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Recommendations Summary

CD: Inclusion of Gluten-Free Oats 2009

Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.


  • Recommendation(s)

    CD: Inclusion of Gluten-Free Oats as Tolerated

    The registered dietitian (RD) should advise individuals with celiac disease who enjoy and can tolerate gluten-free oats to gradually include them in their gluten-free dietary pattern. Research on individuals with celiac disease reports that incorporating oats uncontaminated with wheat, barley or rye at intake levels of approximately 50g dry oats per day is generally safe and improves compliance with the gluten-free dietary pattern. 

    Rating: Fair
    Conditional

    • Risks/Harms of Implementing This Recommendation

      In a small number of persons with celiac disease,  research reports that oats may cause villous atrophy,  an increase in intraepithelial lymphocytes or exacerbate dermatitis herpetiformis. 

    • Conditions of Application

      • This recommendation applies to individuals with celiac disease who enjoy and can tolerate gluten-free oats
      • Inclusion of oats requires medical supervision
      • Gluten-free oats must meet the proposed FDA definition. Oats may be labeled gluten free only if they contain less than 20 parts per million of gluten.
      • The introduction of oats may result in gastrointestinal symptoms such as diarrhea and abdominal discomfort. These symptoms may be due to an increase in fiber intake and not be a sign of intolerance to oats.

      Refer to the recommendation on Education on Food Cross-Contamination available at ada.portalxm.com/eal/template.cfm.

    • Potential Costs Associated with Application

      • Specially-manufactured gluten-free oats may be costly
      • Although costs of medical nutrition therapy (MNT) sessions and reimbursement vary, MNT sessions are essential for improved outcomes.

    • Recommendation Narrative

      • Studies have shown that incorporating oats uncontaminated with wheat, barley or rye into a gluten-free dietary pattern for people with celiac disease at intake levels of approximately 50g dry oats per day is generally safe and improves compliance (Janatuinen et al, 1995; Srinivasan et al, 1996; Hardman et al, 1997; Reunala et al, 1998; Hoffenberg et al, 2000; Janatuinen et al, 2000; Thompson, 2000; Picarelli et al, 2001; Janatuinen et al, 2002; Lundin et al, 2003; Storsrud et al, 2003; Hogberg et al, 2004; Peraaho, Collin et al, 2004; Peraaho, Kaukinen et al, 2004; Srinivasan et al, 2006)
      • However, many studies report that the introduction of oats may result in gastrointestinal symptoms such as diarrhea and abdominal discomfort. These symptoms tend to be the primary reason for study subject withdrawal. 
      • Additional adverse effects that have been reported include dermatitis herpetiformis, villous atrophy and an increased density of intraepithelial lymphocytes, indicating that some persons with celiac disease may be unable to tolerate oats.
      • Since limited research has been conducted on the similarities among those with adverse reactions to oats, further research is needed in this area.

    • Recommendation Strength Rationale

      Conclusion statement received Grade II.

    • Minority Opinions

      Consensus reached.