Celiac Disease Diet: Oats Intolerance Does Exist

Most patients with celiac disease can eliminate their symptoms by life-long adherence to a gluten-free diet. This means no wheat, rye, barley, and, until recently, no oats in their diet. Some recent studies suggested that oats did not cause the intestinal inflammation characteristic of celiac disease, and therefore oats are now often included in the celiac disease diet.

Celiac disease is a digestive disease that damages part of the gut (the small intestine) and interferes with absorption of nutrients from food. Patients with celiac disease do not tolerate a protein called gluten, which is found in wheat, rye, and barley.

When people with celiac disease eat foods containing gluten, their immune system responds by damaging the small intestine. The disease is quite serious in some patients, but eating a strictly gluten-free diet can eliminate all of the symptoms.

Unfortunately, wheat, barley, and rye products like flour are found in many common foods, and patients have to avoid them for the rest of their lives.

A study by Ludvig Sollid and colleagues in the October 2004 issue of PLoS Medicine suggests that oats are not safe in all cases.

The researchers applied the current understanding of celiac disease and a range of molecular pathology tools to studying the response to oats of nine patients with celiac disease.

The nine patients were not a random sample: all of them had been eating oats, and four of them had shown clinical symptoms after oats ingestion. All patients were on a gluten-free diet and ate oats that were free of contamination by other cereals.

The goal of the study was to characterize the intestinal T cell response to oats in these patients, and to relate it to clinical symptoms and intestinal biopsy results.

Three of the four patients who had reported problems after eating oats showed intestinal inflammation typical of celiac disease.

Contrary to other studies, this one demonstrates that oats intolerance does exist in some people with celiac disease. These patients have an immune reaction to oats that is similar to the reaction most celiac disease patients have to wheat, barley, and rye.

However, identical reactions were also seen in two of the patients who were clinically tolerant to oats. They had oats-reactive intestinal T cells which may or may not lead to enhanced susceptibility to oats intolerance.

Oats are not safe for all people with celiac disease, but future studies are needed to determine the frequency of oats intolerance.

Patients who eat oats as part of a gluten-free diet should discuss their diet and any symptoms with their doctors; doctors should keep in mind that patients might develop symptoms when they eat oats.

References:
(2004) Oats Intolerance in Celiac Disease. PLoS Med 1(1): e23 doi:10.1371/journal.pmed.. Copyright: © 2004 Public Library of Science. This is an open-access article distributed under the terms of the Creative Commons Attribution License.

Arentz-Hansen H, Fleckenstein B, Molberg O, Scott H, Koning F, et al. (2004) The Molecular Basis for Oat Intolerance in Patients with Celiac Disease. PLoS Med 1(1): e1 doi:10.1371/journal.pmed.. Copyright: © 2004 Arentz-Hansen et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License.

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