Toronto;
8Bureau of Chemical Safety, Food Directorate, Health Products and Food Branch, Health Canada, Ottawa, Ontario; 9Division of
Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta
Correspondence: Dr Mohsin Rashid, Division of Gastroenterology, Department of Pediatrics, Dalhousie University, IWK Health Centre,
5850 University Avenue, Halifax, Nova Scotia B3K 6R8. Telephone 902-470-8746, fax 902-470-7249,
e-mail mohsin.rashid@iwk.nshealth.ca
Received for publication December 11, 2006. Accepted January 18, 2007
M Rashid, D Butzner, V Burrows, et al. Consumption of pure
oats by individuals with celiac disease: A position statement by
the Canadian Celiac Association. Can J Gastroenterol
2007;21(10):649-651.
The treatment of celiac disease is a strict adherence to a gluten-free
diet for life. In the past, oats were considered to be toxic to individu-
als with celiac disease and were not allowed in a gluten-free diet.
However, recent evidence suggests that oats that are pure and uncon-
taminated with other gluten-containing grains, if taken in limited
quantities, are safe for most individuals with celiac disease. For adults,
up to 70 g (1/2 to 3/4 cup) of oats per day and for children, up to 25 g
(1/4 cup) per day are safe to consume. These oats and oat products
must fulfill the standards for a gluten-free diet set by the Canadian
Food Inspection Agency and Health Canada. The Canadian Celiac
Association, in consultation with Health Canada, Agriculture &
Agri-Food Canada and the Canadian Food Inspection Agency, has
established requirements for growing, processing, and purity testing
and labelling of pure oats. These strategies have led to the production
of pure, uncontaminated oats for the first time in Canada. Oats and
oat products that are safe for consumption by individuals with celiac
disease and dermatitis herpetiformis are now commercially available
in Canada.
Key Words: Celiac disease; Gluten-free diet; Oats; Position
statement
La consommation d’avoine pure par des
personnes atteintes de la maladie cœliaque :
Un document de principes de l’Association
canadienne de la maladie cœliaque
Le traitement de la maladie cœliaque consiste à respecter rigoureusement
un régime sans gluten pendant toute la vie. Par le passé, l’avoine était
considérée comme toxique pour les personnes atteintes de la maladie
cœliaque et n’était pas autorisée dans un régime sans gluten. Cependant,
d’après des données récentes, l’avoine pure non contaminée par d’autres
céréales contenant du gluten, consommée en petite quantité, est sécuri-
taire pour la plupart des personnes atteintes de la maladie cœliaque. Chez
les adultes, il est sécuritaire de consommer jusqu’à 70 g (1/2 à 3/4 de tasse)
d’avoine par jour, tandis que chez les enfants, cette quantité peut attein-
dre 25 g (1/4 de tasse) par jour. L’avoine et les produits de l’avoine doivent
respecter les normes d’un régime sans gluten établies par l’Agence cana-
dienne d’inspection des aliments et Santé Canada. L’Association canadi-
enne de la maladie cœliaque, en consultation avec Santé Canada, le
ministère de l’Agriculture et de l’Agroalimentaire du Canada et l’Agence
canadienne d’inspection des aliments, a établi des exigences pour cultiv-
er, traiter et étiqueter l’avoine pure ainsi que pour en évaluer la pureté.
Pour la première fois au Canada, ces stratégies ont permis la production
d’avoine pure et non contaminée. L’avoine et les produits de l’avoine qui
peuvent être consommés en toute sécurité par les personnes atteintes de
la maladie cœliaque et la dermatite herpétiforme sont désormais en vente
au Canada.
Celiac disease (gluten-sensitive enteropathy) is a perma-
nent intolerance to specific storage proteins in wheat
(gliadin), barley (hordein) and rye (secalin), which are collec-
tively called ‘gluten’ (1). Ingestion of gluten causes damage to
the small intestinal mucosa by an autoimmune mechanism in
genetically susceptible individuals. This can lead to a variety of
symptoms and nutritional deficiencies. The treatment of celiac
disease is a strict, life-long adherence to a gluten-free diet.
Ensuring that the foods and beverages are free of gluten
remains a challenge for patients on such a diet. In a recent sur-
vey of a large number of Canadian individuals with celiac dis-
ease, 85% of respondents reported difficulty in finding gluten-free
foods, especially gluten-free foods of good quality (2,3).
Oats are a good source of vitamins and minerals, and con-
tain approximately twice the protein content of rice. The
starch in oats (composed of amylose and amylopectin) is easily
digested. Oat oil (6% to 8% by weight) is largely polyunsatu-
rated. Oats are rich in soluble dietary fibre, which may help
reduce low-density lipoprotein cholesterol in hypercholes-
terolemic individuals. Oat groats also contain unique antioxi-
dants (avenanthramides). The bran in oats can have a
beneficial laxation effect. In the past, oats (avenin) were
believed to be toxic to individuals with celiac disease and were
not allowed in the gluten-free diet. However, recent evidence
has shown that oats are safe for consumption by most individ-
uals with celiac disease. Availability of oats will not only
REVIEW
©2007 Pulsus Group Inc. All rights reserved
10089_Rashid.qxd 28/09/2007 3:17 PM Page 649
improve the nutritional value of a gluten-free diet but will also
increase palatability, expand food choices and may improve
the quality of life for those with celiac disease (4,5).
Commercially available oats in North America are variably
contaminated with gluten-containing grains (6,7). Contamination
can occur on the farm, during the growing cycle or during stor-
age, cleaning, transportation or processing (8). There was a
need to develop strategies that would provide oats that are
pure and uncontaminated, making them safe for consumption
by individuals with celiac disease and dermatitis herpetiformis.
The Professional Advisory Board of the Canadian Celiac
Association, in collaboration with Health Canada, reviewed
the literature on the safety of oats in celiac disease (9-27) and
developed the following position statement on oats (28):
“The safety of oats in individuals with celiac disease
has been extensively investigated. Clinical evidence
confirms that consumption of pure, uncontaminated
oats is safe in the amount of 50 to 70 grams per day (1/2-
3/4 cup dry rolled oats) by adults and 20 to 25 grams per
day (1/4 cup dry rolled oats) by children with celiac dis-
ease. Studies looking at the consumption of oats over
five years have confirmed their safety. However, the
studies looking at safety of oats in celiac disease have
involved a small number of subjects, the oats used were
pure, free of gluten contamination and the amount
allowed per day was also limited.
In Canada, pure and uncontaminated* oats are now
being produced. Individuals with celiac disease who
wish to add oats or oat products to their diet must ensure
that the oats they are eating are free from gluten con-
tamination.
A small number of individuals with celiac disease
may not tolerate even pure, uncontaminated oats. To
ensure that persons with celiac disease are not intolerant
to pure and uncontaminated oats, proper clinical follow
up with the physician is advised when introducing oats
to a gluten-free diet.
The Canadian Celiac Association will continue to
monitor the scientific developments in the area of oats
in celiac disease and will keep its members updated.
*These oats will meet or exceed the purity standards of
Foundation #1 as defined by the Canada Seeds Act” (29).
The following guidelines are recommended when starting
oats in the diet of a patient with celiac disease:
1. The patient’s celiac disease should be well controlled on
a gluten-free diet and the patient should have no
gastrointestinal complaints.
2. It is recommended that adults receive no more than
50 g to 70 g (1/2 to 3/4 cup) of dry rolled oats daily and
children receive no more than 20 g to 25 g (1/4 cup) of
pure, uncontaminated oats daily.
3. The fibre content of an oat-containing diet is often
higher than the typical gluten-free diet. When adding
oats to the diet, individuals may experience a change in
stool pattern or mild gastrointestinal symptoms,
including abdominal bloating and flatulence. These
symptoms should resolve within a few days.
4. There are case reports of individuals with celiac disease
relapsing with the consumption of pure
uncontaminated oats. Patients should be warned of this
possibility. They should discontinue the oats and
contact their physician if symptoms persist.
5. The physician or a dietitian should review the diet to
ensure that the patient is not consuming foods that
contain gluten.
6. Screening with an immunoglobulin A-tissue
transglutaminase or immunoglubulin A-endomysial
antibody may not identify the rare patient who reacts to
oats. These tests are not sufficiently sensitive for detecting
‘mild’ dietary indiscretions, especially over a short period
of challenge; ie, less than 100 mg to 1000 mg of gluten
per day. A positive endomysial antibody or tissue
transglutaminase will help confirm oats sensitivity but a
negative one will not exclude oats sensitivity.
7. It is worthwhile to rechallenge patients if they wish to
try oats again. Development of symptoms at the time of
the second challenge would strongly suggest intolerance
to oats. Extensive patient research suggests intolerance
to oats occurs but is rare. The mechanism for this is
unknown.
In consultation with Health Canada, Agriculture & Agri-
Food Canada and the Canadian Food Inspection Agency
(CFIA), requirements for growing, processing, and purity test-
ing and labelling have been established. The Canadian Celiac
Association has adopted the grade of Foundation #1 (grown by
Select Seed Growers) as the standard for seed to be used for
patients with celiac disease, because this grade only permits
0 to 1 wheat, barley, rye or triticale seed/kg of oat groats
(approximately 30,000 to 40,000 oat groats/kg) to be present.
The actual number of groats/kg depends on the kernel weight
of the seeds, which is a reflection of both genetic and environ-
mental factors. Pedigreed Foundation seed is a very good meas-
ure of oat purity because CFIA inspectors carefully examine
thousands of plants in the field (large sample size) and official
seed testing laboratories monitor the purity of the harvested
grain before deciding if it meets Foundation #1 classification.
Seeds produced in this dedicated system can be delivered to a
dedicated Hazard Analysis Critical Control Points certified oat
processing facility and made into product. The rolled oats or
the oat flour made into products from these oats are then eval-
uated for gluten content using an R5-ELISA test (30,31). This
test will detect gluten contamination with as little as 3 ppm.
One wheat seed per kilogram of oats will contribute approxi-
mately 1 ppm to 2 ppm of gluten/kg in a thoroughly mixed
(essential) oat flour. This degree of contamination will not be
detected even with the R5-ELISA test and is well below the
20 ppm maximum allowed in gluten-free foods by the CFIA
and Health Canada.
To produce pure, uncontaminated oats, the manufacturer
must have a dedicated system, including fields, harvesting, pro-
duction, storage, transportation, manufacturing equipment and
a production plant. Growers and processors able to meet these
requirements were contacted. The CFIA and Health Canada
were consulted to establish their support and labelling require-
ments. The oat food manufacturers will ensure that the pure
oats they use and sell are grown and processed in the prescribed
dedicated manner and the oats and products pass ‘track and
trace procedures’. The pure oats that are sold as rolled oats, oat
groats or whole oat flour, or the products that are made from
these oats must have passed a CFIA field inspection (visual and
Rashid et al
Can J Gastroenterol Vol 21 No 10 October 2007650
10089_Rashid.qxd 28/09/2007 3:17 PM Page 650
chemical), a registered seed analysis to qualify for the
Foundation #1 rating and an R5-ELISA test in a Hazard
Analysis Critical Control Points certified food processing facil-
ity. The Canadian Celiac Association is working on the
development of a special trademark that would identify these
pure and uncontaminated oats, thereby making it easier for
the consumer to identify products that meet the strict guide-
lines.
In Canada, pure and uncontaminated oats are now com-
mercially available. Since 2005, one company, based in the
province of Quebec, has produced and marketed oats that
meet the required purity standards. These oats are now avail-
able to consumers as rolled oats, oat flour and whole oat ker-
nels (groats). It is expected that other Canadian companies
will also start producing pure oats in the coming year.
In conclusion, oats that are pure and uncontaminated by
gluten-containing grains are safe for consumption by most
individuals with celiac disease, when taken in limited quanti-
ties. The availability of oats would improve food choices for
those on a gluten-free diet.
Safety of oats in celiac disease
Can J Gastroenterol Vol 21 No 10 October 2007 651
REFERENCES
1. Shan L, Molberg Ø, Parrot I, et al. Structural basis for gluten
intolerance in celiac sprue. Science 2002;297:2275-9.
2. Zarkadas M, Cranney A, Case S, et al. The impact of a gluten-free
diet on adults with coeliac disease: Results of a national survey.
J Hum Nutr Diet 2006;19:41-9.
3. Rashid M, Cranney A, Zarkadas M, et al. Celiac disease: Evaluation
of the diagnosis and dietary compliance in Canadian children.
Pediatrics 2005;116:e754-9.
4. Thompson T. Do oats belong in a gluten-free diet? J Am Diet Assoc
1997;97:1413-6.
5. Thompson T. Oats and the gluten-free diet. J Am Diet Assoc
2003;103:376-9.
6. Thompson T. Gluten contamination of commercial oat products in
the United States. N Engl J Med 2004;351:2021-2.
7. Thompson T. Contaminated oats and other gluten-free foods in the
United States. J Am Diet Assoc 2005;105:348.
8. Størsrud S, Malmheden Yman I, Lenner RA. Gluten
contamination in oat products and products naturally free from
gluten. Eur Food Res Technol 2003;217:481-5.
9. Arentz-Hansen H, Fleckenstein B, Molberg Ø, et al. The Molecular
basis for oat intolerance in patients with celiac disease. PLoS Med
2004;1:e1.
10. Hardman C, Fry L, Tatham A, Thomas HJ. Absence of toxicity of
avenin in patients with dermatitis herpetiformis. N Engl J Med
1999;340:321.
11. Högberg L, Laurin P, Fälth-Magnusson K, et al. Oats to children
with newly diagnosed coeliac disease: A randomised double blind
study. Gut 2004;53:649-54.
12. Hoffenberg EJ, Haas J, Drescher A, et al. A trial of oats in children
with newly diagnosed celiac disease. J Pediatr
2000;137:361-6.
13. Hollén E, Högberg L, Stenhammar L, Fälth-Magnusson K,
Magnusson KE. Antibodies to oat prolamines (avenins) in children
with coeliac disease. Scand J Gastroenterol 2003;38:742-6.
14. Hollén E, Holmgren Peterson K, Sundqvist T, et al. Coeliac
children on a gluten-free diet with or without oats display equal
anti-avenin antibody titres. Scand J Gastroenterol
2006;41:42-7.
15. Janatuinen EK, Kemppainen TA, Julkunen RJ, et al. No harm from
five year ingestion of oats in coeliac disease. Gut
2002;50:332-5.
16. Janatuinen EK, Kemppainen TA, Pikkarainen PH, et al. Lack of
cellular and humoral immunological responses to oats in adults
with coeliac disease. Gut 2000;46:327-31.
17. Janatuinen EK, Pikkarainen PH, Kemppainen TA, et al.
A comparison of diets with and without oats in adults with celiac
disease. N Engl J Med 1995;333:1033-7.
18. 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;52:47-52.
19. Peräaho M, Collin P, Kaukinen K, Kekkonen L, Miettinen S,
Maki M. Oats can diversify a gluten-free diet in celiac disease and
dermatitis herpetiformis. J Am Diet Assoc 2004;104:1148-50.
20. Peräaho M, Kaukinen K, Mustalahti K, et al. Effect of an oats-
containing gluten-free diet on symptoms and quality of life in
coeliac disease. A randomized study. Scand J Gastroenterol
2004;39:27-31.
21. Picarelli A, Di Tola M, Sabbatella L, et al. Immunologic evidence
of no harmful effect of oats in celiac disease. Am J Clin Nutr
2001;74:137-40.
22. Reunala T, Collin P, Holm K, et al. Tolerance to oats in dermatitis
herpetiformis. Gut 1998;43:490-3.
23. Schmitz J. Lack of oats toxicity in coeliac disease. BMJ 1997;314:159-60.
24. Srinivasan U, Leonard N, Jones E, et al. Absence of oats toxicity in
adult coeliac disease. BMJ 1996;313:1300-1.
25. Størsrud S, Hulthén LR, Lenner RA. Beneficial effects of oats in
the gluten-free diet of adults with special reference to nutrient
status, symptoms and subjective experiences. Br J Nutr
2003;90:101-7.
26. 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;57:163-9.
27. Lundin KE, Nilsen EM, Scott HG, et al. Oats induced villous
atrophy in coeliac disease. Gut 2003;52:1649-52.
28. Professional Advisory Board of the Canadian Celiac Association:
Position statement on oats. <http://www.celiac.ca/Articles/
PABoats.html> Version current at July 11, 2007.
29. Department of Justice Canada: Seeds Act (RS, 1985, c S-8)
<http://laws.justice.gc.ca/en/S-8/text.html> Version current at
July 10, 2007.
30. Osman AA, Uhlig HH, Valdes I, Amin M, Méndez E, Mothes T.
A monoclonal antibody that recognizes a potential coeliac-toxic
repetitive pentapeptide epitope in gliadins. Eur J Gastroenterol
Hepatol 2001;13:1189-93.
31. Valdes I, Garcia E, Llorente M, Mendez E. Innovative approach to
low-level gluten determination in foods using a novel sandwich
enzyme-linked immunosorbent assay protocol. Eur J Gastroenterol
Hepatol 2003;15:465-74. (Erratum in 2003;15:839).
10089_Rashid.qxd 28/09/2007 3:17 PM Page 651
... The safety of oats in a GFD is still a matter of discussion. If pure, oats appear to be well tolerated in moderate amounts (20-25 g/day for children and 50-70 g/day for adults [65]) by most CD patients in remission, and harmful for less than 1%. In addition, oats are also a source of antioxidants, dietary fibre and unsaturated fatty acids, and that can make them a great ally in the GFD. ...
Article
Full-text available
A lifelong gluten-free diet (GFD) is the only treatment for celiac disease and other gluten-related disorders. Nevertheless, strict adherence to the GFD is often challenging due to concerns about social isolation, risk of gluten contaminations, high cost, poor quality and the taste of gluten-free products. Moreover, although the GFD is effective in achieving mucosal healing, it may lead to dietary imbalances due to nutrient deficiencies over a long period of time. To overcome these issues, several gluten-free wheat flours have been developed to create products that closely resemble their gluten-containing counterparts. Furthermore, given the critical importance of adhering to the GFD, it becomes essential to promote adherence and monitor possible voluntary or involuntary transgressions. Various methods, including clinical assessment, questionnaires, serology for celiac disease, duodenal biopsies and the detection of Gluten Immunogenic Peptides (GIPs) are employed for this purpose, but none are considered entirely satisfactory. Since adherence to the GFD poses challenges, alternative therapies should be implemented in the coming years to improve treatment efficacy and the quality of life of patients with celiac disease. The aim of this narrative review is to explore current knowledge of the GFD and investigate its future perspectives, focusing on technology advancements, follow-up strategies and insights into a rapidly changing future.
... It is an excellent source of dietary fiber β-glucan and are easily available food source that are incorporated into the diet. Several workers had reported that oat groats and oat bran can be used as an alternative food for persons suffering from celiac disease as it does not contain any gluten [6,16]. Oat has also been used in the preparation of different types of oat based products like oat flakes, pastes, bakery products, beverages etc. several breakfast cereals and bread products are also made from oat flour A Ad dv va an nc ce es s i in n B Bi io or re es se ea ar rc ch h ©2018 Society of Education, India and rolled oat products. ...
Article
In this study we have evaluated the preclinical observation of the Force Drop on the mature male albino rats. The Force Drop is the product of N. P. Dutt and Son, Kolkata, in this product have many herbal plants with their androgenic activity. Mainly we have compared this product with the activity of testosterone. We have used testosterone in this study as a standard drug or chemical. In this study we have grouped the all animals in 4 and each group has 6 animals, there are one untreated, treated with testosterone or standard group, another two groups are low dosed Force Drop treated group and last one is higher dosed Force Drop treated group. The study has shown that the animals of standard group increased the dry weight of androgen sensitivity tissues and overall body weight and the animals of treated groups or Force Drop Ptreated groups increased the dry weight of sensitivity tissues and overall body weight but lesser the testosterone treated group and more than untreated group. But the lower dosed Force Drop Ptreated group increased weight of androgen sensitivity tissues and body weight which are less than higher dosed Force Drop treated animal group and more than untreated group. And the higher dosed Force Drop treated animals group increased weight much more than the untreated group of animals and lower than standard group or testosterone treated group.
Chapter
Este livro tem por objetivo descrever os avanços ocorridos nas áreas de tecnologia de alimentos e de nutrição humana durante o século XX até os dias de hoje. Novos paradigmas e conceitos foram estabelecidos a partir da segunda metade do século passado, particularmente em nutrição humana, com descobertas nos alimentos de compostos bioativos, até então considerados “não nutrientes”. O primeiro capítulo é uma descrição histórica dos principais avanços ocorridos e da importância das descobertas no período supracitado. Nos capítulos seguintes, é descrito e conceituado o que se convencionou chamar de compostos bioativos e nutrição funcional. Os últimos capítulos tratam de inovações em pesquisas, nas quais os conceitos de dieta funcional, nutrigenômica e nutrição personalizada são introduzidos. Esses conceitos poderão conduzir o leitor à seguinte indagação: Dieta ideal é um desafio atingível ou uma utopia? Para os pesquisadores parece ser mais um desafio inatingível, por se tratar de alcançar uma fronteira que se move constantemente pela pressão evolutiva.
Article
Full-text available
Oat (Avena sativa) is well-known for its nutritional value and health-promoting properties. There are only a few oat-based value-added products on the market in Ethiopia, and this study attempted to develop a new product that is both nutritionally enhanced and sensory acceptable, therefore, the objective of this study was to optimize the nutritional and sensory properties of a beverage made from oat, lupine (Lupinus albus), stinging nettle (Urtica simensis), and premix. D-optimal mixture experimental design was used to generate 11 runs applying the following constraints: 60–70% toasted oat, 10–25% roasted and soaked de-bittered white lupine, 5–15% boiled stinging nettle leaves, and 10% premix (flour of toasted black cardamom (2.8%), malted wheat (2.8%), pumpkin (2.6%), spiced chili peppers (1.1%), and table salt (0.7%). Statistical model evaluation and optimization were carried out using Minitab 19 software. The nutritional composition of the product was assessed, and results show that increasing the proportion of oat flour in the blend resulted in a significant (p < 0.05) increase in fat, carbohydrate, gross energy, and mineral contents (Fe, Zn). An increase in lupine flour increased crude protein, crude fiber, gross energy, phytate, tannin, oxalate, and antinutrient to mineral molar ratios. In contrast increased in stinging nettle leaf powder increased the ash and beta-carotene contents. Sensory of 11 composite sample beverages and control (90% oat plus 10% premix) were also carried out by 50 untrained panelists. Consequently, eight responses were optimized: protein, fat, Fe, Zn, beta-carotene, taste, appearance, and overall acceptability. The optimal blending ratio obtained was 70% oats, 11.3% lupine, 8.7% stinging nettle flour, and 10.0% premix. The study's findings suggested that the optimal combination of these traditionally processed ingredients in a beverage can be considered a valuable food with the potential to improve diet quality.
Book
Full-text available
INSAC WORLD HEALTH SCIENCES
Article
Full-text available
The current trend is to allow coeliac disease (CD) patients to introduce oats to their gluten free diet. We sought further data from the clinical setting with regards to oats consumption by coeliac patients. Several oat products were tested for wheat contamination using a commercial enzyme linked immunoassay (ELISA) kit, and six samples were examined by an ELISA using a cocktail of monoclonal antibodies, mass spectrometry, and western blot analysis. Nineteen adult CD patients on a gluten free diet were challenged with 50 g of oats per day for 12 weeks. Serological testing and gastroduodenoscopy was performed before and after the challenge. Biopsies were scored histologically and levels of mRNA specific for interferon gamma were determined by reverse transcription-polymerase chain reaction analysis. Oats were well tolerated by most patients but several reported initial abdominal discomfort and bloating. One of the patients developed partial villous atrophy and a rash during the first oats challenge. She subsequently improved on an oats free diet but developed subtotal villous atrophy and dramatic dermatitis during a second challenge. Five of the patients showed positive levels of interferon gamma mRNA after challenge. Some concerns therefore remain with respect to the safety of oats for coeliacs.
Article
Full-text available
Coeliac disease is a gluten-sensitive disorder characterised by malabsorption and a typical histological lesion. Treatment with a strict gluten-free diet results in complete clinical and histological recovery. The conventional gluten-free diet used to treat coeliac disease proscribes oats cereal as well as wheat, barley, and rye.1 However, the issue of oats toxicity has not been conclusively resolved, and the prohibition of this important cereal deprives patients of a valuable source of fibre and nutrients. The aim of this study was to examine the clinical, histological, and immunological responses of adult patients with coeliac disease to challenge with oats. Ten adult patients with coeliac disease in clinical and histological remission were recruited from the coeliac outpatient clinic in St James's Hospital, Dublin. Each patient …
Article
Background: Treatment of coeliac disease (CD) requires lifelong adherence to a strict gluten free diet (GFD) which hitherto has consisted of a diet free of wheat, rye, barley, and oats. Recent studies, mainly in adults, have shown that oats are non-toxic to CD patients. In children, only open studies comprising a small number of patients have been performed. Aim: To determine if children with CD tolerate oats in their GFD. Patients and methods: In this double blind multicentre study involving eight paediatric clinics, 116 children with newly diagnosed CD were randomised to one of two groups: one group was given a standard GFD (GFD-std) and one group was given a GFD with additional wheat free oat products (GFD-oats). The study period was one year. Small bowel biopsy was performed at the beginning and end of the study. Serum IgA antigliadin, antiendomysium, and antitissue transglutaminase antibodies were monitored at 0, 3, 6, and 12 months. Results: Ninety three patients completed the study. Median (range) daily oat intake in the GFD-oats group (n = 42) was 15 (5–40) g at the six month control and 15 (0–43) g at the end of the study. All patients were in clinical remission after the study period. The GFD-oats and GFD-std groups did not differ significantly at the end of the study regarding coeliac serology markers or small bowel mucosal architecture, including numbers of intraepithelial lymphocytes. Significantly more children in the youngest age group withdrew. Conclusions: This is the first randomised double blind study showing that the addition of moderate amounts of oats to a GFD does not prevent clinical or small bowel mucosal healing, or humoral immunological downregulation in coeliac children. This is in accordance with the findings of studies in adult coeliacs and indicates that oats, added to the otherwise GFD, can be accepted and tolerated by the majority of children with CD.
Article
Some countries now allow celiac patients to include oats in their gluten-free diet. Studies have shown that commercially available oats can be contaminated with gluten. The aim of the study was to analyse oat products and products naturally free from gluten to determine the degree of contamination. A total of 88 oat products and 22 products based on maize, rice, millet or buckwheat were analysed, using a commercially available enzyme-linked immunosorbent assay (ELISA) with a monoclonal antibody to gliadin. The ELISA is quantitative with a detection limit of 20mg/kg gluten. Some of the positive samples were also analysed for the presence of DNA from wheat, barley or rye. Thirteen percent of the oat products had gluten content over 200mg/kg. Of the products naturally free from gluten 14% had a gluten content over 200mg/kg. There was a tendency for higher levels of contamination with increased processing. The risk of gluten contamination in oat products as well as in non-gluten cereals must be considered. The level of contamination was in most cases low. The results regarding oats can be compared to those of such cereals as maize, rice, buckwheat and millet.
Article
Wheat, rye, and barley damage the small-intestinal mucosa of patients with celiac disease; maize and rice are harmless. The effects of a diet containing oats are uncertain. In a randomized trial, we compared the effects of gluten-free diets without oats and with oats (with a goal of 50 to 70 g per day from three sources: two types of wheat-starch flour mixed with an equal amount of oats, muesli containing 60 percent oats, and rolled-oat breakfast cereal). Fifty-two adults with celiac disease in remission were followed for 6 months and 40 with newly diagnosed disease for 12 months. Endoscopy with duodenal biopsy was performed at the beginning and end of the study. The mean (+/- SD) oat intake in the oat group was 49.9 +/- 14.7 g per day at 6 months for patients in remission and 46.6 +/- 13.3 g per day at 12 months for patients with newly diagnosed disease. The oat and control groups did not differ significantly in nutritional status, symptoms, or laboratory measures. Patients in remission, regardless of diet, did not have worsening architecture of the duodenal villi or increased mononuclear-cell infiltration. All the patients with new diagnoses were in remission at one year, except for one in the control group. Six patients in the oat groups and five in the control group withdrew from the study. Moderate amounts of oats can be included in a gluten-free diet for most adult patients with celiac disease without adverse effects.
Article
In his pioneering study of “the harmful effects of certain types of cereal on patients suffering from coeliac disease,” Dicke showed that wheat and rye could reproducibly trigger anorexia, diarrhoea, and steatorrhoea in these patients.1 Soon after, using the same prolonged fecal balance studies, Dicke found that oats were also noxious whereas corn, rice, and potatoes were not.2 3 Reports suggesting that barley was toxic came later.4 5 Simultaneously, the “injurious constituent of wheat” was found to be its prolamin (or alcohol soluble protein), gliadin.3 Secalin, hordein, and avenin, the prolamins of rye, barley, and oats respectively, were thus considered as the toxic fractions of these cereals. However, whereas the noxious effects of wheat, barley, and rye could be reproduced, the harmful effects of oats remained controversial–observed by some workers,2 3 denied by others,6 7 and variable for still others.5 8 This uncertainty stems from several factors. Firstly, the early studies included small numbers of patients …
Article
Celiac disease is an intolerance to protein fractions in wheat, rye, barley, and possibly oats. When these grains are consumed by a person with celiac disease, they damage the mucosa of the small intestine, which eventually leads to malabsorption of nutrients. Patients are therefore advised to remove these grains from their diet, with lifelong adherence generally suggested. Although many dietitians and physicians consider this dietary prescription to be standard protocol, it is actually quite controversial. Whether oats can safely be consumed by persons with celiac disease has been debated since the gluten-free diet was first advocated more than 40 years ago. Historically, there have been several reasons for this debate, including the difficulty in identifying the precise amino acid sequence in gliadin that is responsible for toxicity; the differences in cereal chemistry between wheat and oats; and the lack of well-designed studies to assess the toxicity of oats. A growing body of evidence now suggests that moderate amounts of oats may be safely consumed by most adults with celiac disease. If further research continues to find no adverse effects from oat consumption, a consensus may emerge on the place of oats in the gluten-free diet. In the meantime, individual dietary prescriptions, routinely assessed for appropriateness using histologic and/or serologic studies, may be warranted to prevent unnecessary dietary restrictiveness and undesirable medical complications.