Post by kickingfrog on Feb 9, 2011 10:41:27 GMT
Nutr Rev. 2011 Feb;69(2):107-15. doi: 10.1111/j.1753-4887.2010.00368.x.
Celiac disease, gluten-free diet, and oats.
Fric P, Gabrovska D, Nevoral J.
...
Abstract
Oats in a gluten-free diet increase the diet's nutritional value, but their use remains controversial.
Contamination with prolamins of other cereals is frequent, and some clinical and experimental studies support the view that a subgroup of celiac patients may be intolerant to pure oats.
Thus, this issue is more complex than previously suggested. In order to produce oats that are safe for all celiac patients, the following topics should be addressed: selection of oat cultivars with low avenin content, research on such recombinant varieties of oats, development of assay methods to detect avenins in oat products, guidelines for the agricultural processing of oats and the manufacture of oat products, as well as guidelines for following up with celiac patients who consume oats.
© 2011 International Life Sciences Institute.
********************
Nutrients. 2013 Nov 6;5(11):4380-9. doi: 10.3390/nu5114380.
Long-term consumption of oats in adult celiac disease patients.
Kaukinen K, Collin P, Huhtala H, Mäki M.
...
Abstract
Many celiac disease patients tolerate oats, but limited data are available on its long-term consumption.
This was evaluated in the present study, focusing on small-bowel mucosal histology and gastrointestinal symptoms in celiac adults maintaining a strict gluten-free diet with or without oats.
Altogether 106 long-term treated celiac adults were enrolled for this cross-sectional follow-up study.
Daily consumption of oats and fiber was assessed, and small-bowel mucosal morphology and densities of CD3+, αβ+ and γσ+ intraepithelial lymphocytes determined. Gastrointestinal symptoms were assessed by a validated Gastrointestinal Symptom Rating Scale questionnaire.
Seventy (66%) out of the 106 treated celiac disease patients had consumed a median of 20 g of oats (range 1-100 g) per day for up to eight years; all consumed oat products bought from general stores. Daily intake and long-term consumption of oats did not result in small-bowel mucosal villous damage, inflammation, or gastrointestinal symptoms.
Oat-consumers had a significantly higher daily intake of fiber than those who did not use oats.
Two thirds of celiac disease patients preferred to use oats in their daily diet.
Even long-term ingestion of oats had no harmful effects.
**************************************************************************************************
Gut 2011;60:915-922 doi:10.1136/gut.2010.225268
Coeliac disease
Diversity in oat potential immunogenicity: basis for the selection of oat varieties with no toxicity in coeliac disease
OPEN ACCESS
Isabel Comino1, Ana Real1, Laura de Lorenzo1,2, Hugh Cornell3, Miguel Ángel López-Casado4, Francisco Barro5, Pedro Lorite6, Ma Isabel Torres6, Ángel Cebolla7, Carolina Sousa1
+ Author Affiliations
1Departamento de Microbiología y Parasitología, Facultad de Farmacia, Universidad de Sevilla, Sevilla, Spain
2Centro Nacional de Biotecnología (CNB-CSIC), Departamento de Genética Molecular de Plantas, Cantoblanco, Madrid, Spain
3School of Applied Sciences, RMIT University, Melbourne, Australia
4Hospital Virgen de las Nieves, Granada, Spain
5Instituto de Agricultura Sostenible (CSIC), Alameda del Obispo, Córdoba, Spain
6Departamento de Biología Experimental, Campus Universitario Las Lagunillas, Jaén, Spain
7Biomedal, Sevilla, Spain
Correspondence to
Professor Carolina Sousa, Departamento de Microbiología y Parasitología, Facultad de Farmacia, Universidad de Sevilla, C/Profesor García González, no. 2, Sevilla 41012, Spain; csoumar@us.es
Contributors Conceived and designed the experiments: CI, TM, CA, SC. Performed the experiments: CI, RA, LL, LAM, BF, LP. Analysed the data: CI, LL, TM, CA, SC. Contributed reagents/materials/analysis tools: CH, LAM, BF, CA, CS. Wrote the paper: CI, LL, BF, TM, CA, SC.
Revised 23 December 2010
Accepted 1 January 2011
Published Online First 12 February 2011
Abstract
Background and aims Coeliac disease (CD) is triggered by an abnormal reaction to gluten. Peptides resulting from partially digested gluten of wheat, barley or rye cause inflammation of the small intestinal mucosa. Previous contradictory studies suggest that oats may trigger the abnormal immunological response in patients with CD. Monoclonal antibodies (moAbs) against the main immunotoxic 33-mer peptide (A1 and G12) react strongly against wheat, barley and rye but have less reactivity against oats. The stated aim of this study is to test whether this observed reactivity could be related to the potential toxicity of oats for patients with CD.
Methods In the present study, different oat varieties, controlled for their purity and by their distinct protein pattern, were used to examine differences in moAb G12 recognition by ELISA and western blot. Immunogenicity of oat varieties was determined by 33-mer concentration, T cell proliferation and interferon γ production.
Results Three groups of oat cultivars reacting differently against moAb G12 could be distinguished: a group with considerable affinity, a group showing slight reactivity and a third with no detectable reactivity. The immunogenicity of the three types of oats as well as that of a positive and negative control was determined with isolated peripheral blood mononuclear T cells from patients with CD by measurement of cell proliferation and interferon γ release. A direct correlation of the reactivity with G12 and the immunogenicity of the different prolamins was observed.
Conclusions The results showed that the reactivity of the moAb G12 is proportional to the potential immunotoxicity of the cereal cultivar. These differences may explain the different clinical responses observed in patients suffering from CD and open up a means to identify immunologically safe oat cultivars, which could be used to enrich a gluten-free diet.
gut.bmj.com/content/60/7/915.abstract
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Beneficial effects of oats in the gluten-free diet of adults with special reference to nutrient status, symptoms and subjective experiences
Stine Størsrud1, Lena R. Hulthén1, Ragnhild A. Lenner1
1Department of Clinical Nutrition, Göteborg University, Gothenburg, Sweden
(Received 28 January 2002–Revised 27 January 2003–Accepted 21 February 2003)
In several studies oats have been reported to be tolerated by coeliac patients.
The aim of the present study was to investigate the nutritional and symptomatic effects of including oats in the gluten-free diet, as well as the patients' subjective experiences.
Twenty adult coeliac patients included large amounts of oats in their diet.
Food intake, gastrointestinal symptoms, blood samples and body weight were examined and compared with examination at baseline. Diet compliance was checked monthly.
The results are based on fifteen patients eating oats for 2 years plus three with only 6-months consumption. The median daily intake of oats was 93 (range 27–137) g/d, and the compliance was good. The mean intakes of Fe and dietary fibre increased (P<0·001) with the oat diet, as well as the intakes of thiamin and Zn (P<0·02).
The bioavailability of Fe tended to decrease; this seems not to have influenced the Fe status.
Temporary increased flatulence was experienced the first few weeks, as well as improved bowel function with oats in the diet.
All patients who carried out the whole study period wanted to continue eating oats after the study, as they found that addition of oats in the gluten-free diet gave more variation, better taste and satiety.
Oats improved the nutritional value of the gluten-free diet, had no negative effects on nutritional status and were appreciated by the subjects.
Including oats can help coeliac patients following a strict gluten-free diet.
www.nutritionsociety.org.uk/bjn/090/bjn0900101.htm
*************
From Coeliac UK;
*******
Oats & coeliacs
'Coeliac disease and oats: a systematic review'
A systematic review has been .... published by
researchers that questions the evidence base surrounding
the recommendation of oats in a gluten free diet.
N Y Haboubi et al Postgraduate Medical Journal 2006; 82:
672-678
Dr William Dickey, member of the Medical Advisory Council of
Coeliac UK writes:
''Concerns are still expressed about their safety in coeliac
disease and many coeliac societies are reluctant to endorse
their use.
This review included six studies, three sharing authors, which
compared patients on a strict gluten free diet (GFD) with
those on a GFD with oats.
The most common reason for
study exclusion was lack of comparison of patients on a GFD
containing oats with those on a strict GFD.
In fact, there are
#many linear studies where biopsies are compared in the
same patients before and after oats, which are valid and
should be included in any analysis on the subject.
While no studies included in the review showed a significant
loss of villous height in patients taking oats, two did report
significant increases in the inflammatory cell (lymphocyte)
counts in follow-up biopsies.
Coeliac antibody levels in the
blood returned to normal equally in strict GFD and GFD-oats
patients.
I feel the authors' interpretation of the data is perhaps
unduly alarmist.
They raise concerns about significant
complications like cancer which we know are much less
common than previously believed, even in untreated patients.
The significance of persisting lymphocytes in the biopsy is
uncertain.
The authors state that many patients with normal
villi and raised lymphocytes will progress to full villous
atrophy: this is certainly true for untreated patients, but we
know that patients on a full GFD who are doing very well
clinically often have persistent lymphocytes even after some
years, after the villi have grown back.
The researchers state that oats should be only introduced if
the patient is undergoing lifelong specialist review:
this should be the routine standard of care in any case.
While a follow-up biopsy after taking oats may be prudent,
their proposal that this is done regularly (presumably annually) seems unnecessary.
A minority of coeliacs are intolerant of even pure oats:
careful monitoring of symptoms, blood tests and infrequent
biopsy will identify these and should not be a reason for restricting the majority. It also seems reasonable to avoid
oats in patients with persisting villous atrophy despite a
strict GFD.
Quite rightly, many are worried about contamination of oats by wheat, barley and rye. New techniques allow the accurate assessment of foods for gluten content. ...
Oats, at relatively low cost, add fibre content and welcome variety to the GFD. Consuming oat products which are guaranteed to be free from contamination increases food choice, can help to improve compliance to the GFD and are safe for most people with coeliac disease.''
Peraaho M et al. 'Oats can diversify a gluten-free diet in celiac disease and dermatitis herpetiformis'. Journal of the American Dietetic Association 2004; 104: 1148-50.
This paper from Pekka Collin's group describes Finnish patients' experience with the oat-containing GFD.
Coeliac UK would refer any individual enquiry about the
suitability of including uncontaminated oats in a GFD to refer
to their health care team for specific guidance based on their
own sensitivity and ongoing management.
CoeliacUK
Guidelines on Coeliac Disease & Oats
The Coeliac Societies' Medical Advisory Council has... published a position paper for health professionals, to help
them consider the growing evidence suggesting that oats
can form part of the gluten-free diet for some patients with
Coeliac disease and Dermatitis Herpetiformis.
www.coeliac.co.uk/
*********************
THE FINNISH COELIAC SOCIETY
The only treatment in CD is a gluten-free diet, where wheat,
rye and barley are strictly excluded.
Oats can be included in
the adult coeliac patient's diet.
*********************
BMJ
Absence of oats toxicity in adult coeliac disease
www.bmj.com/content/313/7068/1300.full
*****************
International Coeliac Symposium Tampere, Finland, Day 2
\l "Copyright" by Michael Jones, Bill Elkus, Jim Lyles, and Lisa Lewis 1995, 1996, 1997 - All rights reserved worldwide.
From an oral report by Dr. Murray; transcribed for the list by Ann Whelan, editor of the bi-monthly newsletter "Gluten-Free Living".
The big story today from Finland is oats. There were two talks and several posters presented about the topic.
In the first talk, Dr. Risto Julkunen spoke about the Finnish five-year follow-up study in which oats were given to a population of well-controlled celiacs. They ingested an average of 34 grams, which is slightly over one ounce, daily for up to five years.
The oats used in the study were specially grown and tested to be free of wheat, barley and rye. The researchers claim there was no difference in those allowed the oats and those who were not.
www.enabling.org/ia/celiac/conf9602.html
***************************************
New rules in USA re oats
FDA & GF foods
**************************
Why did FDA not include oats as one of the "prohibited grains" in its proposed definition of the term "gluten-free"?
FDA did not include oats as one of the "prohibited grains" in its proposed definition of the term "gluten free" for the following reasons:
There is no consensus among nutrition experts or authorities on the unconditional exclusion of oats from the diet of individuals with celiac disease. For example, the following celiac disease experts/authorities do not support the unconditional exclusion of oats: The National Institutes of Health, the American Dietetic Association, and some celiac disease research/treatment centers.
Research data suggest that the majority of individuals with celiac disease can tolerate a daily intake of a limited amount (e.g., 50 grams) of oats that are free of gluten from wheat, rye, barley or their crossbred hybrids.
Oats are reported to add variety, taste, satiety, dietary fiber, and other essential nutrients to the diet of individuals with celiac disease and may make their diet more appealing.
Allowing oats free of gluten from wheat, rye, barley or their crossbred hybrids, to bear a "gluten-free" labeling claim would make it easier for consumers to identify such oats in the marketplace and may serve as an incentive for more manufacturers to produce such oats.
www.fda.gov/default.htm
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From FSA
Where do oats fit into allergen labelling legislation?
Under current food allergen labelling, oats are classed as a gluten-containing cereal.
If oats have been used as a deliberate ingredient they must be declared on the ingredients list.
If a manufacturer chooses to use an allergy advice box (which is not compulsory) patients will see the term 'contains oat gluten'.
refs
1. Janatuinen EK et al (2002) No harm from five year ingestion of oats in coeliac disease. Gut. 50: 332-335.
2. Garsed, K & Scott-Brian, B (2007) Can oats be taken in a gluten-free diet? A systematic review. Scandinavian Journal of Gastroenterology. 42(2):171-178.
3. Hogberg L et al (2004) Oats to children with newly diagnosed coeliac disease: a randomised double blind study. Gut. 53: 649-654.
4. Thompson T (2005) Contaminated oats and other gluten-free foods in the United States. Journal of the American Dietetic Association. 105:348.
5. Lundin, K et al (2003) Oats induced villous atrophy in coeliac disease. Gut. 52: 1649-1652.
6. Haboubi NY et al (2006) Coeliac disease and oats: a systematic review. Postgraduate Med J. 82: 672-678.
******************
No harm from five year ingestion of oats in celiac disease
www.ibdnet.ch/dt/medinfo/papers/paper0205.html
"No harm from five year ingestion of oats in celiac disease"
Janatuinen EK et al. GUT 2002;50:332-335
Seven years ago Janatuinen and coworkers demonstrated, that 6 to 12 months of ingestion of oats does not have a harmful effect in adult patients with celiac disease (NEJM 1995; 333:1033-1037). Subsequently, other investigators confirmed these results. Now, the same group extended their initial study to assess the safety of long term ingestion of oat products in celiac patients. Clinical and nutritional status, duodenal biopsies and the established serological markers of celiac disease were compared in two groups of celiac patients, either under conventional gluten free diet (28 patients) or under gluten free diet plus oats products (23 patients). The authors found no significant differences between controls and the oat consumers with respect to duodenal villous architecture, inflammatory cell infiltration of the duodenal mucosa or anti-body titres after five years of follow up.
The authors conclude, that the results of this study provide evidence of the long-term safety of oats in adult patients with celiac disease.
Comment: The dietary restrictions for patients with celiac disease are a lifelong burden. Therefore it is not surprising, that the compliance in maintaining a strict gluten free diet is low. Removal of oat products from the list of forbidden cereals in the celiac diet could increase compliance and reduce the costs for the daily food. The message of this study, performed by the Kuopio group, is that long term ingestion of oats can be considered as well tolerated and safe. This information is important for celiac patients and may improve their quality of live. However, one point must be emphasised: Depending upon planting and processing techniques, oat products can be contaminated with gliadin. The oat products used In Finland have been proven to be free of gluten. Considering these local differences, the established oat restriction cannot be relaxed immediately worldwide.
Before making a decision, the gliadin content of the local distributed oat products must be controlled.
**********
Oats and other cereals
Pathogenesis of coeliac disease: implications for treatment
Jocelyn S Fraser, Paul J Ciclitira
Department of Gastroenterology, The Rayne Institute, St Thomas′ Hospital, London SE1 7EH, UK
Correspondence to: Professor PJ Ciclitira, Department of Gastroenterology (GKT), The Rayne Institute, St Thomas′ Hospital, London SE1 7EH, UK. "mailto:paul.ciclitira@kcl.ac.uk"
Telephone: +44 20 7928 9292 Ext. 3063, Fax: +44 20 7620 2597
Received 2001-07-21 Accepted 2001-08-15
Fraser JS, Ciclitira PJ. Pathogenesis of coeliac disease: implications for treatment. World J Gastroenterol, 2001;7(6):772-776
.....................................
Prolamins, the alcohol-soluble fraction of storage proteins are responsible for triggering the disease[9]. Wheat, barley and rye, being closely related, all contain prolamins (known respectively as gliadins, hordeins and secalins) with a high composition of glutamine and proline, whereas the prolamins of oats and more distantly related cereals, contain less glutamine and proline and more alanine and leucine[10]. The glutamine-rich peptide sequences appear to be responsible for the toxicity of wheat, barley and rye in coeliac disease.
............................Oats are a member of the avena tribe of the gramineae, or grass family, of plant s, whereas wheat, barley and rye belong to the triticeae tribe, both tribes belo nging to the pooideae sub-family. Thus avenin, the prolamin of oats, is genetically less like gliadin than secalin and hordein
............. The taxonomic relationships of cereals. After P Shewr y, A Tatham and D Kasarda[10]...............................
The toxicity of oats to patients with coeliac disease has been a controversial issue, as early studies have shown conflicting results. Harmful effects were observed by some workers[9,13], but not by others[14,15], and some investigators found variable results[16,17]. However, a recent Finnish study[18]on newly diagnosed patients, as well as coeliac patien ts in remission on a gluten-free diet, have shown that moderate amounts (up to 60?g/day) of oats are not detrimental, as witnessed by no significant differences in gliadin and reticulin antibodies, as well as numbers of intra-epithelial lymphocytes before and after introduction of oats into the diet. ...Sequence homologies, and weak immunological cross reactivity, have been found between avenin and the prolamins of wheat, barley and rye[10,19,20]. Additionally, only 5% to 15% of the total protein in oats is avenin, whereas 40% to 50% of the total protein in wheat, barley and rye are made up of their respective prolamins[21]. Thus, there is a smaller amount of avenin per gram if oat seed, and there are fewer toxic epitopes per gram of avenin.
This suggests that a small amount of oats can be consumed by patients with coeliac disease, as long as the oats are not contaminated by wheat flour.
In many mills however, the same equipment is used to grind wheat, as that used to grind oats, causing enough contamination to have a detrimental effect on the health of sensitive coeliac patients.
*****************
Coeliacs eating oats (CUK).
CUK list of pure oats & oat products is in their GF Food & Drink directory.
It is recommended that no more than 50g of oats per day are eaten, you are a fit adult on an established GF diet & the oats are uncontaminated.
You should tell your GP / dietitian if you are a coeliac eating oats.
Children should not eat oats before taking medical advice.
******
Children with CD-oats
Dr. Butzner also discussed the effect of oats on children with CD. He stated that his clinical experience has shown that 40% of celiac children cheat on their GF diets and hence the study on celiac children and oats. The aim of the study was to determine the safety of adding a moderate amount of commercially-available oats to the diet of celiac children. Quaker Oats provided their standard product for the study as there were no GF oats available in the market. 14 children, aged 8 to 16, with normal growth and no abnormalities, consumed oats 25 days per month. They were given 1 gram (gm) of oats for each kilogram (kg) of body weight per day, up to a maximum of 50 gm/day. The clinic followed up by telephone at 1, 3, 6, and 9 months and with blood testing and biopsy at one year. None of the children displayed any symptoms during the year. After one year, one child had elevated blood readings but a normal biopsy. Also, after one year, one child who displayed blunted villi was determined to have been consuming other grains.
When the child returned to oats only, the blood antibodies returned to normal in 3 months.
The conclusions that were drawn by Dr. Butzner from his research were:
1. Commercially available oats are OK for celiac children to consume daily for one year.
2. IGA-EMA testing is a sensitive method of monitoring dietary compliance.
3. The quality of antibody testing must be improved so as to be equivalent anywhere.
4. More food testing is needed and standards have to be established.
5. A safe source of oats should be available. To date there have been no failures in two adult CD studies, two adult dermatitis herpetiformis studies and now two children CD studies with oats.
**********************************
Adult coeliac patients do tolerate large amounts of oats
S Størsrud, M Olsson, R Arvidsson Lenner, L Å Nilsson, O Nilsson and A Kilander
The median intake of oats was 93 g/day and the compliance to the oat diet was found to be good. Examinations of the patients after drop-out did not show any deterioration in small bowel histology or nutritional status nor raised levels of antibodies.
Conclusion: Results from this study indicate that adult patients with coeliac disease in remission can include large amounts of controlled wheat-free rolled oats for an extended period of time without adverse effects.
www.nature.com/index.html?file=/ejcn/journal/v57/n1/full/1601525a.html
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Oats & GF diet
Coeliac Disease
Bramwell Cook
September 18th 2002
............ In the 1940s, Professor Willem-Karel
Dicke, a Dutch paediatrician, was the first to recognise the deleterious effects of
wheat, his classic thesis on this subject being published in 1950. During the next
decade, Dicke and his colleagues confirmed that gluten, not starch, was responsible
for this effect. As a result of their work, wheat, rye, barley and oats were identified as
toxic to patients with CD, and exclusion of all four cereals became the basis for the
“gluten free” diet that revolutionised the management of coeliac disease. While the
evidence for the toxicity of oats found in Dicke’s studies would not pass scrutiny
today it was not till 1974 that the toxicity of oats was questioned. Numerous studies
have now confirmed the lack of toxicity of oats.
While gluten is strictly the storage protein of wheat, for the patient with coeliac
disease this word has became associated with the storage proteins from wheat, rye and
barley (and oats).
...................
Prolamins are rich in glutamine and proline, and in wheat are known as gliadin,
secalin in rye and hordein in barley. Gliadin, which gliadin contains 40% glutamine,
is the alcohol-soluble fraction of wheat gluten. The complexity of the chemistry of
these cereal proteins has made the task of finding their common toxic component
extremely difficult.
................
The aim of management is to restore full health. The cornerstone of treatment is strict
adherence to a gluten-free diet by excluding wheat, barley and rye. Several recent
studies have consistently shown no harmful from the ingestion of oats. The advice
sometimes given that oats can be taken safely in “moderate amounts” has been based
on the assumption that oats may be contaminated by wheat during the milling process.
…..
******************************************************
Research and Professional Briefs
Oats and the gluten-free diet
Whether oats should be included in a gluten-free diet has been debated for half a century.
In 1995, the largest and most scientifically rigorous study on the safety of oats was published. Investigators concluded that the consumption of oats was safe for adults with celiac disease.
Since 1995, several additional studies have been published. Without exception, these investigations found no adverse effects associated with the regular consumption of moderate amounts of oats.
However, there are concerns among some authorities on celiac disease that even if oats themselves are safe, they nonetheless may be contaminated with wheat, rye, or barley.
Unfortunately, the extent to which contamination of commercial oat products occurs is not known.
Ideally, if a patient appears likely to use oats, they should be advised to consume only those products tested and found to be free of contamination.
J Am Diet Assoc. 2003;103:376-379.
**************************************
Oats induced villous atrophy in coeliac disease
K E A Lundin1, E M Nilsen2, H G Scott3, E M Løberg4, A Gjøen5, J Bratlie6, V Skar7, E Mendez8, A Løvik1 and K Kett1
1 Department of Medicine, Rikshospitalet, Oslo, Norway
2 LIIPAT, Institute of Pathology, Rikshospitalet and University of Oslo, Oslo, Norway
3 Department of Pathology, Rikshospitalet, Oslo, Norway
4 Department of Pathology, Ullevaal University Hospital, Oslo, Norway
5 Department of Medicine, Ullevaal University Hospital, Oslo, Norway
6 Institute for Medical Research, Rikshospitalet and University of Oslo, Oslo, Norway
7 Department of Medicine, Lovisenberg Hospital, Oslo, Norway
8 Unidad de Analisis Estructural Proteinas, Centro Nacional de Biotechnologica, CSIC, Madrid, Spain
Correspondence to:
Dr K E A Lundin
Department of Medicine, Rikshospitalet, N-0027 Oslo, Norway; knut.lundin@rikshospitalet.no
ABSTRACT
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 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 mRNA after challenge.
Some concerns therefore remain with respect to the safety of oats for coeliacs
*************
NB Only uncontaminated (pure) oats are recommended for coeliacs.
**************
Oats in Finland
From Finnish Coeliac Society:
Oats and Coeliac Disease
Although oats is allowed for coeliacs in Finland it cannot be added to any commercial gluten-free products or dishes.
******************
Avenin
Avenin fails to induce a Th1 response in coeliac tissue following in vitro culture
C Kilmartin et al
ABSTRACT
Background: It is well established that the wheat protein gliadin triggers inflammation in coeliac patients.
However, the potential toxicity of avenin, the equivalent protein in oats, is debated.
Conclusions: The findings of this study suggest that the immunogenic sequences in gliadin are not present in avenin.
Moreover, they are in keeping with in vivo studies which report that oats are safe for consumption by coeliac patients.
gut.bmjjournals.com/cgi/content/abstract/52/1/47
*****************************************************
The Molecular Basis for Oat Intolerance in Patients with Celiac Disease
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.
www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0010001
***********************
Beneficial effects of oats in the gluten-free diet of adults
Br J Nutr. 2003 Jul;90(1):101-7.
Beneficial effects of oats in the gluten-free diet of adults with special reference to nutrient status, symptoms and subjective experiences.
Storsrud S, Hulthen LR, Lenner RA.
Department of Clinical Nutrition, Goteborg University, Gothenburg, Sweden. stine.storsrud@nutrition.gu.se
In several studies oats have been reported to be tolerated by coeliac patients. The aim of the present study was to investigate the nutritional and symptomatic effects of including oats in the gluten-free diet, as well as the patients' subjective experiences. Twenty adult coeliac patients included large amounts of oats in their diet. Food intake, gastrointestinal symptoms, blood samples and body weight were examined and compared with examination at baseline. Diet compliance was checked monthly. The results are based on fifteen patients eating oats for 2 years plus three with only 6-months consumption. The median daily intake of oats was 93 (range 27-137) g/d, and the compliance was good. The mean intakes of Fe and dietary fibre increased (P<0.001) with the oat diet, as well as the intakes of thiamin and Zn (P<0.02). The bioavailability of Fe tended to decrease; this seems not to have influenced the Fe status. Temporary increased flatulence was experienced the first few weeks, as well as improved bowel function with oats in the diet. All patients who carried out the whole study period wanted to continue eating oats after the study, as they found that addition of oats in the gluten-free diet gave more variation, better taste and satiety.
Oats improved the nutritional value of the gluten-free diet, had no negative effects on nutritional status and were appreciated by the subjects. Including oats can help coeliac patients following a strict gluten-free diet.
PMID: 12844381 [PubMed - indexed for MEDLINE]
**********
--------- Gut. 2004 May;53(5):649-654
Oats to children with newly diagnosed coeliac disease: a randomised double blind study.
Hogberg L, Laurin P, Falth-Magnusson K, Grant C, Grodzinsky E, Jansson G, Ascher H, Browaldh L, Hammersjo JA, Lindberg E, Myrdal U, Stenhammar L.
Department of Paediatrics, Norrkoping Hospital, Sweden, and Department of Paediatrics, Linkoping University Hospital, Sweden. Department of Paediatrics, Linkoping University Hospital, Sweden. Laboratory Medicine Ostergotland, Pathology, Norrkoping Hospital, Sweden. Development Unit for Primary Care and Psychiatry, County Council in Ostergotland, Sweden. Department of Paediatrics, Motala Hospital, Sweden. Department of Paediatrics, The Sahlgrenska Academy, Goteborg University, Goteborg, Sweden. Department of Paediatrics, Sachsska Hospital, Stockholm, Sweden. Department of Paediatrics, Vastervik Hospital, Sweden. Department of Paediatrics, Orebro University Hospital, Sweden. Department of Paediatrics, Vasteras Hospital, Sweden.
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.
PMID: 15082581 [PubMed - as supplied by publisher]
*******************************************
Journal of Pediatric Gastroenterology & Nutrition: Volume 28(5) May 1999 p 572
NO HARMFUL EFFECT OF OATS IN THE DIET OF COELIAC CHILDREN
Urbonas, V.
Vilnius University Children's Hospital Centre for Paediatrics, Vilnius, Lithuania.
Abstract 113
Background: The role of oats in the coeliac diet has been a subject of disagreement. Since the results of previous studies on the usefulness of oats in the coeliac diet have been contradictory this study was aimed to evaluate whether coeliac children are able to use oats in their diet without causing clinical and antibody response.
Methods: Fourteen coeliac children (age 4-15, mean 7.5 years) to whom diagnosis was made 2-4 years ago and who were on the strict gluten free diet (GFD) without any clinical and clinical laboratory symptoms and had negative serum IgA class gliadin antibody test started taking 30 grams (below the 7 years old) and 50 grams (over the 7 years old) of oats per day. All these children had active form of coeliac disease (CD) with positive serum IgA class gliadin antibody test at the time of diagnosis. The diagnosis of CD was made according to revised ESPGHAN criteria. All patients were examined at the beginning of the study and at 1, 3, 6 and 12 months. Clinical, clinical laboratory (red cell characteristics: Hb, RBC, RDW, MCV, MCH, MCHC), serological (serum IgA class gliadin antibody test) and nutritional evaluations were performed.
Results: CD patients did not develop any clinical, clinical laboratory and nutritional symptoms under the 12 months follow up time. Red cell characteristics did not differ significantly between the beginning and the end of the study. The growth velocity did not decline. Non of the patients developed IgA gliadin response.
Conclusion: This study shows that coeliac children on a GFD are able to eat oats without harmful effects on the clinical symptoms, red cell characteristics and IgA gliadin antibody levels.
Section Description
GASTROENTEROLOGY
© 1999 Lippincott Williams & Wilkins, Inc.
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Oats in USA
The mission of Gluten Free Oats® is to provide the purest oats available for people with celiac disease. Inspected by celiacs from planting to packaging, we understand the importance of avoiding cross-contamination from wheat, rye or barley. Gluten Free Oats® can be considered SAFE for people who are gluten intolerant because they tested below detectable limits of 3 parts per million (ppm) by the University of Nebraska FARRP Laboratory
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Scand J Gastroenterol. 2006 Jan;41(1):42-7. Related Articles, Links
Coeliac children on a gluten-free diet with or without oats display equal anti-avenin antibody titres.
Hollen E, Holmgren Peterson K, Sundqvist T, Grodzinsky E, Hogberg L, Laurin P, Stenhammar L, Falth-Magnusson K, Magnusson KE.
Division of Medical Microbiology, Linkoping University, Sweden.
Objective. Recent studies report negligible toxicity of oats in the majority of coeliac disease (CD) patients. It has previously been shown that children with untreated CD have circulating antibodies to oats avenin. In this study we performed serial assessments of anti-avenin antibodies in children under investigation for CD on a gluten-free diet with or without oats.
Material and methods. The study involved 116 children, randomized to a standard gluten-free diet or a gluten-free diet supplemented with oats. Sera were obtained from 86 children, 48 in the standard gluten-free group and 38 in the gluten-free oats group, of which 33 consumed at least 10 g of oats daily. IgA and IgG anti-avenin antibodies were monitored at 0, 3, 6 and 12 months. Nitric oxide metabolites were measured in 7 patients, with deviating antibody results.
Results. There was a significant decrease in anti-avenin antibodies in both groups at the end as compared to the beginning of the study, (p<0.001), but no difference was found between the two groups. IgA titres already declined after 3 months. IgG titres, although significantly decreased, remained high in the majority of patients in both groups. Nitric oxide levels were high in four of the analysed samples.
Conclusions. Oats per se, do not seem to produce a humoral immune reaction in children with CD when given in an otherwise gluten-free diet, indicating that the reaction requires gluten challenge.
Anti-avenin antibodies were equal in the two study groups, and these findings strengthen the clinical impression that oats can be tolerated by the majority of patients with CD.
***************
Celiac disease, gluten-free diet, and oats.
Fric P, Gabrovska D, Nevoral J.
...
Abstract
Oats in a gluten-free diet increase the diet's nutritional value, but their use remains controversial.
Contamination with prolamins of other cereals is frequent, and some clinical and experimental studies support the view that a subgroup of celiac patients may be intolerant to pure oats.
Thus, this issue is more complex than previously suggested. In order to produce oats that are safe for all celiac patients, the following topics should be addressed: selection of oat cultivars with low avenin content, research on such recombinant varieties of oats, development of assay methods to detect avenins in oat products, guidelines for the agricultural processing of oats and the manufacture of oat products, as well as guidelines for following up with celiac patients who consume oats.
© 2011 International Life Sciences Institute.
********************
Nutrients. 2013 Nov 6;5(11):4380-9. doi: 10.3390/nu5114380.
Long-term consumption of oats in adult celiac disease patients.
Kaukinen K, Collin P, Huhtala H, Mäki M.
...
Abstract
Many celiac disease patients tolerate oats, but limited data are available on its long-term consumption.
This was evaluated in the present study, focusing on small-bowel mucosal histology and gastrointestinal symptoms in celiac adults maintaining a strict gluten-free diet with or without oats.
Altogether 106 long-term treated celiac adults were enrolled for this cross-sectional follow-up study.
Daily consumption of oats and fiber was assessed, and small-bowel mucosal morphology and densities of CD3+, αβ+ and γσ+ intraepithelial lymphocytes determined. Gastrointestinal symptoms were assessed by a validated Gastrointestinal Symptom Rating Scale questionnaire.
Seventy (66%) out of the 106 treated celiac disease patients had consumed a median of 20 g of oats (range 1-100 g) per day for up to eight years; all consumed oat products bought from general stores. Daily intake and long-term consumption of oats did not result in small-bowel mucosal villous damage, inflammation, or gastrointestinal symptoms.
Oat-consumers had a significantly higher daily intake of fiber than those who did not use oats.
Two thirds of celiac disease patients preferred to use oats in their daily diet.
Even long-term ingestion of oats had no harmful effects.
**************************************************************************************************
Gut 2011;60:915-922 doi:10.1136/gut.2010.225268
Coeliac disease
Diversity in oat potential immunogenicity: basis for the selection of oat varieties with no toxicity in coeliac disease
OPEN ACCESS
Isabel Comino1, Ana Real1, Laura de Lorenzo1,2, Hugh Cornell3, Miguel Ángel López-Casado4, Francisco Barro5, Pedro Lorite6, Ma Isabel Torres6, Ángel Cebolla7, Carolina Sousa1
+ Author Affiliations
1Departamento de Microbiología y Parasitología, Facultad de Farmacia, Universidad de Sevilla, Sevilla, Spain
2Centro Nacional de Biotecnología (CNB-CSIC), Departamento de Genética Molecular de Plantas, Cantoblanco, Madrid, Spain
3School of Applied Sciences, RMIT University, Melbourne, Australia
4Hospital Virgen de las Nieves, Granada, Spain
5Instituto de Agricultura Sostenible (CSIC), Alameda del Obispo, Córdoba, Spain
6Departamento de Biología Experimental, Campus Universitario Las Lagunillas, Jaén, Spain
7Biomedal, Sevilla, Spain
Correspondence to
Professor Carolina Sousa, Departamento de Microbiología y Parasitología, Facultad de Farmacia, Universidad de Sevilla, C/Profesor García González, no. 2, Sevilla 41012, Spain; csoumar@us.es
Contributors Conceived and designed the experiments: CI, TM, CA, SC. Performed the experiments: CI, RA, LL, LAM, BF, LP. Analysed the data: CI, LL, TM, CA, SC. Contributed reagents/materials/analysis tools: CH, LAM, BF, CA, CS. Wrote the paper: CI, LL, BF, TM, CA, SC.
Revised 23 December 2010
Accepted 1 January 2011
Published Online First 12 February 2011
Abstract
Background and aims Coeliac disease (CD) is triggered by an abnormal reaction to gluten. Peptides resulting from partially digested gluten of wheat, barley or rye cause inflammation of the small intestinal mucosa. Previous contradictory studies suggest that oats may trigger the abnormal immunological response in patients with CD. Monoclonal antibodies (moAbs) against the main immunotoxic 33-mer peptide (A1 and G12) react strongly against wheat, barley and rye but have less reactivity against oats. The stated aim of this study is to test whether this observed reactivity could be related to the potential toxicity of oats for patients with CD.
Methods In the present study, different oat varieties, controlled for their purity and by their distinct protein pattern, were used to examine differences in moAb G12 recognition by ELISA and western blot. Immunogenicity of oat varieties was determined by 33-mer concentration, T cell proliferation and interferon γ production.
Results Three groups of oat cultivars reacting differently against moAb G12 could be distinguished: a group with considerable affinity, a group showing slight reactivity and a third with no detectable reactivity. The immunogenicity of the three types of oats as well as that of a positive and negative control was determined with isolated peripheral blood mononuclear T cells from patients with CD by measurement of cell proliferation and interferon γ release. A direct correlation of the reactivity with G12 and the immunogenicity of the different prolamins was observed.
Conclusions The results showed that the reactivity of the moAb G12 is proportional to the potential immunotoxicity of the cereal cultivar. These differences may explain the different clinical responses observed in patients suffering from CD and open up a means to identify immunologically safe oat cultivars, which could be used to enrich a gluten-free diet.
gut.bmj.com/content/60/7/915.abstract
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Beneficial effects of oats in the gluten-free diet of adults with special reference to nutrient status, symptoms and subjective experiences
Stine Størsrud1, Lena R. Hulthén1, Ragnhild A. Lenner1
1Department of Clinical Nutrition, Göteborg University, Gothenburg, Sweden
(Received 28 January 2002–Revised 27 January 2003–Accepted 21 February 2003)
In several studies oats have been reported to be tolerated by coeliac patients.
The aim of the present study was to investigate the nutritional and symptomatic effects of including oats in the gluten-free diet, as well as the patients' subjective experiences.
Twenty adult coeliac patients included large amounts of oats in their diet.
Food intake, gastrointestinal symptoms, blood samples and body weight were examined and compared with examination at baseline. Diet compliance was checked monthly.
The results are based on fifteen patients eating oats for 2 years plus three with only 6-months consumption. The median daily intake of oats was 93 (range 27–137) g/d, and the compliance was good. The mean intakes of Fe and dietary fibre increased (P<0·001) with the oat diet, as well as the intakes of thiamin and Zn (P<0·02).
The bioavailability of Fe tended to decrease; this seems not to have influenced the Fe status.
Temporary increased flatulence was experienced the first few weeks, as well as improved bowel function with oats in the diet.
All patients who carried out the whole study period wanted to continue eating oats after the study, as they found that addition of oats in the gluten-free diet gave more variation, better taste and satiety.
Oats improved the nutritional value of the gluten-free diet, had no negative effects on nutritional status and were appreciated by the subjects.
Including oats can help coeliac patients following a strict gluten-free diet.
www.nutritionsociety.org.uk/bjn/090/bjn0900101.htm
*************
From Coeliac UK;
*******
Oats & coeliacs
'Coeliac disease and oats: a systematic review'
A systematic review has been .... published by
researchers that questions the evidence base surrounding
the recommendation of oats in a gluten free diet.
N Y Haboubi et al Postgraduate Medical Journal 2006; 82:
672-678
Dr William Dickey, member of the Medical Advisory Council of
Coeliac UK writes:
''Concerns are still expressed about their safety in coeliac
disease and many coeliac societies are reluctant to endorse
their use.
This review included six studies, three sharing authors, which
compared patients on a strict gluten free diet (GFD) with
those on a GFD with oats.
The most common reason for
study exclusion was lack of comparison of patients on a GFD
containing oats with those on a strict GFD.
In fact, there are
#many linear studies where biopsies are compared in the
same patients before and after oats, which are valid and
should be included in any analysis on the subject.
While no studies included in the review showed a significant
loss of villous height in patients taking oats, two did report
significant increases in the inflammatory cell (lymphocyte)
counts in follow-up biopsies.
Coeliac antibody levels in the
blood returned to normal equally in strict GFD and GFD-oats
patients.
I feel the authors' interpretation of the data is perhaps
unduly alarmist.
They raise concerns about significant
complications like cancer which we know are much less
common than previously believed, even in untreated patients.
The significance of persisting lymphocytes in the biopsy is
uncertain.
The authors state that many patients with normal
villi and raised lymphocytes will progress to full villous
atrophy: this is certainly true for untreated patients, but we
know that patients on a full GFD who are doing very well
clinically often have persistent lymphocytes even after some
years, after the villi have grown back.
The researchers state that oats should be only introduced if
the patient is undergoing lifelong specialist review:
this should be the routine standard of care in any case.
While a follow-up biopsy after taking oats may be prudent,
their proposal that this is done regularly (presumably annually) seems unnecessary.
A minority of coeliacs are intolerant of even pure oats:
careful monitoring of symptoms, blood tests and infrequent
biopsy will identify these and should not be a reason for restricting the majority. It also seems reasonable to avoid
oats in patients with persisting villous atrophy despite a
strict GFD.
Quite rightly, many are worried about contamination of oats by wheat, barley and rye. New techniques allow the accurate assessment of foods for gluten content. ...
Oats, at relatively low cost, add fibre content and welcome variety to the GFD. Consuming oat products which are guaranteed to be free from contamination increases food choice, can help to improve compliance to the GFD and are safe for most people with coeliac disease.''
Peraaho M et al. 'Oats can diversify a gluten-free diet in celiac disease and dermatitis herpetiformis'. Journal of the American Dietetic Association 2004; 104: 1148-50.
This paper from Pekka Collin's group describes Finnish patients' experience with the oat-containing GFD.
Coeliac UK would refer any individual enquiry about the
suitability of including uncontaminated oats in a GFD to refer
to their health care team for specific guidance based on their
own sensitivity and ongoing management.
CoeliacUK
Guidelines on Coeliac Disease & Oats
The Coeliac Societies' Medical Advisory Council has... published a position paper for health professionals, to help
them consider the growing evidence suggesting that oats
can form part of the gluten-free diet for some patients with
Coeliac disease and Dermatitis Herpetiformis.
www.coeliac.co.uk/
*********************
THE FINNISH COELIAC SOCIETY
The only treatment in CD is a gluten-free diet, where wheat,
rye and barley are strictly excluded.
Oats can be included in
the adult coeliac patient's diet.
*********************
BMJ
Absence of oats toxicity in adult coeliac disease
www.bmj.com/content/313/7068/1300.full
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International Coeliac Symposium Tampere, Finland, Day 2
\l "Copyright" by Michael Jones, Bill Elkus, Jim Lyles, and Lisa Lewis 1995, 1996, 1997 - All rights reserved worldwide.
From an oral report by Dr. Murray; transcribed for the list by Ann Whelan, editor of the bi-monthly newsletter "Gluten-Free Living".
The big story today from Finland is oats. There were two talks and several posters presented about the topic.
In the first talk, Dr. Risto Julkunen spoke about the Finnish five-year follow-up study in which oats were given to a population of well-controlled celiacs. They ingested an average of 34 grams, which is slightly over one ounce, daily for up to five years.
The oats used in the study were specially grown and tested to be free of wheat, barley and rye. The researchers claim there was no difference in those allowed the oats and those who were not.
www.enabling.org/ia/celiac/conf9602.html
***************************************
New rules in USA re oats
FDA & GF foods
**************************
Why did FDA not include oats as one of the "prohibited grains" in its proposed definition of the term "gluten-free"?
FDA did not include oats as one of the "prohibited grains" in its proposed definition of the term "gluten free" for the following reasons:
There is no consensus among nutrition experts or authorities on the unconditional exclusion of oats from the diet of individuals with celiac disease. For example, the following celiac disease experts/authorities do not support the unconditional exclusion of oats: The National Institutes of Health, the American Dietetic Association, and some celiac disease research/treatment centers.
Research data suggest that the majority of individuals with celiac disease can tolerate a daily intake of a limited amount (e.g., 50 grams) of oats that are free of gluten from wheat, rye, barley or their crossbred hybrids.
Oats are reported to add variety, taste, satiety, dietary fiber, and other essential nutrients to the diet of individuals with celiac disease and may make their diet more appealing.
Allowing oats free of gluten from wheat, rye, barley or their crossbred hybrids, to bear a "gluten-free" labeling claim would make it easier for consumers to identify such oats in the marketplace and may serve as an incentive for more manufacturers to produce such oats.
www.fda.gov/default.htm
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From FSA
Where do oats fit into allergen labelling legislation?
Under current food allergen labelling, oats are classed as a gluten-containing cereal.
If oats have been used as a deliberate ingredient they must be declared on the ingredients list.
If a manufacturer chooses to use an allergy advice box (which is not compulsory) patients will see the term 'contains oat gluten'.
refs
1. Janatuinen EK et al (2002) No harm from five year ingestion of oats in coeliac disease. Gut. 50: 332-335.
2. Garsed, K & Scott-Brian, B (2007) Can oats be taken in a gluten-free diet? A systematic review. Scandinavian Journal of Gastroenterology. 42(2):171-178.
3. Hogberg L et al (2004) Oats to children with newly diagnosed coeliac disease: a randomised double blind study. Gut. 53: 649-654.
4. Thompson T (2005) Contaminated oats and other gluten-free foods in the United States. Journal of the American Dietetic Association. 105:348.
5. Lundin, K et al (2003) Oats induced villous atrophy in coeliac disease. Gut. 52: 1649-1652.
6. Haboubi NY et al (2006) Coeliac disease and oats: a systematic review. Postgraduate Med J. 82: 672-678.
******************
No harm from five year ingestion of oats in celiac disease
www.ibdnet.ch/dt/medinfo/papers/paper0205.html
"No harm from five year ingestion of oats in celiac disease"
Janatuinen EK et al. GUT 2002;50:332-335
Seven years ago Janatuinen and coworkers demonstrated, that 6 to 12 months of ingestion of oats does not have a harmful effect in adult patients with celiac disease (NEJM 1995; 333:1033-1037). Subsequently, other investigators confirmed these results. Now, the same group extended their initial study to assess the safety of long term ingestion of oat products in celiac patients. Clinical and nutritional status, duodenal biopsies and the established serological markers of celiac disease were compared in two groups of celiac patients, either under conventional gluten free diet (28 patients) or under gluten free diet plus oats products (23 patients). The authors found no significant differences between controls and the oat consumers with respect to duodenal villous architecture, inflammatory cell infiltration of the duodenal mucosa or anti-body titres after five years of follow up.
The authors conclude, that the results of this study provide evidence of the long-term safety of oats in adult patients with celiac disease.
Comment: The dietary restrictions for patients with celiac disease are a lifelong burden. Therefore it is not surprising, that the compliance in maintaining a strict gluten free diet is low. Removal of oat products from the list of forbidden cereals in the celiac diet could increase compliance and reduce the costs for the daily food. The message of this study, performed by the Kuopio group, is that long term ingestion of oats can be considered as well tolerated and safe. This information is important for celiac patients and may improve their quality of live. However, one point must be emphasised: Depending upon planting and processing techniques, oat products can be contaminated with gliadin. The oat products used In Finland have been proven to be free of gluten. Considering these local differences, the established oat restriction cannot be relaxed immediately worldwide.
Before making a decision, the gliadin content of the local distributed oat products must be controlled.
**********
Oats and other cereals
Pathogenesis of coeliac disease: implications for treatment
Jocelyn S Fraser, Paul J Ciclitira
Department of Gastroenterology, The Rayne Institute, St Thomas′ Hospital, London SE1 7EH, UK
Correspondence to: Professor PJ Ciclitira, Department of Gastroenterology (GKT), The Rayne Institute, St Thomas′ Hospital, London SE1 7EH, UK. "mailto:paul.ciclitira@kcl.ac.uk"
Telephone: +44 20 7928 9292 Ext. 3063, Fax: +44 20 7620 2597
Received 2001-07-21 Accepted 2001-08-15
Fraser JS, Ciclitira PJ. Pathogenesis of coeliac disease: implications for treatment. World J Gastroenterol, 2001;7(6):772-776
.....................................
Prolamins, the alcohol-soluble fraction of storage proteins are responsible for triggering the disease[9]. Wheat, barley and rye, being closely related, all contain prolamins (known respectively as gliadins, hordeins and secalins) with a high composition of glutamine and proline, whereas the prolamins of oats and more distantly related cereals, contain less glutamine and proline and more alanine and leucine[10]. The glutamine-rich peptide sequences appear to be responsible for the toxicity of wheat, barley and rye in coeliac disease.
............................Oats are a member of the avena tribe of the gramineae, or grass family, of plant s, whereas wheat, barley and rye belong to the triticeae tribe, both tribes belo nging to the pooideae sub-family. Thus avenin, the prolamin of oats, is genetically less like gliadin than secalin and hordein
............. The taxonomic relationships of cereals. After P Shewr y, A Tatham and D Kasarda[10]...............................
The toxicity of oats to patients with coeliac disease has been a controversial issue, as early studies have shown conflicting results. Harmful effects were observed by some workers[9,13], but not by others[14,15], and some investigators found variable results[16,17]. However, a recent Finnish study[18]on newly diagnosed patients, as well as coeliac patien ts in remission on a gluten-free diet, have shown that moderate amounts (up to 60?g/day) of oats are not detrimental, as witnessed by no significant differences in gliadin and reticulin antibodies, as well as numbers of intra-epithelial lymphocytes before and after introduction of oats into the diet. ...Sequence homologies, and weak immunological cross reactivity, have been found between avenin and the prolamins of wheat, barley and rye[10,19,20]. Additionally, only 5% to 15% of the total protein in oats is avenin, whereas 40% to 50% of the total protein in wheat, barley and rye are made up of their respective prolamins[21]. Thus, there is a smaller amount of avenin per gram if oat seed, and there are fewer toxic epitopes per gram of avenin.
This suggests that a small amount of oats can be consumed by patients with coeliac disease, as long as the oats are not contaminated by wheat flour.
In many mills however, the same equipment is used to grind wheat, as that used to grind oats, causing enough contamination to have a detrimental effect on the health of sensitive coeliac patients.
*****************
Coeliacs eating oats (CUK).
CUK list of pure oats & oat products is in their GF Food & Drink directory.
It is recommended that no more than 50g of oats per day are eaten, you are a fit adult on an established GF diet & the oats are uncontaminated.
You should tell your GP / dietitian if you are a coeliac eating oats.
Children should not eat oats before taking medical advice.
******
Children with CD-oats
Dr. Butzner also discussed the effect of oats on children with CD. He stated that his clinical experience has shown that 40% of celiac children cheat on their GF diets and hence the study on celiac children and oats. The aim of the study was to determine the safety of adding a moderate amount of commercially-available oats to the diet of celiac children. Quaker Oats provided their standard product for the study as there were no GF oats available in the market. 14 children, aged 8 to 16, with normal growth and no abnormalities, consumed oats 25 days per month. They were given 1 gram (gm) of oats for each kilogram (kg) of body weight per day, up to a maximum of 50 gm/day. The clinic followed up by telephone at 1, 3, 6, and 9 months and with blood testing and biopsy at one year. None of the children displayed any symptoms during the year. After one year, one child had elevated blood readings but a normal biopsy. Also, after one year, one child who displayed blunted villi was determined to have been consuming other grains.
When the child returned to oats only, the blood antibodies returned to normal in 3 months.
The conclusions that were drawn by Dr. Butzner from his research were:
1. Commercially available oats are OK for celiac children to consume daily for one year.
2. IGA-EMA testing is a sensitive method of monitoring dietary compliance.
3. The quality of antibody testing must be improved so as to be equivalent anywhere.
4. More food testing is needed and standards have to be established.
5. A safe source of oats should be available. To date there have been no failures in two adult CD studies, two adult dermatitis herpetiformis studies and now two children CD studies with oats.
**********************************
Adult coeliac patients do tolerate large amounts of oats
S Størsrud, M Olsson, R Arvidsson Lenner, L Å Nilsson, O Nilsson and A Kilander
The median intake of oats was 93 g/day and the compliance to the oat diet was found to be good. Examinations of the patients after drop-out did not show any deterioration in small bowel histology or nutritional status nor raised levels of antibodies.
Conclusion: Results from this study indicate that adult patients with coeliac disease in remission can include large amounts of controlled wheat-free rolled oats for an extended period of time without adverse effects.
www.nature.com/index.html?file=/ejcn/journal/v57/n1/full/1601525a.html
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Oats & GF diet
Coeliac Disease
Bramwell Cook
September 18th 2002
............ In the 1940s, Professor Willem-Karel
Dicke, a Dutch paediatrician, was the first to recognise the deleterious effects of
wheat, his classic thesis on this subject being published in 1950. During the next
decade, Dicke and his colleagues confirmed that gluten, not starch, was responsible
for this effect. As a result of their work, wheat, rye, barley and oats were identified as
toxic to patients with CD, and exclusion of all four cereals became the basis for the
“gluten free” diet that revolutionised the management of coeliac disease. While the
evidence for the toxicity of oats found in Dicke’s studies would not pass scrutiny
today it was not till 1974 that the toxicity of oats was questioned. Numerous studies
have now confirmed the lack of toxicity of oats.
While gluten is strictly the storage protein of wheat, for the patient with coeliac
disease this word has became associated with the storage proteins from wheat, rye and
barley (and oats).
...................
Prolamins are rich in glutamine and proline, and in wheat are known as gliadin,
secalin in rye and hordein in barley. Gliadin, which gliadin contains 40% glutamine,
is the alcohol-soluble fraction of wheat gluten. The complexity of the chemistry of
these cereal proteins has made the task of finding their common toxic component
extremely difficult.
................
The aim of management is to restore full health. The cornerstone of treatment is strict
adherence to a gluten-free diet by excluding wheat, barley and rye. Several recent
studies have consistently shown no harmful from the ingestion of oats. The advice
sometimes given that oats can be taken safely in “moderate amounts” has been based
on the assumption that oats may be contaminated by wheat during the milling process.
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Research and Professional Briefs
Oats and the gluten-free diet
Whether oats should be included in a gluten-free diet has been debated for half a century.
In 1995, the largest and most scientifically rigorous study on the safety of oats was published. Investigators concluded that the consumption of oats was safe for adults with celiac disease.
Since 1995, several additional studies have been published. Without exception, these investigations found no adverse effects associated with the regular consumption of moderate amounts of oats.
However, there are concerns among some authorities on celiac disease that even if oats themselves are safe, they nonetheless may be contaminated with wheat, rye, or barley.
Unfortunately, the extent to which contamination of commercial oat products occurs is not known.
Ideally, if a patient appears likely to use oats, they should be advised to consume only those products tested and found to be free of contamination.
J Am Diet Assoc. 2003;103:376-379.
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Oats induced villous atrophy in coeliac disease
K E A Lundin1, E M Nilsen2, H G Scott3, E M Løberg4, A Gjøen5, J Bratlie6, V Skar7, E Mendez8, A Løvik1 and K Kett1
1 Department of Medicine, Rikshospitalet, Oslo, Norway
2 LIIPAT, Institute of Pathology, Rikshospitalet and University of Oslo, Oslo, Norway
3 Department of Pathology, Rikshospitalet, Oslo, Norway
4 Department of Pathology, Ullevaal University Hospital, Oslo, Norway
5 Department of Medicine, Ullevaal University Hospital, Oslo, Norway
6 Institute for Medical Research, Rikshospitalet and University of Oslo, Oslo, Norway
7 Department of Medicine, Lovisenberg Hospital, Oslo, Norway
8 Unidad de Analisis Estructural Proteinas, Centro Nacional de Biotechnologica, CSIC, Madrid, Spain
Correspondence to:
Dr K E A Lundin
Department of Medicine, Rikshospitalet, N-0027 Oslo, Norway; knut.lundin@rikshospitalet.no
ABSTRACT
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 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 mRNA after challenge.
Some concerns therefore remain with respect to the safety of oats for coeliacs
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NB Only uncontaminated (pure) oats are recommended for coeliacs.
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Oats in Finland
From Finnish Coeliac Society:
Oats and Coeliac Disease
Although oats is allowed for coeliacs in Finland it cannot be added to any commercial gluten-free products or dishes.
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Avenin
Avenin fails to induce a Th1 response in coeliac tissue following in vitro culture
C Kilmartin et al
ABSTRACT
Background: It is well established that the wheat protein gliadin triggers inflammation in coeliac patients.
However, the potential toxicity of avenin, the equivalent protein in oats, is debated.
Conclusions: The findings of this study suggest that the immunogenic sequences in gliadin are not present in avenin.
Moreover, they are in keeping with in vivo studies which report that oats are safe for consumption by coeliac patients.
gut.bmjjournals.com/cgi/content/abstract/52/1/47
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The Molecular Basis for Oat Intolerance in Patients with Celiac Disease
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.
www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0010001
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Beneficial effects of oats in the gluten-free diet of adults
Br J Nutr. 2003 Jul;90(1):101-7.
Beneficial effects of oats in the gluten-free diet of adults with special reference to nutrient status, symptoms and subjective experiences.
Storsrud S, Hulthen LR, Lenner RA.
Department of Clinical Nutrition, Goteborg University, Gothenburg, Sweden. stine.storsrud@nutrition.gu.se
In several studies oats have been reported to be tolerated by coeliac patients. The aim of the present study was to investigate the nutritional and symptomatic effects of including oats in the gluten-free diet, as well as the patients' subjective experiences. Twenty adult coeliac patients included large amounts of oats in their diet. Food intake, gastrointestinal symptoms, blood samples and body weight were examined and compared with examination at baseline. Diet compliance was checked monthly. The results are based on fifteen patients eating oats for 2 years plus three with only 6-months consumption. The median daily intake of oats was 93 (range 27-137) g/d, and the compliance was good. The mean intakes of Fe and dietary fibre increased (P<0.001) with the oat diet, as well as the intakes of thiamin and Zn (P<0.02). The bioavailability of Fe tended to decrease; this seems not to have influenced the Fe status. Temporary increased flatulence was experienced the first few weeks, as well as improved bowel function with oats in the diet. All patients who carried out the whole study period wanted to continue eating oats after the study, as they found that addition of oats in the gluten-free diet gave more variation, better taste and satiety.
Oats improved the nutritional value of the gluten-free diet, had no negative effects on nutritional status and were appreciated by the subjects. Including oats can help coeliac patients following a strict gluten-free diet.
PMID: 12844381 [PubMed - indexed for MEDLINE]
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--------- Gut. 2004 May;53(5):649-654
Oats to children with newly diagnosed coeliac disease: a randomised double blind study.
Hogberg L, Laurin P, Falth-Magnusson K, Grant C, Grodzinsky E, Jansson G, Ascher H, Browaldh L, Hammersjo JA, Lindberg E, Myrdal U, Stenhammar L.
Department of Paediatrics, Norrkoping Hospital, Sweden, and Department of Paediatrics, Linkoping University Hospital, Sweden. Department of Paediatrics, Linkoping University Hospital, Sweden. Laboratory Medicine Ostergotland, Pathology, Norrkoping Hospital, Sweden. Development Unit for Primary Care and Psychiatry, County Council in Ostergotland, Sweden. Department of Paediatrics, Motala Hospital, Sweden. Department of Paediatrics, The Sahlgrenska Academy, Goteborg University, Goteborg, Sweden. Department of Paediatrics, Sachsska Hospital, Stockholm, Sweden. Department of Paediatrics, Vastervik Hospital, Sweden. Department of Paediatrics, Orebro University Hospital, Sweden. Department of Paediatrics, Vasteras Hospital, Sweden.
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.
PMID: 15082581 [PubMed - as supplied by publisher]
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Journal of Pediatric Gastroenterology & Nutrition: Volume 28(5) May 1999 p 572
NO HARMFUL EFFECT OF OATS IN THE DIET OF COELIAC CHILDREN
Urbonas, V.
Vilnius University Children's Hospital Centre for Paediatrics, Vilnius, Lithuania.
Abstract 113
Background: The role of oats in the coeliac diet has been a subject of disagreement. Since the results of previous studies on the usefulness of oats in the coeliac diet have been contradictory this study was aimed to evaluate whether coeliac children are able to use oats in their diet without causing clinical and antibody response.
Methods: Fourteen coeliac children (age 4-15, mean 7.5 years) to whom diagnosis was made 2-4 years ago and who were on the strict gluten free diet (GFD) without any clinical and clinical laboratory symptoms and had negative serum IgA class gliadin antibody test started taking 30 grams (below the 7 years old) and 50 grams (over the 7 years old) of oats per day. All these children had active form of coeliac disease (CD) with positive serum IgA class gliadin antibody test at the time of diagnosis. The diagnosis of CD was made according to revised ESPGHAN criteria. All patients were examined at the beginning of the study and at 1, 3, 6 and 12 months. Clinical, clinical laboratory (red cell characteristics: Hb, RBC, RDW, MCV, MCH, MCHC), serological (serum IgA class gliadin antibody test) and nutritional evaluations were performed.
Results: CD patients did not develop any clinical, clinical laboratory and nutritional symptoms under the 12 months follow up time. Red cell characteristics did not differ significantly between the beginning and the end of the study. The growth velocity did not decline. Non of the patients developed IgA gliadin response.
Conclusion: This study shows that coeliac children on a GFD are able to eat oats without harmful effects on the clinical symptoms, red cell characteristics and IgA gliadin antibody levels.
Section Description
GASTROENTEROLOGY
© 1999 Lippincott Williams & Wilkins, Inc.
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Oats in USA
The mission of Gluten Free Oats® is to provide the purest oats available for people with celiac disease. Inspected by celiacs from planting to packaging, we understand the importance of avoiding cross-contamination from wheat, rye or barley. Gluten Free Oats® can be considered SAFE for people who are gluten intolerant because they tested below detectable limits of 3 parts per million (ppm) by the University of Nebraska FARRP Laboratory
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www.glutenfreeoats.com/
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Scand J Gastroenterol. 2006 Jan;41(1):42-7. Related Articles, Links
Coeliac children on a gluten-free diet with or without oats display equal anti-avenin antibody titres.
Hollen E, Holmgren Peterson K, Sundqvist T, Grodzinsky E, Hogberg L, Laurin P, Stenhammar L, Falth-Magnusson K, Magnusson KE.
Division of Medical Microbiology, Linkoping University, Sweden.
Objective. Recent studies report negligible toxicity of oats in the majority of coeliac disease (CD) patients. It has previously been shown that children with untreated CD have circulating antibodies to oats avenin. In this study we performed serial assessments of anti-avenin antibodies in children under investigation for CD on a gluten-free diet with or without oats.
Material and methods. The study involved 116 children, randomized to a standard gluten-free diet or a gluten-free diet supplemented with oats. Sera were obtained from 86 children, 48 in the standard gluten-free group and 38 in the gluten-free oats group, of which 33 consumed at least 10 g of oats daily. IgA and IgG anti-avenin antibodies were monitored at 0, 3, 6 and 12 months. Nitric oxide metabolites were measured in 7 patients, with deviating antibody results.
Results. There was a significant decrease in anti-avenin antibodies in both groups at the end as compared to the beginning of the study, (p<0.001), but no difference was found between the two groups. IgA titres already declined after 3 months. IgG titres, although significantly decreased, remained high in the majority of patients in both groups. Nitric oxide levels were high in four of the analysed samples.
Conclusions. Oats per se, do not seem to produce a humoral immune reaction in children with CD when given in an otherwise gluten-free diet, indicating that the reaction requires gluten challenge.
Anti-avenin antibodies were equal in the two study groups, and these findings strengthen the clinical impression that oats can be tolerated by the majority of patients with CD.
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