The Oats Conundrum

A plethora of questions surrounds patients with celiac disease, regarding the consumption of oats while following a gluten-free diet. Dr. Joseph Murray, M.D., and Jacalyn See, clinical dietitian, take an in-depth look and discuss some of the misconceptions about oats and the celiac patient.

Points to consider: In response to numerous queries concerning the use of oats in various products, the North American Society for the Study of Celiac Disease (NASSCD) has developed this statement: "Based on the available scientific evidence, the use of oats uncontaminated by wheat, barley or rye by individuals with celiac disease and dermatitis herpetiformis in North America has been endorsed by most experts. Oats can add diversity and offer many nutritional benefits to the gluten-free diet."

Oats do not naturally contain gluten. The main problem with oats in gluten-free eating is contamination during harvest and storage. Many commercial oats are processed in facilities that also process wheat, barley, and rye. The gluten in these ingredients can contaminate oats, and with most gluten intolerances, even a trace amount of gluten can cause severe discomfort. Therefore,  it has been stressed that the oats be certified as pure.

Oats contain a protein called "avenin" that has the same properties as gluten. However, adverse reactions to this oat protein are very rare. More commonly, some patients may react to the fiber content or the fermentable carbohydrates in oats, both of which can cause gas, bloating and diarrhea.

There have been extensive studies done in adults and children, and clinical reports now provide strong evidence that pure oats very rarely cause damage to the gut mucosa in people with celiac disease. Jacalyn See urges patients to check with their doctor and dietitian before introducing oats, and to start very slowly. It is important to ensure the oats are labelled gluten-free, but if there is suspicion of contamination, See advises patients to contact the FDA's MedWatch; save all packaging so that the source of contamination can be traced.

Oats are a great source of nutrients that are often lacking in the gluten-free diet, such as iron and fiber. Dr. Murray concludes that, "There is renewed hope and new opportunity for celiac disease patients to expand their diet to an area of the past where they felt uncomfortable doing so before."

Read more about the oats statement by NASSCD, here

For more information about celiac disease, visit mayoclinic.org/celiac disease

Dr. Murray is a gastroenterologist and celiac disease expert at Mayo Clinic.

Jacalyn See is a registered clinical dietitian at Mayo Clinic