Canadian Celiac Association Professional Advisory Council position statement on consumption of oats by individuals with celiac disease
The safety of oats in individuals with celiac disease has been extensively investigated. Health Canada has reviewed the clinical evidence from numerous international studies and has concluded that the consumption of oats, uncontaminated with gluten from wheat, rye or barley, is safe for the vast majority of patients with celiac disease. A 2015 review entitled Celiac Disease and Gluten-Free Claims on Uncontaminated Oats is available on Health Canada’s web page Celiac Disease and Gluten-Free Claims on Uncontaminated Oats
Most commercially available oats in North America are contaminated with gluten-containing grains (wheat, rye, barley). This has been confirmed in various studies including one by Health Canada scientists.
We are fortunate in Canada and the USA that specially-produced pure, uncontaminated oats have been available in the marketplace for many years. These oats are grown on dedicated fields; and are harvested, stored, transported and processed in dedicated gluten-free facilities. In addition, they are accurately tested for their gluten content to be under 20 ppm. This entire process is often referred to as a purity protocol.
Health Canada’s Food and Drug Regulations include oats, along with wheat, rye, barley in the list of gluten-containing grains, so even pure, uncontaminated oats were prohibited from making a gluten-free claim. However, on May 29, 2015, the Minister of Health issued a Marketing Authorization that permits the use of gluten-free claims for specially produced oats and foods containing these oats as ingredients. The Marketing Authorization provision allows for an exemption from the Food and Drug Regulations provided these oats do not contain more than 20 parts per million (ppm) of gluten from wheat, rye, barley or their hybridized strains.
Health Canada does not specify the methods or controls oat producers should use in order to meet the Marketing Authorization requirements. Many producers of gluten-free oats use the purity protocol which has been proven to be effective. Some producers may use other methods such as mechanical and/or optical sorting to remove gluten-containing grains from oats rather than a purity protocol. The Professional Advisory Council is not aware of any published North American data that demonstrates the levels of gluten in oats that have been cleaned using mechanical and/or optical sorting.
The Marketing Authorization and other important information about oats can be found on Health Canada’s web page Gluten-Free Labelling Claims for Specially Produced Oats.
The Canadian Celiac Association supports Health Canada’s decision to allow gluten-free claims for specially produced gluten-free oats and products containing such oats. Also, the Professional Advisory Council recommends the following guidelines for individuals with celiac disease and other gluten-related disorders who wish to add pure, uncontaminated oats or oat products in their diet:
- The individual should be stabilized on the gluten-free diet and their celiac antibody levels should have normalized. This process may take 6-18 months, although there is considerable variation among individuals.
- The fibre content of an oat containing diet is often higher than the typical gluten-free diet. When adding oats to the diet, individuals may experience a change in stool pattern or mild gastrointestinal symptoms, including abdominal bloating and gas. These symptoms should resolve within a few days. Therefore, it is advised to start
with a small amount of oats per day [adults 25-70 grams (1/4-3/4 cup dry rolled oats) and children 10-25 grams (1/8-1/4 cup)] and gradually increase as tolerated.
- There are case reports of individuals with celiac disease relapsing from the consumption of pure, uncontaminated oats. Individuals should be aware of this possibility. If symptoms occur and/or persist, they should discontinue consuming oats.
- If a reaction to oats has occurred, it is worthwhile to do a re-challenge if the individual wants to try oats again. Development of symptoms at the time of the second challenge would strongly suggest intolerance to oats. Research suggests that intolerance to oats occurs but is quite rare. The mechanism for this intolerance is unknown at this time.
- A consultation with a dietitian who can carefully review the diet to ensure that the individual is not consuming foods that contain gluten is highly recommended.
- If a reaction occurs with a re-challenge of gluten-free oats, notify your physician, as well as the Canadian Food Inspection Agency (CFIA) about the reaction. The CFIA requires contact information of the individual, brand name, package size, UPC code, best before date, name and address of store where product was purchased, date of purchase and concern. See www.inspection.gc.ca or call 800-442-2342. The Canadian Celiac Association would also appreciate notification about the product details at firstname.lastname@example.org
- The safety of oats in non-celiac gluten sensitivity has not been studied. The Canadian Celiac Association will continue to monitor the scientific developments in the area of oats in celiac disease and other gluten-related disorders and will keep its members updated.
Professional Advisory Council
br>Canadian Celiac Association
br>May 29, 2015