Prospective Study of Clinical and Histological Safety of Pure and Uncontaminated Canadian Oats in the Management of Celiac Disease

Abstract

Background: Pure oats are safe for most patients with celiac disease, but concerns regarding contamination by other grains limit their consumption. The Canadian Celiac Association recently released guidelines governing the production of pure oats. The objective was to test the safety of a product manufactured under these guidelines. Methods: Fifteen adults with established, biopsy‐confirmed celiac disease of ≥1 year duration were challenged with 350 g/wk of pure oats for 12 weeks. Symptom scores, weight, hemoglobin, ferritin, albumin, and tissue transglutaminase (tTG) were assessed at weeks 0, 6, and 12. Duodenal biopsies were obtained before and after oat challenge and assessed based on the modified Marsh–Oberhuber score. Compliance with a gluten‐free diet was monitored with random food diaries. Results: Fifteen patients completed the study and were analyzed in intention‐to‐treat and per‐protocol analyses. There were no significant changes in symptom scores, weight, hemoglobin, ferritin, or albumin during oat consumption. The tTG remained negative in all patients, and the histology scores did not significantly change during oat challenge. The only relapse occurred in a patient who became noncompliant with her gluten‐free diet. Conclusion: The findings support the safety of pure, uncontaminated oats manufactured under Canadian Celiac Association guidelines for patients with celiac disease.

The Long-Term Consumption of Oats in Celiac Disease Patients Is Safe: A Large Cross-Sectional Study

“…The fact that the histological damage was not fully healed at the one year control biopsy in up to 40% of the patients in both oats and no oats groups here does not reflect poor dietary adherence, but instead is in line with previous studies showing that, despite a strict GFD, the villous recovery often takes a considerably longer time to recover [36]. Our results are supported by studies from other groups also showing no effect of oats in recovery of the villous architecture [18,37,38,39,40]. Nevertheless, one patient in the above-mentioned Norwegian study [12] developed villous atrophy while using purified oats, and in experimental models of celiac disease, certain oat cultivars have triggered immunological responses [27].…”

ACG Clinical Guidelines: Diagnosis and Management of Celiac Disease

“…182 While in the past there has been concern that oats can cause intestinal mucosal damage in people with CD, recent evidence suggests oats that are pure and uncontaminated by other gluten containing grains can be safely ingested by most people with CD provided they are taken in limited quantities. 183–190 However there is still need for caution when introducing oats into the diet of people with CD as there is a high likelihood that commercial oats may be contaminated with gluten from other grains. 191, 192 There is also evidence that a small number of people with CD may be intolerant to pure oats and can develop an immunological response to oat avenins.…”

Celiac Disease, Wheat Allergy, and Gluten Sensitivity

“…In North America, most oats are crop rotated and milled with wheat and are therefore considered to have levels of contamination, with wheat gluten high enough to make them not acceptable for the routine GFD 9 . It is possible that pure and uncontaminated oats, made into products that contain less than 20 mg of gluten per kg of oats product, may be incorporated safely into the diet of well‐controlled adult patients with CD 10 , 11 …”