The Reliability Of Oat In Gluten – Free Diet
Compliance with a Gluten Free Diet
11/30/2020
After Celiac Diagnosis
01/26/2021
The Reliability Of Oat In Gluten – Free Diet
Most Published
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Although the symptoms of desert can vary…
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Celiac disease is an intestinal absorption problem…
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What Should Be Done After a Celiac…
There is a classic definition for celiac disease that has been used for years; “Celiac disease is a disease that occurs with sensitivity to gluten protein found in wheat, barley, rye and oats”. Whether or not the oats in the definition should be consumed by celiac patients has been a topic of debate for years. There are two reasons for this controversy: One is the oat protein avenin protein, while the other is that the oats are contaminated by gluten cross-contamination. In this article, “Where should oats be on a gluten-free diet? I will try to bring an up-to-date approach to issues such as “Should it be consumed or not?”
OAT PROTEIN: AVENİN
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Gluten; It is a mixture of gluten and prolamine (prolamines; gliadin in wheat, hordein in barley, secalin in rye) (1). The prolamine protein found in oats is avenin with different structure and properties. While the prolamine content of oats constitutes 10-15% of the total proteins, this ratio is; It is much lower than wheat (40-50%), barley (35-45%) and rye (30-50%) (2). In addition, avenins; It is digested much more easily than gliadin, secalin and hordeins (3). Structural features, distribution and arrangement of proteins in oats are completely different from those in wheat, barley, and rye (2,4). For this reason, oat proteins are separated from wheat, barley and rye proteins (4). However, although oat proteins do not form a gluten structure, some patients may show gluten-like behavior.
A study was conducted on 3 groups of individuals with celiac disease (oats consuming group, non-oats group) and non-celiac individuals (control group) to monitor the physiological changes that may occur after ingestion of the avenin protein in oats (5). As a result of the study, IgA antibody results were found to be similar between the group consuming oats and the group not consuming oats (5). For this reason, it was found that oats did not cause an increase in IgA levels in adult celiac patients, and the idea that celiac patients could tolerate oats was supported (5).
In some celiac patients, antibodies against avenin can be formed in the body by taking the avenin protein into the body. In another study aimed at evaluating anti-avenin antibodies, 116 children; They are divided into two groups as consuming an average of 15g of oats per day and not consuming (6). According to the results of the study, it was observed that no immune reaction was observed with the intake of avenin protein (6). The presence of anti-avenin antibodies at equal levels in both groups strengthens the idea that oats can be tolerated on a gluten-free diet (6).
There are studies showing that some celiac patients may develop a response to pure oats and oat avenin, albeit a very small number compared to the general celiac patient population (7). However, this situation is thought to be related to oat varieties (7).
OATS AND CROSS CONTAMINATION RISK
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Another reason why oats are known as a gluten-containing grain is; It is constantly exposed to gluten cross-contamination during the production phase, especially in the field, post-harvest transportation and due to the fact that it is produced on the same production lines with gluten-containing grains such as wheat, barley and rye (3). Due to these conditions, oats are considered a gluten-containing grain.
Studies show that commercial oats are generally processed in the same band as wheat-containing products, resulting in increased gluten exposure (7). In a large-scale study conducted in Spain, 108 oat samples (oatmeal, oatmeal and oat flakes) collected from Europe, the USA and Canada were examined (8). According to the results of the research, it was determined that 75% of the oat samples taken were contaminated with gluten (gluten content more than 20ppm) (8).
In a study conducted on 12 containers carrying oats in the United States, it was found that 9 out of 12 containers had between 23 and 1807 ppm gluten (9). This study describes the gluten exposure of oats that were not properly transported during transportation. Recent studies confirm that pure oats, which are not contaminated with gluten, can be used by celiac patients (5,6,7,10). “Health Canada” recommends the consumption of certified and approved oat products with a maximum gluten content of 20ppm and the statement that they are gluten-free in cases where celiac patients will consume oats (10). The reason for this is that gluten is found in many products that do not have the phrase “gluten-free” or “gluten free” as a result of gluten cross contamination and this has been proven by many studies (7,8,9,10).
Kodeks Alimentarius ve Türk Gıda Kodeksine göre glüten içermez ibaresi bulunan besinlerde glüten seviyesinin en fazla 20mg/kg (20ppm) olması istenmektedir(11,12). Glütensiz bir ürünün glüten seviyesinin 20mg/kg üstünde olması çapraz bulaşmaya maruz kaldığını göstermektedir.
CONCLUSION AND RECOMMENDATIONS
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Yapılan çok az çalışmada yulaf tüketiminden sonra olumsuz sonuçlar bildirilirken, birçok çalışma çölyak hastalarında yulafın tüketiminin tolere edilebildiğini ve güvenli olduğunu göstermiştir(3,6,7,9,10,13,14,15). Avrupa Çölyak Hastalığı Araştırma Derneği Kılavuzu ve Amerikan Koleji Gastroenteroloji Klinik Kılavuzu; yulafın sağlık üzerine kanıtlanmış etkileri sebebiyle, saflığından emin olunan, çapraz bulaşma riski taşımayan, ‘’glütensiz’’ ibaresi taşıyan, sertifikalı ürünlerin çölyak hastaları tarafından tüketilmesini önermektedir(13,14). Kılavuzlar, diyete yulafın eklenmesiyle birlikte bireyin hem fiziksel hem de biyolojik belirtilerinin her ihtimale karşı bir süre, dikkatli bir şekilde incelenmesi gerektiğini önermektedir(13,14). Yulaf tüketim oranları bireylerin durumuna ve vereceği biyolojik yanıtlara göre değişse de genel olarak çocuklar için günlük 20-25g yulaf tüketimi önerilirken, yetişkinler içinse 50-100g yulaf tüketimi önerilmektedir(3,4,7,10).
Dietician Can KOCAKURT
REFERENCES
1- Biesiekierski, J. R. (2017). What is gluten? Journal of Gastroenterology and Hepatology, 78-81.
2- Rasane, P., Jha, A., Sabikhi, L., Kumar, A., & Unnikrishnan, V. S. (2015). Nutritional advantages of oats and opportunities for its processing as value added foods – a review. Journal of Food Science and Technology, 662-675.
3- Gilissen, L. J., Meer, I. M., & Smulders, M. J. (2016). Why Oats Are Safe and Healthy for Celiac Disease Patients. Medical Sciences.
4- Hoffmanová, I., Sánchez, D., Szczepanková, A., & Tlaskalová-Hogenová, H. (2019). The Pros and Cons of Using Oat in a Gluten-Free Diet for Celiac Patients. Nutrients, 2345.
5- Guttormsen, V., Løvik, A., Bye, A., Bratlie, J., Mørkrid, L., & Lundin, K. E. (2008). No induction of anti-avenin IgA by oats in adult, diet-treated coeliac disease. Scandinavian Journal of Gastroenterology, 161-165.
6- Hollén, E., Peterson, K. H., Sundqvist, T., Grodzinsky, E., Högberg, L., Laurin, P.,. . . Magnusson, K.-E. (2006). Coeliac children on a gluten-free diet with or without oats display equal anti-avenin antibody titres. Scandinavian Journal of Gastroenterology, 42-47.
7- Cohen, I. S., Day, A. S., & Shaoul, R. (2019). To Be Oats or Not to Be? An Update on the Ongoing Debate on Oats for Patients With Celiac Disease. Frontiers in Pediatrics, 1-8.
8- Hernando, A., Mujico, J. R., & David Juanas, E. M. (2006). Confirmation of the cereal type in oat products highly contaminated with gluten. Journal of the American Dietetic Association, 665-666.
9- Thompson, T., Lee, A. R., & Grace, T. (2010). Gluten contamination of grains, seeds, and flours in the United States: a pilot study. Journal of the American Dietetic Association, 937-940.
10- Souza, M. C., Deschênes, M.-E., Laurencelle, S., Godet, P., Roy, C. C., & Djilali-Saiah, I. (2016). Pure Oats as Part of the Canadian Gluten-Free Diet in Celiac Disease: The Need to Revisit the Issue. Canadian journal of gastroenterology & hepatology.
11- Food, T. v. (2012, January 4). Official newspaper. Retrieved from https://www.resmigazete.gov.tr/eskiler/2012/01/20120104-8.htm
12- FAO, & WHO. (2008). STANDARD FOR FOODS FOR SPECIAL DIETARY USE FOR PERSONS INTOLERANT TO GLUTEN. Codex Alimentarius International Food Standards, (pp. 118-1979).
13- Al-Toma, A., Volta, U., Auricchio, R., Castillejo, G., Sanders, D. S., Cellier, C.,. . . Lundin, K. E. (2019). European Society for the Study of Coeliac Disease (ESsCD) guideline for coeliac disease and other gluten-related disorders. United European Gastroenterology Journal, 583–613.
14- Rubio-Tapia, A., Hill, I. D., Kelly, C. P., Calderwood, A. H., & Murray, J. A. (2013). AMERICAN COLLEGE OF GASTROENTEROLOGY CLINICAL GUIDELINE: DIAGNOSIS AND MANAGEMENT OF CELIAC DISEASE. The American journal of gastroenterology, 656-677.
15- Pinto-Sánchez, M. I., Causada-Calo, N., Bercik, P., Ford, A. C., Murray, J. A., Armstrong, D., . . . Green, P. (2017). Safety of Adding Oats to a Gluten-Free Diet for Patients With Celiac Disease: Systematic Review and Meta-analysis of Clinical and Observational Studies. Gastroenterology, 395-409
THE RELIABILITY OF OAT IN GLUTEN-FREE DIET
There is a classic definition for celiac disease that has been used for years; “Celiac disease is a disease that occurs with sensitivity to gluten protein found in wheat, barley, rye and oats”. Whether or not the oats in the definition should be consumed by celiac patients has been a topic of debate for years. There are two reasons for this controversy: One is the oat protein avenin protein, while the other is that the oats are contaminated by gluten cross-contamination. In this article, “Where should oats be on a gluten-free diet? I will try to bring an up-to-date approach to issues such as “Should it be consumed or not?”
OAT PROTEIN: AVENİN
Gluten; It is a mixture of gluten and prolamine (prolamines; gliadin in wheat, hordein in barley, secalin in rye) (1). The prolamine protein found in oats is avenin with different structure and properties. While the prolamine content of oats constitutes 10-15% of the total proteins, this ratio is; It is much lower than wheat (40-50%), barley (35-45%) and rye (30-50%) (2). In addition, avenins; It is digested much more easily than gliadin, secalin and hordeins (3). Structural features, distribution and arrangement of proteins in oats are completely different from those in wheat, barley, and rye (2,4). For this reason, oat proteins are separated from wheat, barley and rye proteins (4). However, although oat proteins do not form a gluten structure, some patients may show gluten-like behavior.
A study was conducted on 3 groups of individuals with celiac disease (oats consuming group, non-oats group) and non-celiac individuals (control group) to monitor the physiological changes that may occur after ingestion of the avenin protein in oats (5). As a result of the study, IgA antibody results were found to be similar between the group consuming oats and the group not consuming oats (5). For this reason, it was found that oats did not cause an increase in IgA levels in adult celiac patients, and the idea that celiac patients could tolerate oats was supported (5).
In some celiac patients, antibodies against avenin can be formed in the body by taking the avenin protein into the body. In another study aimed at evaluating anti-avenin antibodies, 116 children; They are divided into two groups as consuming an average of 15g of oats per day and not consuming (6). According to the results of the study, it was observed that no immune reaction was observed with the intake of avenin protein (6). The presence of anti-avenin antibodies at equal levels in both groups strengthens the idea that oats can be tolerated on a gluten-free diet (6).
There are studies showing that some celiac patients may develop a response to pure oats and oat avenin, albeit a very small number compared to the general celiac patient population (7). However, this situation is thought to be related to oat varieties (7).
OATS AND CROSS CONTAMINATION RISK
Another reason why oats are known as a gluten-containing grain is; It is constantly exposed to gluten cross-contamination during the production phase, especially in the field, post-harvest transportation and due to the fact that it is produced on the same production lines with gluten-containing grains such as wheat, barley and rye (3). Due to these conditions, oats are considered a gluten-containing grain.
Studies show that commercial oats are generally processed in the same band as wheat-containing products, resulting in increased gluten exposure (7). In a large-scale study conducted in Spain, 108 oat samples (oatmeal, oatmeal and oat flakes) collected from Europe, the USA and Canada were examined (8). According to the results of the research, it was determined that 75% of the oat samples taken were contaminated with gluten (gluten content more than 20ppm) (8).
In a study conducted on 12 containers carrying oats in the United States, it was found that 9 out of 12 containers had between 23 and 1807 ppm gluten (9). This study describes the gluten exposure of oats that were not properly transported during transportation. Recent studies confirm that pure oats, which are not contaminated with gluten, can be used by celiac patients (5,6,7,10). “Health Canada” recommends the consumption of certified and approved oat products with a maximum gluten content of 20ppm and the statement that they are gluten-free in cases where celiac patients will consume oats (10). The reason for this is that gluten is found in many products that do not have the phrase “gluten-free” or “gluten free” as a result of gluten cross contamination and this has been proven by many studies (7,8,9,10).
Kodeks Alimentarius ve Türk Gıda Kodeksine göre glüten içermez ibaresi bulunan besinlerde glüten seviyesinin en fazla 20mg/kg (20ppm) olması istenmektedir(11,12). Glütensiz bir ürünün glüten seviyesinin 20mg/kg üstünde olması çapraz bulaşmaya maruz kaldığını göstermektedir.
CONCLUSION AND RECOMMENDATIONS
Yapılan çok az çalışmada yulaf tüketiminden sonra olumsuz sonuçlar bildirilirken, birçok çalışma çölyak hastalarında yulafın tüketiminin tolere edilebildiğini ve güvenli olduğunu göstermiştir(3,6,7,9,10,13,14,15). Avrupa Çölyak Hastalığı Araştırma Derneği Kılavuzu ve Amerikan Koleji Gastroenteroloji Klinik Kılavuzu; yulafın sağlık üzerine kanıtlanmış etkileri sebebiyle, saflığından emin olunan, çapraz bulaşma riski taşımayan, ‘’glütensiz’’ ibaresi taşıyan, sertifikalı ürünlerin çölyak hastaları tarafından tüketilmesini önermektedir(13,14). Kılavuzlar, diyete yulafın eklenmesiyle birlikte bireyin hem fiziksel hem de biyolojik belirtilerinin her ihtimale karşı bir süre, dikkatli bir şekilde incelenmesi gerektiğini önermektedir(13,14). Yulaf tüketim oranları bireylerin durumuna ve vereceği biyolojik yanıtlara göre değişse de genel olarak çocuklar için günlük 20-25g yulaf tüketimi önerilirken, yetişkinler içinse 50-100g yulaf tüketimi önerilmektedir(3,4,7,10). Dietician Can KOCAKURT
THE RELIABILITY OF OAT IN GLUTEN-FREE DIET
There is a classic definition for celiac disease that has been used for years; “Celiac disease is a disease that occurs with sensitivity to gluten protein found in wheat, barley, rye and oats”. Whether or not the oats in the definition should be consumed by celiac patients has been a topic of debate for years. There are two reasons for this controversy: One is the oat protein avenin protein, while the other is that the oats are contaminated by gluten cross-contamination. In this article, “Where should oats be on a gluten-free diet? I will try to bring an up-to-date approach to issues such as “Should it be consumed or not?”
OAT PROTEIN: AVENİN
Gluten; It is a mixture of gluten and prolamine (prolamines; gliadin in wheat, hordein in barley, secalin in rye) (1). The prolamine protein found in oats is avenin with different structure and properties. While the prolamine content of oats constitutes 10-15% of the total proteins, this ratio is; It is much lower than wheat (40-50%), barley (35-45%) and rye (30-50%) (2). In addition, avenins; It is digested much more easily than gliadin, secalin and hordeins (3). Structural features, distribution and arrangement of proteins in oats are completely different from those in wheat, barley, and rye (2,4). For this reason, oat proteins are separated from wheat, barley and rye proteins (4). However, although oat proteins do not form a gluten structure, some patients may show gluten-like behavior.
A study was conducted on 3 groups of individuals with celiac disease (oats consuming group, non-oats group) and non-celiac individuals (control group) to monitor the physiological changes that may occur after ingestion of the avenin protein in oats (5). As a result of the study, IgA antibody results were found to be similar between the group consuming oats and the group not consuming oats (5). For this reason, it was found that oats did not cause an increase in IgA levels in adult celiac patients, and the idea that celiac patients could tolerate oats was supported (5).
In some celiac patients, antibodies against avenin can be formed in the body by taking the avenin protein into the body. In another study aimed at evaluating anti-avenin antibodies, 116 children; They are divided into two groups as consuming an average of 15g of oats per day and not consuming (6). According to the results of the study, it was observed that no immune reaction was observed with the intake of avenin protein (6). The presence of anti-avenin antibodies at equal levels in both groups strengthens the idea that oats can be tolerated on a gluten-free diet (6).
There are studies showing that some celiac patients may develop a response to pure oats and oat avenin, albeit a very small number compared to the general celiac patient population (7). However, this situation is thought to be related to oat varieties (7).
OATS AND CROSS CONTAMINATION RISK
Another reason why oats are known as a gluten-containing grain is; It is constantly exposed to gluten cross-contamination during the production phase, especially in the field, post-harvest transportation and due to the fact that it is produced on the same production lines with gluten-containing grains such as wheat, barley and rye (3). Due to these conditions, oats are considered a gluten-containing grain.
Studies show that commercial oats are generally processed in the same band as wheat-containing products, resulting in increased gluten exposure (7). In a large-scale study conducted in Spain, 108 oat samples (oatmeal, oatmeal and oat flakes) collected from Europe, the USA and Canada were examined (8). According to the results of the research, it was determined that 75% of the oat samples taken were contaminated with gluten (gluten content more than 20ppm) (8).
In a study conducted on 12 containers carrying oats in the United States, it was found that 9 out of 12 containers had between 23 and 1807 ppm gluten (9). This study describes the gluten exposure of oats that were not properly transported during transportation. Recent studies confirm that pure oats, which are not contaminated with gluten, can be used by celiac patients (5,6,7,10). “Health Canada” recommends the consumption of certified and approved oat products with a maximum gluten content of 20ppm and the statement that they are gluten-free in cases where celiac patients will consume oats (10). The reason for this is that gluten is found in many products that do not have the phrase “gluten-free” or “gluten free” as a result of gluten cross contamination and this has been proven by many studies (7,8,9,10).
Kodeks Alimentarius ve Türk Gıda Kodeksine göre glüten içermez ibaresi bulunan besinlerde glüten seviyesinin en fazla 20mg/kg (20ppm) olması istenmektedir(11,12). Glütensiz bir ürünün glüten seviyesinin 20mg/kg üstünde olması çapraz bulaşmaya maruz kaldığını göstermektedir.
CONCLUSION AND RECOMMENDATIONS
Yapılan çok az çalışmada yulaf tüketiminden sonra olumsuz sonuçlar bildirilirken, birçok çalışma çölyak hastalarında yulafın tüketiminin tolere edilebildiğini ve güvenli olduğunu göstermiştir(3,6,7,9,10,13,14,15). Avrupa Çölyak Hastalığı Araştırma Derneği Kılavuzu ve Amerikan Koleji Gastroenteroloji Klinik Kılavuzu; yulafın sağlık üzerine kanıtlanmış etkileri sebebiyle, saflığından emin olunan, çapraz bulaşma riski taşımayan, ‘’glütensiz’’ ibaresi taşıyan, sertifikalı ürünlerin çölyak hastaları tarafından tüketilmesini önermektedir(13,14). Kılavuzlar, diyete yulafın eklenmesiyle birlikte bireyin hem fiziksel hem de biyolojik belirtilerinin her ihtimale karşı bir süre, dikkatli bir şekilde incelenmesi gerektiğini önermektedir(13,14). Yulaf tüketim oranları bireylerin durumuna ve vereceği biyolojik yanıtlara göre değişse de genel olarak çocuklar için günlük 20-25g yulaf tüketimi önerilirken, yetişkinler içinse 50-100g yulaf tüketimi önerilmektedir(3,4,7,10).
Dietician Can KOCAKURT
REFERENCES
1- Biesiekierski, J. R. (2017). What is gluten? Journal of Gastroenterology and Hepatology, 78-81.
2- Rasane, P., Jha, A., Sabikhi, L., Kumar, A., & Unnikrishnan, V. S. (2015). Nutritional advantages of oats and opportunities for its processing as value added foods – a review. Journal of Food Science and Technology, 662-675.
3- Gilissen, L. J., Meer, I. M., & Smulders, M. J. (2016). Why Oats Are Safe and Healthy for Celiac Disease Patients. Medical Sciences.
4- Hoffmanová, I., Sánchez, D., Szczepanková, A., & Tlaskalová-Hogenová, H. (2019). The Pros and Cons of Using Oat in a Gluten-Free Diet for Celiac Patients. Nutrients, 2345.
5- Guttormsen, V., Løvik, A., Bye, A., Bratlie, J., Mørkrid, L., & Lundin, K. E. (2008). No induction of anti-avenin IgA by oats in adult, diet-treated coeliac disease. Scandinavian Journal of Gastroenterology, 161-165.
6- Hollén, E., Peterson, K. H., Sundqvist, T., Grodzinsky, E., Högberg, L., Laurin, P.,. . . Magnusson, K.-E. (2006). Coeliac children on a gluten-free diet with or without oats display equal anti-avenin antibody titres. Scandinavian Journal of Gastroenterology, 42-47.
7- Cohen, I. S., Day, A. S., & Shaoul, R. (2019). To Be Oats or Not to Be? An Update on the Ongoing Debate on Oats for Patients With Celiac Disease. Frontiers in Pediatrics, 1-8.
8- Hernando, A., Mujico, J. R., & David Juanas, E. M. (2006). Confirmation of the cereal type in oat products highly contaminated with gluten. Journal of the American Dietetic Association, 665-666.
9- Thompson, T., Lee, A. R., & Grace, T. (2010). Gluten contamination of grains, seeds, and flours in the United States: a pilot study. Journal of the American Dietetic Association, 937-940.
10- Souza, M. C., Deschênes, M.-E., Laurencelle, S., Godet, P., Roy, C. C., & Djilali-Saiah, I. (2016). Pure Oats as Part of the Canadian Gluten-Free Diet in Celiac Disease: The Need to Revisit the Issue. Canadian journal of gastroenterology & hepatology.
11- Food, T. v. (2012, January 4). Official newspaper. Retrieved from https://www.resmigazete.gov.tr/eskiler/2012/01/20120104-8.htm
12- FAO, & WHO. (2008). STANDARD FOR FOODS FOR SPECIAL DIETARY USE FOR PERSONS INTOLERANT TO GLUTEN. Codex Alimentarius International Food Standards, (pp. 118-1979).
13- Al-Toma, A., Volta, U., Auricchio, R., Castillejo, G., Sanders, D. S., Cellier, C.,. . . Lundin, K. E. (2019). European Society for the Study of Coeliac Disease (ESsCD) guideline for coeliac disease and other gluten-related disorders. United European Gastroenterology Journal, 583–613.
14- Rubio-Tapia, A., Hill, I. D., Kelly, C. P., Calderwood, A. H., & Murray, J. A. (2013). AMERICAN COLLEGE OF GASTROENTEROLOGY CLINICAL GUIDELINE: DIAGNOSIS AND MANAGEMENT OF CELIAC DISEASE. The American journal of gastroenterology, 656-677.
15- Pinto-Sánchez, M. I., Causada-Calo, N., Bercik, P., Ford, A. C., Murray, J. A., Armstrong, D., . . . Green, P. (2017). Safety of Adding Oats to a Gluten-Free Diet for Patients With Celiac Disease: Systematic Review and Meta-analysis of Clinical and Observational Studies. Gastroenterology, 395-409
