Celiac Disease

CD: Oats and Gluten Intolerance (2005)

• Intervention
  How does the inclusion of oats in a dietary pattern for people with celiac disease impact effectiveness and acceptability of the dietary pattern?

  • Conclusion

    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 50 g dry oats per day, is generally safe and improves compliance. 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. Further research is also needed regarding the contamination of oats by wheat, barley and rye.

  • Grade: II
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: How does the inclusion of oats in a dietary pattern for people with celiac disease impact effectiveness and acceptability of the dietary pattern?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Hardman CM, Garioch JJ, Leonard JN, Thomas HJW, Walker MM, Lortan JE, Lister A, Fry L. Absence of toxicity of oats in patients with dermatitis herpetiformis. N Engl J Med 1997; 337: 1884-7. 
      • Hoffenberg EJ, Haas J, Drescher A, Barnhurst R, Osberg I, Bao F, Eisenbarth G. A trial of oats in children with newly diagnosed celiac disease. J Pediatr 2000; 137: 361-6.
      • Hogberg L, Laurin P, Falth-Magnusson K, Grant C, Grodzinsky E, Jansson G, Ascher H, Browaldh L, Hammersjo JA, Lindberg E, Myrdal U, Stenhammar L. Oats to children with newly diagnosed celiac disease: a randomized double blind study. Gut 2004; 53:649-654.
      • Janatuinen EK, Kemppainen TA, Julkunen RJK, Kosma VM, Maki M, Heikkinen M, Uusitupa MIJ. No harm from five year ingestion of oats in celiac disease. Gut 2002; 50: 332-335. 
      • Janatuinen EK, Kemppainen TA, Pikkarainen PH, Holm KH, Kosma VM, Uusitupa MIJ, Maki M, Julkunen RJK. Lack of cellular and humoral immunological responses to oats in adults with celiac disease. Gut 2000; 46: 327-331.
      • Janatuinen EK, Pikkarainen PH, Kemppainen TA, Kosma VM, Jarvinen RMK, Uusitupa MIJ, Julkunen RJK. A comparison of diets with and without oats in adults with celiac disease. N Engl J Med 1995; 333: 1033-7.
      • Lundin KEA, Nilsen EM, Scott HG, Loberg EM, Gjoen A, Bratlie J, Skar V, Mendez E, Lovik A, Kett K. Oats induced villous atrophy in celiac disease. Gut 2003; 52: 1649-1652.
      • Peraaho M, Kaukinen K, Mustalahti K, Vuolteenaho N, Maki M, Laippala P, Collin P. Effect of an oats-containing gluten-free diet on symptoms and quality of life in celiac disease. A randomized study.  Scand J Gastroenterol 2004; 39:27-31.
      • Peraaho M, Collin P, Kaukinen L, Miettinen S, Maki M.  Oats can diversify a gluten-free diet in celiac disease and dermatitis herpetiformis. J Am Diet Assoc 2004; 104: 1148-1150.
      • Picarelli A, Di Tola M, Sabbatella L, Gabrielli F, Di Cello T, Anania MC, Mastracchio A, Silano M, De Vincenzi M. Immunologic evidence of no harmful effect of oats in celiac disease. Am J Clin Nutr 2001; 74: 137-140.
      • Reunala T, Collin P, Holm K, Pikkarainen P, Miettinen A, Vuolteenaho N, Maki M. Tolerance to oats in dermatitis herpetiformis. Gut 1998; 43: 490-493.
      • Srinivasan U, Leonard N, Jones E, Kasarda DD, Weir DG, O'Farrelly C, Feighery C. Absence of oats toxicity in adult celiac disease. BMJ 1996; 313: 1300-1301.
      • Storsrud S, Hulthen LR, Lenner RA. Beneficial effects of oats in the gluten-free diet of adults with special reference to nutrient status, symptoms and subjective experiences. Br J Nutrition 2003; 90: 101-107.
      • Thompson T. Questionable foods and the gluten-free diet: Survey of current recommendations. J Am Diet Assoc 2000; 100(4):463-465.
  • Search Plan and Results: CD: Inclusion of Oats 2007