Let's Talk: Oats in Celiac Disease
Avena Sativa. How could something that sounds so exotic and so esteemed be the cause of so much controversy? Avena Sativa is little more than your average oat; your average ‘gluten-free oat’ because oats are considered naturally gluten-free in many countries but they don’t necessarily stay that way. By the time oatmeal hits your bowl it may have come into contact with gluten at many stages of production.
If you’ve wondered why you still get an upset stomach, along with diarrhea, bloating or excessive gas after eating gluten-free oatmeal read on. The added fibre in your diet could be the culprit, but you might simply have an oat intolerance. An oat intolerance may be caused by the protein avenin in oats.
Oat intolerance with Celiac Disease is uncommon but it is a thing. Discussion about the safe inclusion of oats in the gluten-free diet of people with Celiac Disease continues in 2019.
Gluten is the blanket term that defines storage proteins in grains - wheat (gliadin), barley (hordein) and rye (secalin). Neither the United Kingdom nor the United States consider avenin to be gluten but Australia and Canada do even though Health Canada describes it as structurally different than the gluten in wheat, barley and rye. Read on to find out how oats are sold as gluten-free in North America.
Should Gluten-Free Oats Be Labelled Gluten-Free?
In Europe and the US, even though oats are naturally gluten-free they are at high-risk of gluten contamination because they frequently pass through the same facilities and machinery as wheat, rye and barley. The ‘Purity Protocol’ is a process in North America that stipulates oats grown on gluten-free fields are also harvested, stored, transported, and processed in gluten-free only facilities. These pure uncontaminated oats are later tested to certify that their gluten content is under 20 ppm (parts per million), the commonly accepted standard for maximum gluten content. If the oats meet ‘Purity Protocol’ standards they can legally be sold as gluten-free oats in Canada and the United States.
Coeliac* Australia follows a different practice: The Australia Food Standards Code prohibits products that contain any oats from being labelled gluten-free, and it considers ‘gluten-free’ oats equivalent to wheat-free oats (as there is no measurable contamination with wheat, rye or barley).
*Coeliac is the UK and Australian spelling.
Can Gluten-Free Oats Be Re-Added to the Gluten-Free Diet for People With Celiac Disease?
Even this subject is contentious. Groups in different countries give contrasting advice on reintroducing oats to your diet. Coeliac UK recommends introducing pure uncontaminated oats into your diet right when you are diagnosed with Celiac Disease.
But Coeliac Australia suggests reintroducing pure uncontaminated oats only (if at all) under medical supervision after a gastroscopy and a small bowel biopsy to determine if your bowel is healthy enough. A second gastroscopy and second small bowel biopsy are recommended 3 months later to help determine how the oats might affect your bowel.
The Canadian Celiac Association recommends that people with Celiac Disease wait until their celiac antibody levels have returned to normal before consuming gluten-free oats. This requires following a strict gluten-free diet for about 6 to 12 months. Blood tests are then required to measure these levels.
What Does the Latest Research Say?
In 2017, an article in the journal Gastroenterology titled, ‘Safety of Adding Oats to a Gluten-Free Diet for Patients With Celiac Disease: Systematic Review and Meta-analysis of Clinical Observational Studies’ analyzed 28 studies on adding oats to gluten-free diets. Six of the studies were randomized control trials (the highest quality studies) while the remaining studies were observational. The authors found that gluten-free oats had no effect on the symptoms, immunity or histology (the study of the microscopic structure of tissues) of patients with Celiac Disease. These results might encourage people to re-add oats to their gluten-free diets but the authors warn that the number of studies available for analysis is small, the geographic distribution is limited and the evidence is of low quality. So the results aren’t quite definitive.
So What’s All the Fuss with Gluten-free Oats Anyway?
If oats are suspect why can’t we just avoid oats if we have Celiac Disease?
Oats are whole grains which have lots of fibre (especially soluble fibre), vitamins and minerals (including B vitamins, vitamin E, iron, zinc, and magnesium), healthy fats and antioxidants. A whole grain kernel is a combination of three layers (bran, endosperm, germ) which have important nutrients that can potentially lower your risk of type 2 diabetes, heart disease, stroke, certain cancers and digestive conditions. People who avoid oats will miss out on these benefits.
Once your gut is healthy again most people with Celiac Disease can tolerate oats.
What Else Can I Eat If I’m Oat Intolerant with Celiac Disease?
Luckily, there are many other whole grain gluten-free options like wild or brown rice, cornmeal, popcorn, amaranth, sorghum, teff, buckwheat and quinoa. So, if you’re oat-intolerant and have Celiac disease you can use quinoa or buckwheat flakes to enjoy hot cereal and granola too.
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