Oats in the gluten-free diet

Many studies have been carried out on oats in the gluten-free diet over recent years and most researchers have come to the conclusion that pure, uncontaminated oats and oat products are not toxic to the majority of adults and children with coeliac disease (1, 2, 3).

However, the vast majority of oats and oats products on the market are contaminated with wheat, rye and/or barley during processing such as milling (4) which makes them unsuitable for those with coeliac disease.

There is some evidence to suggest that some people with coeliac disease may even react to pure, uncontaminated oats (5, 6).

Pure oat and oat products that are free from contamination i.e. are 'pure' oats, are listed in Appendix III of our Food & Drink Directory.

Suitability for including pure uncontaminated oats in the gluten-free diet should be considered on an individual patient basis, and patients should be closely followed up.

Including pure oats in the gluten-free diet can add variety to the diet and increase food choice. Oats are also a useful source of soluble fibre, which has been shown to be beneficial in maintaining healthy bowel function, managing hyperlipideamia and helping glycaemic control in those with diabetes for example.

The decision to include pure oats in the gluten-free diet is individual; some people prefer not to have them. Coeliac UK always refers enquirers about including uncontaminated oats in the gluten-free diet to their health care team for specific guidance based on an individual's own level of sensitivity and on going management.

Where do oats fit into allergen labelling legislation?
 
Under the current food allergen labelling directive, oats are classed as a gluten-containing cereal. This means that is oats have been used as a deliberate ingredient, it must be declared on the ingredients' list.  If a manufacturer chooses to use an allergy advice box (which is not compulsory) patients will see the term 'contains oat gluten'.

Coeliac UK position on pure, uncontaminated oats in the gluten-free diet

Coeliac UK advises any enquirer about whether to include oats into their gluten-free diet to discuss the issue specifically with their healthcare team for specific guidance and monitoring.   After discussion, many specialist doctors do advise that their patients take pure, uncontaminated oats.

One approach would be to exclude all oats initially after diagnosis, so the patient can become symptom free and achieve a 'baseline of wellness', and then to gradually re-introduce pure, uncontaminated oats at a later stage.

Monitoring your patients with coeliac serology, symptoms etc, is recommended. Continued low antibody levels months after re-introduction into the diet may offer reassurance.

References:

1. Janatuinen EK et al. No harm from five year ingestion of oats in coeliac disease. Gut 2002;50:332-335.

2. Garsed, K & Scott-Brian, B. Can oats be taken in a gluten-free diet? A systematic review. Scandinavian Journal of Gastroenterology 2007; 42(2): 171-178.

3. Hogberg L et al. Oats to children with newly diagnosed coeliac disease: a randomised double blind study. Gut 2004;53:649-654.

4. Thompson T. Contaminated oats and other gluten-free foods in the United States. Journal of the American Dietetic Association 2005;105:348.

5 Lundin, K et al; Oats induced villous atrophy in coeliac disease. Gut 2003 52:  1649-1652.

6. Haboubi NY et al; Coeliac disease and oats: a systematic review. Postgraduate Med J 2006; 82:672-678