Coeliac Australia’s updated position statement encourages an individual approach to the inclusion of pure oats in the gluten-free diet. The following Q&As are intended to supplement the position statement and provide additional information. Read the position statement here.
What has changed in Coeliac Australia’s advice on the suitability of oats for those with coeliac disease?
Previously, oats have not been encouraged in the gluten-free diet in Australia. We are now encouraging those with coeliac disease to proactively discuss the suitability of pure oats with their dietitian and specialist.
While it is known that a small percentage of people with coeliac disease may react to oats, there is great nutritional benefit to those who are able to tolerate them. The gluten-free diet commonly lacks fibre and other important nutrients; the addition of uncontaminated (pure) oats to a gluten-free diet can help address these inadequacies. An improvement in quality-of-life scores has also been reported in those who include pure oats in their gluten-free diet.
A small bowel biopsy pre and post challenge has previously been prescribed as an essential part of the oat challenge. While biopsies may still be appropriate in some people, it is important that there be individual discussion with your specialist and dietitian to determine the best way to monitor oat tolerance for you.
Is the gluten-free standard changing? And will Oats be permitted in ‘gluten free’ foods?
Short answer: No.
The gluten-free standard and the requirement to declare oats as an allergen in Australia and New Zealand remains unchanged. Products that contain oats cannot be labelled ‘gluten free’.
If I want to try pure oats, how should I be monitored?
There is no standard way that oat tolerance should be monitored, and internationally the approach varies. An individual approach tailored to your needs in collaboration with your specialist and dietitian is important.
What we do know:
Antibody blood tests/ serology are not a useful tool when monitoring the immune response to oats.
Overseas, symptoms (or lack thereof) are commonly used as a marker of pure oat tolerance. Further studies are required to determine whether this is an appropriate means of monitoring tolerance for all people with coeliac disease who wish to try oats. Planning is underway for further research to investigate this very area.
A biopsy may be recommended by your specialist; it is important to discuss the best approach for you with your doctor.
It is important that the entire clinical picture be examined in context; there may not be one single approach that suits every person. Importantly, you should receive relevant monitoring and follow-up care to help manage your coeliac disease.
If I want to try oats, how much should I have?
Many international guidelines do not specify the quantity of oats that should be used when first introducing them to a gluten-free diet. There is evidence to support the general safety of 50-70g of pure oats (approx. 1/2-3/4 cup of uncooked rolled oats) for the majority of adults with coeliac disease (25g for children).
The suggestion to start with smaller amounts of pure oats and gradually increase the quantity consumed is a sensible approach. This approach (along with drinking adequate water) will also help to counteract the confounding symptoms that some may experience due to an increase in fibre intake.
If it is decided that I should have a biopsy supervised oat challenge, what should this look like?
If it is decided that a biopsy monitored oat challenge is appropriate, this would involve:
- pre-challenge biopsy to obtain baseline data (this can be the biopsy done as part of normal follow -p care, or a separate biopsy done specifically for the oat challenge)
- a challenge period with pure oats (approximately 50-70g most days) for 3 months or longer
- a subsequent biopsy to confirm there is no evidence of bowel damage.
You say that up to 10% of people may react to oats – this seems like a lot
When we talk about ‘reacting’ to oats, this can refer to symptoms, subtle markers of inflammation in the blood, raised inflammatory cells and less commonly villous atrophy. The significance of some of these ‘reactions’ is not clear, hence the need for an individual approach in collaboration with your specialist and dietitian.
How can I choose / identify suitable (pure) oats?
Only specially produced oats that are free of wheat, rye and barley contamination may be suitable for those with coeliac disease.
While overseas you will find uncontaminated oats labelled as ‘gluten free’, there is no legislation in Australia mandating what uncontaminated or pure oats should be called. This can make it difficult to confidently identify oats that have been specially produced to be free of wheat, rye and barley contamination (pure oats).
Some terminology that is used includes ‘wheat free’, ‘uncontaminated’, ‘low gluten’, and ‘pure’, but the terminology is used inconsistently leading to ambiguity and confusion. For example, ‘wheat free’ may be used on a product where rye and/or barley contamination may still be an issue.
Coeliac Australia is in the process of collating information from oat producers. We will have this information available on our website so that you can make an informed decision about what oats may be suitable for you to use.
If an oat is labelled ‘organic’ does that mean it is suitable?
No, an ‘organic’ claim indicates the oat has been grown without pesticides; this in no way ensures they have been grown to be free of wheat, rye or barley contamination.
How is oat avenin different to the prolamins in wheat, rye and barley?
The term ‘gluten’ is used to describe the grain storage proteins from wheat, rye and barley that are toxic to people with coeliac disease. There is a similar protein in oats called avenin. However, oats are less toxic to people with coeliac disease because there is not much avenin in oats, and the avenin present is less likely to trigger harmful immune responses compared to wheat, rye and barley.
What does it mean when oats are labelled ‘gluten free’
The current ELISA based assay used to test for ‘gluten’ in food can measure gliadin, hordein, and secalin. A separate assay for avenin is now also available.
Food Standards Australia New Zealand (FSANZ) prohibits the use of a ‘gluten free’ claim on oat containing products. There is no suggestion that the current food code be amended to allow oats to be labelled ‘gluten free’ in Australia.
The Australian food code differs to the regulations in Europe, UK and the USA, where oats can be marketed as ‘gluten free’. More accurately, these ‘gluten-free’ oats are oats that are uncontaminated (pure) i.e., there is no measurable contamination with wheat, rye or barley.
Is gluten friendly allowed?
No, due to its ambiguity gluten friendly is not a permitted term on oats or any food product per the food code. Only ‘gluten free’ or ‘low gluten’ claims are permitted on food products. Products containing oats cannot be labelled ‘gluten free’.
Research into oats
The long-awaited study at WEHI into oat safety has now been completed. We are currently waiting for the results of this study to be published so that we can share more detail with you. A feature on oats is planned for the next edition of Gluten-Free Living magazine.
A study is also currently being mapped out to review and guide future approaches for the introduction and monitoring of those with coeliac disease who wish to trial pure oats. With this study, we hope to find answers to some of the questions that remain and guide standard practice in this space.