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Subj: Arbor Clinical Nutrition Update #149: Can coeliac patients eat oats ?

Thursday, March 13, 2003 1:55:30 AM

helmant

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helmant (Dr Tony Helman)

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ARBOR CLINICAL NUTRITION UPDATES ©

 

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This week we consider recent evidence on whether patients with coeliac

 

disease can safely eat oats.

 

 

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Editorial team,

 

Arbor Clinical Nutrition Updates

 

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NUTRITION RESEARCH REVIEW

 

 

 

Study 1: Oats still OK at five year follow up

 

----------------------------

 

A five year follow up of an important clinical trial from Finland confirms

 

that people with coeliac disease can eat oats without suffering any

 

aggravation of their disease.

 

 

Subjects: In the original trial there were 45 adult subjects in the

 

experimental group (oats included with coeliac diet) and 47 in the control

 

group (coeliac diet with no oats allowed). At five year follow up there

 

were 35 in the oats group (of whom 23 were still on the experimental diet)

 

and 28 in the control group.

 

 

Method: In the original study subjects were instructed on their diet and

 

given either gluten-free cereal products or special gluten free products

 

supplemented with oats, intended to average an intake of 50-70 gm of oats/day.

 

 

Patients had clinical and nutritional assessment, anitbody titres

 

(antiendomysial, antireticulin, and antigliadin) and duodenal biopsy.

 

 

Results: There were no significant differences between the groups at the

 

five year follow up.

 

 

Reference: Gut 2002 Mar;50(3):332-5

 

 

 

 

Study 2: Biological basis for oat safety

 

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A theoretical basis for the lack of adverse affects of oats in patients

 

with coeliac disease has been suggested by a recent finding on the

 

molecular chemistry of antigen production.

 

 

Researchers from Holland found that the production of specific gluten

 

peptides from the amino acid glutamine which stimulate immune T-cell

 

activity (a part of the pathology of coeliac disease) only occurs in

 

particular glutamine residues.

 

 

This biochemical process involves the enzyme known as tissue

 

transglutaminase, and the researchers showed that the enzyme's specificity

 

for the glutamine reaction depends on the spacing between glutamine and

 

proline (the second most abundant amino acid found in gluten).

 

 

Based on their findings, they were able to develop an algorithm to predict

 

the likely immune stimulatory impact of other gluten like substances. They

 

went on to identify many similar peptides in the gluten-like compounds

 

found in barley and rye, but not in oats. This is because, in oats, these

 

compounds have a relative lack of proline.

 

 

 

Reference: J Exp Med 2002 Mar 4;195(5):643-9

 

 

COMMENTS

 

Whether or not oats should be excluded from the diet of patients with

 

coeliac disease has been debated for many years (ref.1).

 

 

It is undisputed that coealic patients should avoid the food protein

 

alpha-gliadin which is derived from wheat gluten. For a long time, it was

 

believed that this also applied to the related compounds known as secalins

 

(in barley), hordeins (in rye), and avenins (in oats) (ref 2).

 

 

However, it has also been long recognised that, from a botanical

 

perspective, oats are not as closely related within the grass family as are

 

the other three grains. Since coeliacs already have to follow a diet

 

restricting many of our most widely eaten foods, it would be very useful to

 

be able to allow them a grain as common as oats.

 

 

For years doctors have suggested that oats could be tolerated in small

 

quantities (ref. 2,3). Even the notion that the apparent lack of toxicity

 

of oats in coeliac patients is related to the low proline content of oats

 

was raised over 20 years ago (ref.4).

 

 

Howvever, talking about " small quantities " is not the same thing as saying

 

that they are safe for these patients. The first study summarised above has

 

therefore been of great importance in providing this freedom to those with

 

coeliac disease. Original results were published in 1995 (ref.5) it is

 

encouraging that at 5 year follow-up no adverse effects of any kind were

found.

 

 

Since the original study, a number of other research groups have produced

 

results which confirm the acceptability of oats for coeliacs (ref.1),

 

including in children (ref.6). The second study summarised in this issue

 

suggests a feasible mechanism for this finding.

 

 

It seems as though this issue is now settled. However, there is still a

 

concern that even if oats are safe in theory, in practice they may be

 

contaminated with those less safe grains. and that it is not easy to know

 

to what degree this occurs in any particular food (ref. 1).

 

 

For this reason amongst others, it will ultimately always be up to the

 

physician to decide each coeliac patient's tolerance to oats, based on

 

individual assessment. However, these latest findings do offer reassurance

 

that, in most cases, it should be possible to include this useful food in

 

their diet.

 

 

References:

 

1. J Am Diet Assoc 2003 Mar;103(3):376-9

 

2. Am J Clin Nutr 1999 Mar;69(3):354-65

 

3. Can Med Assoc J 1982 Nov 15;127(10):963-5

 

4. Reprod Nutr Dev 1980;20(4B):1369-77

 

5. N Engl J Med 1995 Oct 19;333(16):1033-7

 

6. J Pediatr 2000 Sep;137(3):361-6

 

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