Oats

[Guest]

Recent article on WebMD about oats in a gluten free diet...Sorry...they really gotta go (If you haven't gotten rid of them already)

http://my.webmd.com/content/Article/95/103344.htm

Researchers in Norway studied nine adults with celiac disease who had eaten oats in the past. Four participants had symptoms of abdominal bloating or diarrhea. Three of those four patients had "intestinal inflammation typical of celiac disease at the time of oats exposure," write the researchers.

[chuck]

My wife went without oats until she talked to a friend of the family, who has a much more severe condition, said that oats was one food that she could eat with no effects. My wife tried a small, I mean very small, portion risking side effects and nothing ??? So now she eats it when ever she wants.. There again it may be a personal thing.

[GFSarahSmiles]

I did my research and found that they think many people react to oats because in the US most all products use US-grown oats, which are grown very near wheat crops and they figure that somehow the gluten is transferred by being grown in such close proximity to each other. Oats grown in Ireland, however, have not produced ill effects in Celiac children in the clinical trials. (Oats in Ireland are not grown near wheat crops) Imported oats from Ireland are very difficult to find, but I've found them at Lowe's Foods. I was skeptical about it, but I tried them and I think they may be okay for me. I've been eating them for about a week and a half or two weeks now, and the only reason I said I only think they are okay is because I had a reaction to something 5 or 4 days ago, and while I'm pretty sure it was something else, I can't be absolutely certain because I did not get to read the package of what I think the gluten came from before it was thrown away.

But at any rate, the oats seem to be going okay so far for me. Just remember that if anyone else wants to try them, you must make sure they are imported from Ireland. There are some that say "Irish Style" and some even boast that they are wheat-free - I highly recommend avoiding these anyway! Only the imported ones seem to be okay.

If anyone else does or has tried this, please let me know of your experience and reaction. Thanks!

[Coulter]

The problem isn't the structure of the oat the way it works w/ wheat, rye, barley, etc. It's the inevitable contamination due to fields that grow gluten-containing products and then oats....or due to how the grains are processed at mills. There was a study done on some mainstream brands of oats: Quaker, etc. in which they gave the average ppm of gluten in the packages. Quaker was the worst, some other companies were sometimes gf, sometimes not. Just wanted to say that it's not the structure of the oat--it's the cross-contamination

[GFSarahSmiles]

Yeah, that is my understanding too. I realize now that I didn't make that very clear, and you said pretty much what I was thinking but a lot more effectively. Thanks. And I hope it wasn't too terribly confusing to anyone else who read it.

Basically:
Here in the US oats almost always get contaminated which is why they've always said we can't have them, but they don't get contaminted in Ireland, so the assumption is that if they are imported then they are okay. The study I was reading basically described a study conducted with children which showed that most reacted to oats that were grown in the US, but not to oats that they had imported from Ireland. That was the jist of it.

If you know any more about the topic, I'm all ears. Since I am currently trying them, I'll be grateful for all the info that anyone has to offer!

[babsro]

Thanks for the information on oats. It has been confusing to me why they can't be included in a GF diet. The cross-contamination theory is interesting. I have been avoiding them, but plan to try a bit of Irish oats once I am fully stabilized. Thanks again.

[tracybperry@videotron.ca]

Greetings! To folks with celiac disease (CD), wheat sensitivity, MS, autism, and other conditions that are or may be aggravated by the gluten in wheat and cereals that are closely related to wheat.

I am writing this post in the hope that it will expand upon and clarify some of the information that has already appeared on this and a number of other CD bulletin boards and other on-line resources. This note specifically refers to CD, but, as noted above, it may be relevant to other conditions too.

During the past ten years, there has been a significant increase in interest, in both the medical and lay communities in Europe and North America, in the safety of oats consumption by people with CD. A substantial part of this interest has been based on the impression within both constituencies that if people with CD could add oats to their diets they would have a significantly improved quality of life, through improved nutrition and improved palatability.

Many medical studies addressing this issue have been conducted in Scandinavia – particularly Sweden, Norway and Finland, but also in Ireland, Italy and the Mayo Clinic in Minnesota - and the results have been published in very highly respected medical journals. Taken all together, these studies have shown that MOST, but NOT ALL (my emphasis), people with CD tolerate oats in their diets reasonably well. However, it is important to note that, because most of these studies are relatively recent, by definition there have been no long-term follow-up studies to see whether people with CD tolerate oats over very long duration. The longest-term follow-up study published to date (January, 2005) has been five years – actually low-intermediate term - and most study subjects were still in good health at the time of publication. However, it still is not known how CD people on oats will fare in the very long term, and, again by definition, this will not be known for another 50 – 80 years. The recent U.S. National Institutes of Health Consensus Development Conference on Celiac Disease (June 29-30, 2004)
( http://consensus.nih.gov/cons/118/118celiacPDF.pdf ) states on page 6, paragraph 6 that “Oats appear to be safe for use by most individuals with celiac disease, but their practical inclusion in a gluten-free diet is limited by potential contamination with gluten during processing.”

While on the subject of medical studies, I would like to address one particular very interesting and informative publication that has prompted considerable comment within the CD community, with respect to oats in the CD diet – ie the Public Library of Science (PLoS) paper by Arentz-Hansen, published on-line in October, 2004:
http://medicine.plosjournals.org/archive/1549-1676/1/1/pdf/10.1371_journal.pmed.0010001-S.pdf

I am concerned that a number of reviews of this paper published in forums of particular interest to CD people present out-of-context conclusions in a way that may mislead people with celiac disease about the safety of including oats in their diets. The problem with some of these reviews is that they interpret the results of this study in a way that conveys to many CD people – many of whom may not be critical readers - an impression that it is not safe for anybody with CD to eat oats – even if they are gluten-free.

Considering the history of the PLoS Med paper, the authors started out by publishing, in a 2003 issue of the medical journal Gut, results of their Norwegian study of 19 CD patients. They found that 5 of the 19 (26%) had increased IFN-γ levels after an oats challenge. After 1.5 years following completion of the initial part of the study, 15 subjects returned for follow-up and all 12 who had continued to consume oats during the interim had satisfactory small-intestinal histology and normal serology, and all expressed satisfaction with the addition of oats to their diets.

However, the authors were especially interested in the five who had increased IFN-γ levels, so they decided to include them in another study (the PLoS Med paper) aimed at elucidating a molecular explanation for the intolerance. This study also included four additional patients, some of whom had been consuming oats and who were referred to the authors because of “complicated celiac disease”. Of the nine, three had clinical oat intolerance and three others “eat and tolerate oats”. The authors state at the outset that “the selection of the patients was not random” and later that “this case series is thus not a consecutive series of ordinary patients with celiac disease”. The authors “…conclude that some celiac disease patients have avenin-reactive T-cells that can cause mucosal inflammation…” and that “clinical follow-up of celiac disease patients eating oats is advisable”.

They also state near the beginning that “it remains to be proven that ALL (my emphasis) celiac disease patients tolerate oats following long-term exposure” and in the discussion part of their paper that “a number of previous reports concluded that ALL (my emphasis) celiac disease patients tolerate oats”. These statements are troubling because, while they may technically be true (it DOES remain to be proven and probably will not be; “one” is a “number”) the reality is that most reports have concluded that MOST, but NOT ALL CD people tolerate gluten-free oats quite well.

The authors conclude that “oat intolerance can cause complications in the large group of celiac disease patients who are now regularly consuming oats. At this stage we do not know how frequently such complications occur. Presumably such complications will not be common, but only clinical follow-up of oats-consuming celiac disease patients will establish the frequency” (of complications).

The point here is that 1) the authors of this study specifically sought out and studied people who were known not to tolerate eating oats; 2) most, but not all CD people will be able to eat oats if they are free of cross-contamination with wheat, etc; 3) CD people who would like to include oats in their diets should consult with their physician and/or dietitian before doing so; 4) CD people who do consume oats should have regular medical follow-up.

As I have alluded above, the problem with oats in the diets of people with CD has in most cases been a result of cross-contamination with wheat, barley, rye, triticale, kamut and spelt – grains of the triticae family, of which wheat is the most prominent. This contamination is present at planting, growth, harvest, transport, storage and processing, and is very difficult to remove. As noted above, if the cross-contamination could be eliminated, most CD people probably would tolerate oats acceptably.

This leads us to a discussion of sources of un-contaminated oats. A number of web postings have addressed this issue, and sadly, it appears that at present there are few if any sources if pure oats available in North America. A recent letter to the editor published in the New England Journal of Medicine (vol. 351; no. 19; pp 2021-2022, Nov. 4, 2004) by Tricia Thompson, a registered dietitian, showed that while some containers of commercial oat products purchased off-the-shelf at various stores were gluten-free, consumers could not consistently rely on their being pure even from one manufacturer. In summary, she purchased and had tested oats made by Quaker (because they are a popular brand of oatmeal in the U.S.), Country Choice, (because they are certified organic), and McCann’s of Ireland, (because they are processed in an oats-only facility). The four different lots of Quaker oats contained from 17 to 90 times as much gluten as the maximum amount recommended for “gluten-free” labelling. The four different lots of Country Choice oats had from 6.5 to 10.5 times the recommended maximum. The four different lots of McCann’s oats had from below the limit of detection (ie almost none) to 36 times the recommended maximum. That is, for the McCann’s, three out of the four containers probably would have been OK for most CD people to eat, but the fourth contained 36 times the recommended maximum safe amount, and there is no practical way to determine which container would be safe. Thus, the conclusion is that a CD consumer could not rely on the safety of any of these brands for their own consumption.

It is important here to mention one final point about CD individuals’ use of foods that do contain substantial amounts of gluten. It appears that there is a very broad range of sensitivity to gluten among people with CD – so much so that many are not even diagnosed, while at the opposite extreme, others may experience severe abdominal discomfort from licking a postage stamp or envelope flap (the glues of which are wheat-based). Apparently, many people with diagnosed, but relatively mild, CD “cheat” and say to themselves that they will have a wheat-based pizza, a beer or something else with substantial amounts of gluten in it and suffer the (not-too-upsetting for them) consequences for a couple of days to satisfy their craving for the foods that they like. While this may provide instant gratification, it could have significant negative long-term effects such as delayed puberty, infertility, recurrent fetal loss, osteoporosis, protein calorie malnutrition, etc. Thus each affected individual should think twice before eating foods with wheat gluten in them.

Finally, for those CD people who would like to add oats to their diets, with assurance that they are free of cross-contamination, there is hope for the near future. Beth Armour and I in Montreal have developed a process for producing oat products that do not have wheat, barley, rye, triticale, kamut or spelt in them and that consistently have gluten tests that are well below the 20ppm upper limit that is accepted in many countries. We hope to have products (oat flakes for porridge and flour for baking) available by the end of March, 2005. Later, we will introduce oat-containing mixes, such as those for cookies, cakes, pancakes, etc. and prepared foods such as oatmeal cookies and granola bars. If you would like more information, please write to us at: creamhillestate@videotron.ca . We will try to answer your questions.

Most importantly, remember: Check with your physician and/or dietitian before consuming oat-containing products.