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Celiac Center, Beth Israel Deaconess Medical Center
Boston, MA
December 2005

The role of oats in celiac disease and the gluten-free diet remains controversial.  Based on numerous studies conducted with adults and children in Europe and the United States, it appears that the majority of individuals with CD can tolerate oats (1-4).

Oats, however, are often grown or processed with other cereals leading to cross-contamination with wheat, barley or rye. Currently, there are also very few known producers of pure gluten-free oats in North America. The American Dietetic Association recommends that those with newly diagnosed celiac disease avoid oats, and that the addition of oats be discussed with the individual’s clinician only after the intestine has healed as documented by normalization of blood work and small intestinal biopsy appearance. 

Although oats appear to be safe in the vast majority of individuals with celiac disease, there is evidence that, in some individuals, the protein in oats (avenins) in oats can trigger an immune response similar to gluten (5-6).  In addition, some people may need to avoid oats due to sensitivities or allergies, similar to other foods, such as nuts or shellfish.  For these reasons, close monitoring by a healthcare professional experienced in celiac disease is recommended during introduction of oats into a gluten free diet.

Currently, avoiding consumption of oats is recommended by the clinicians of the Celiac Center at BIDMC for newly diagnosed patients until it can be clearly demonstrated that celiac disease is well-controlled. Good control is demonstrated by the complete resolution of symptoms (diarrhea, other symptoms of malabsorption or DH skin rash) and a normal tissue transglutaminase level (IgA tTG). At that point, under physician guidance, the gradual addition of pure oats up to 50 grams/day (a little more than 1/2 cup rolled oats or ¼ cup steel oats) from a dedicated gluten-free facility may be attempted. Follow-up with the patient’s gastroenterologist should occur three to six months after the addition of oats into the gluten-free diet.

We remain optimistic that uncontaminated sources of oats will become more widely available and affordable in this country and can be a safe and useful addition to the gluten-free diet.

References:

1. Storsrud S, Olsson M, Arvidsson Lenner R, Nilsson LA, Nilsson O, Kilander A. Adult coeliac patients do tolerate large amounts of oats. Eur J Clin Nutr. 2003 Jan;57(1):163-9.
   
2.  Janatuinen EK, Pikkarainen PH, Kemppainen TA, et al. A comparison of diets with and without oats in adults with celiac disease. N Engl J Med.1995;333:1033-1037.
   
3. Hogberg L, Laurin P, Flath-Magnusson K, et al. Oats to children with newly diagnosed coeliac disease: a randomized double blind study. Gut 2004; 53:649-654.
   
4. Janatuinen EK, Pikkarainen PH, Kemppainen TA, et al. Lack of cellular and humoral immunological responses to oats in adults with coeliac disease. Gut 2000;46:327-331.
   
5. Peraaho M, Kaukinen K, Mustalahti K, Vuolteenaho N, Maki M, Laippala P, et al. Effect of an oats-containing gluten-free diet on symptoms and quality of life in coeliac disease. A randomized study. Scand J Gastroenterol. 2004, Jan;39(1):27-31.
   
6. Arentz-Hansen H, Fleckenstein B, Molberg O, Scott H, Koning F, Jung G,Roepstorff P, Lundin KE, Sollid LM. The molecular basis for oat intolerance in patients with celiac disease. PLoS Med. 2004 Oct;1(1):e1. Epub 2004. Oct 19.