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Why oats are not safe for most people on gluten-free diets

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Think oats are safe for your gluten-free diet because they're labeled gluten free? You might want to think again.

There is a lot of misunderstanding in the gluten free community about the safety of oats for people with Celiac Disease and gluten sensitivity. The biggest of these is the idea that as long as oats are certified gluten free, that they are automatically safe for people who can't tolerate gluten.

For a long time, oats were automatically off-limits for gluten-free diets because of the contamination issue. It was well known that oats were grown, stored, milled and packaged with wheat products are were typically very contaminated with gluten. Even oats that were labeled gluten free tended to show dangerous levels of gluten contamination in random tests.

Then businesses began designating fields, factories and packaging lines specifically for gluten-free oats. For the first time, oats were available that were supposedly safe from gluten contamination. Gluten-free blogs and cookbooks suddenly exploded with recipes calling for gluten-free oats.

However, cross-contamination was only one of the reasons people on gluten-free diets were advised to avoid consuming oats.

Oats can be dangerous for those on gluten-free diets, even gluten-free oats. Among the reasons:

  1. The protein in oats (avenin) is so similar to the protein in wheat (gluten) that the body often reacts the same to oats, even gluten free ones.
  2. A subset of people with Celiac Disease will suffer intestinal damage from any consumption of oats. Some experts put this figure as low as 5% or refer to it as "rare," while many other sources say it is about 10-15% of the Celiac population. The National Foundation for Celiac Awareness says it is 20%, or 1 in 5. There is no test to know if you're in this group other than to consume oats and see if they adversely affect your health.
  3. Even for those who are not in that highly sensitive group, there is a limit for all people with Celiac Disease and gluten sensitivities for how many oats can be consumed before health damage will occur. Note that this damage has been demonstrated for people with gluten sensitivity as well as true Celiac Disease.

About.com's Celiac Disease explains:

In numerous studies with adults and children, the majority of patients with celiac disease could tolerate limited amounts of oats. When consumed in moderation (generally no more than about half to three quarters of a cup of dry rolled oats per day for adults, a quarter of a cup per day for children), oats did not cause abdominal symptoms or prevent intestinal healing in most cases.

A small number of people with celiac disease, however, could not tolerate even pure, uncontaminated oats. In these individuals, a protein in oats called avenin triggered an immune response similar to gluten. There was no way to tell in advance which patients would be sensitive to avenins.

Note that even for those who seem to be able to consume oats, there is a limit before the oats will cause health damage. It is not even a high limit. One bowl of "gluten free" oatmeal is already past the safe limit. If you are using gluten free flour mixes that contain oat flour, the potential for extensive damage is very high.

Gluten Free Works is even less forgiving to oats, saying:

Close inspection of available medical research clearly shows that oats, even “gluten-free” oats, should not be included in the gluten-free diet at this time.

The site goes on to point out:

The controversy over oat safety is not resolved because neither the long-term effect or the actual percentage of people who are intolerant are known. Large scale studies consisting of thousands of subjects are needed to produce valid answers. Such expensive research has not been undertaken to date.

Meanwhile, oat growers, millers and manufacturers actively purvey the notion that so-called “gluten-free oats” are safe. Packaging does not contain the caveat that oats are not safe for everyone, that they should not be consumed in amounts larger than ¼ to ½ cup per day, and that the patient should be closely followed by a physician to monitor changes to their health.

Some people report that they feel fine after consuming oats, so they believe they have determined that they are in the group that can eat oats. The Gluten Free Society addresses this issue, saying:

The common response I hear back from people is – “Dr. Osborne, I don’t feel bad when I eat oatmeal.” or “My other doctor says that oatmeal is safe.” or “The package of oatmeal claims to be gluten free.”

Keep in mind the following: It is not how bad you feel after consumption that tells you whether or not you are having an inflammatory immune reaction. This type of damage can take years to manifest into symptoms. That is one of the primary reasons that most people diagnosed with gluten problems don’t get their diagnosis until later in life. The inflammatory damage builds over time, and is typically not an immediate response. The food labeling laws don’t include oatmeal because there is not a firm scientific consensus. Many claim that celiac patients react to oats only because they are cross contaminated with wheat. And although it is true that many packaged grain products are cross contaminated, non cross contaminated oats have also been shown to cause an inflammatory reaction in patients diagnosed with gluten intolerance.

When European researchers studied Celiac patients who had introduced "safe" oats into their gluten free diets, they found some patients who were significantly harmed by the oats, despite the small study. They wrote:

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 may occur.

Possibly some of these patients may have latent oat intolerance that will develop into overt disease after prolonged exposure, but this remains speculative.

Our observations demonstrate that even if oats seem to be well tolerated by many celiac disease patients, there are patients who have an intestinal T-cell response to oats. Until the prevalence of oat intolerance in celiac disease patients is established, clinical follow-up of celiac disease patients eating oats is advisable. Clinicians should be aware that 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.

The Celiac-Sprue Association weighed in by saying:

Studies continue with mixed conclusions on...whether the consumption of oats evokes an immune response in those with celiac disease and dermatitis herpetiformis. Until it can be determined if the responses that occur are due to cross-contamination in commercially processed oats, to the protein structure of the grain or to other individual differences...excluding oats is the only risk free choice for those on a gluten-free diet.

Coeliac Australia officially says:

It is recommended by the Medical Advisory Committee (MAC) for Coeliac Australia that despite the extensive medical research done in relation to oats and coeliac disease, oats should be excluded from a gluten free diet until the research is more conclusive and definitive.

About.com points out that the current medical recommendation is typically:

Most of the large celiac societies and clinical treatment centers now advise patients with celiac disease to consider adding limited amounts of pure, uncontaminated oats to their diet under a doctor's supervision.

Newly diagnosed patients, however, are advised not to eat oats until their celiac disease is well controlled (that is, their symptoms have gone away and their blood test results are normal).

In all cases, patients who add oats to their diet are advised to see their doctors three to six months later.

As one woman commented regarding the oat issue:

As a celiac whose healing was thwarted for a year due to faithfully eating those GF oats, I would be very happy to see warning labels on the oats. Such a warning could have saved me that year of misguided (and expensive) grief. After serologic confirmation that oats were the culprit, I took all my remaining unopened GF oat products to give away at a local celiac support group meeting — and no one would take them! Every member of this group avoided all oats, and rightfully so.

I fret that GF oat products, especially flour, will be used restaurants claiming to offer GF food — how can they know this is a problem if the dietary nutritional community is pushing it? It’s another unnecessary complication that threatens my healing. My local grocer has filled their GF section with GF oat products — rolled oats, granola, cookies, flour — because they have no idea what the subtleties of the diet are.

The current “wisdom” on GF oats is very misleading, and will perpetuate damage for celiacs.

I encourage you to read further on this issue and discuss the issue with your own health care provider, as well.

Here are some sites for more information:

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