The CCA surveyed thousands of Canadians with celiac to see what they know about oats.
The Canadian Celiac Association (CCA) recently conducted a survey about oats, called “Oats & You.” The purpose was to gain a better understanding of what type of information individuals on a gluten-free diet received about the use of oats, as well as their current consumption of regular and gluten-free oats.
The CCA recognized the need for this survey because there appears to be great variability in the advice patients with celiac disease are being given regarding the introduction of gluten-free oats. Regular oats are frequently contaminated with wheat, rye and/or barley, and should therefore not be consumed by individuals on a gluten-free diet. However, specially produced gluten-free oats have been shown to be safe for patients with celiac disease, with no evidence that they cause additional symptoms, changes in celiac serology or duodenal histology. For more information on the safety of oats, see Health Canada’s review entitled “Celiac disease and Gluten-Free Claims on Uncontaminated Oats” as well as the CCA Professional Advisory Council Position Statement on Consumption of Oats by Individuals with Celiac Disease.
Some 3,900 respondents participated in the survey, over a period of eight days.
Characteristics of the respondents
– 80% were female
– 92% reported a diagnosis of celiac disease.
– 7.5% were under 24 years of age and 55% were over 55 year of age.
– 70% reported being on a gluten-free diet for over 5 years.
– 83% consumed gluten-free oats while 17% did not eat oats at all.
– 49% consumed oats at least a few times a week.
– 25% consumed oats a few times a month, 8% less than once a month and 17% several times per year or less.
Introduction of oats into the gluten-free diet
Approximately one-third consumed oats at the same time they started on the gluten-free diet, while 40% waited more than 1 year after initiating the diet. Unfortunately, 56% of respondents never recalled receiving specific advice about the optimal time to introduce gluten-free oats into their diet. We do not know if these individuals ever received formal dietary consultation on gluten-free diet or if the education they were provided simply did not address consumption of oats. Knowing this information would be very helpful in order to gain a better understanding of whether this essential component of gluten-free diet education is occurring regularly or not.
Symptoms related to eating oats
Not surprising, 55% developed symptoms when they ate regular oats; however, 14% also reported symptoms when consuming gluten-free oats. It should be noted that there are many different “gluten-free” oat products on the market. The sources of these oats can vary from one producer to another. (See sidebar for information on the different ways gluten-free oats are produced.)
The majority of individual with celiac disease consumed gluten-free oats. However, there are still a proportion of individuals that consumed regular oats, leading to higher risk of presenting symptoms at follow up. Education on the gluten-free diet and consumption of oats was missing in more than half of respondents, which may explain the variability on type and timing of oats introduction in our survey. The CCA strongly encourages newly diagnosed patients with celiac disease to consult with a registered dietitian with expertise in celiac disease and the gluten-free diet to ensure they consume a balanced gluten-free diet, with adequate fibre. It is also important that individuals with celiac disease consult with their physician to discuss new and/or persistent symptoms, whether they suspect possible reaction to food or other, in order to maintain optimal health. Combined efforts from the CCA, health care providers and community are needed to improve education on the gluten-free diet, including oats and timing of introduction, which is not occurring regularly.
The Professional Advisory Board of the CCA would like to again thank everyone who participated in this survey and have helped us to better inform the consumption and knowledge about oats for those with celiac disease following a gluten-free diet.
Ways of producing gluten-free oats
Some producers of gluten-free oats use a “purity protocol” which involves various steps to prevent cross-contact with gluten-containing grains. These protocols can include no gluten-containing grains grown on the land previously for at least 2-4 years, using pure uncontaminated oat seed for planting; and dedicated or cleaned equipment for seeding, harvesting, oat storage, transportation, milling and processing. Farmers are required to submit oat samples after harvesting and prior to delivering to the mill. Also, the miller conducts frequent testing of the oats during and after processing.
Mechanically/Optically Sorted Oats
Other producers use highly sophisticated mechanical and/or optical sorters to remove gluten-containing grains from regular commodity oats. These specialized equipment technologies can separate grains according to their shape, size, colour and density. Although a very high percentage of gluten-containing grains can be removed using these technologies, the complete elimination of all whole and broken kernels of gluten-containing grains from oats is not always possible. Also, the separated oats may have traces of gluten-containing grain dust. Further research is needed to investigate whether this poses a health risk.
Verification of Gluten-Free Oats
Producers may utilize various protocols for gluten testing. Regardless of the production methods, it is essential that scientifically validated gluten-testing methods and procedures are utilized. Multiple samples from various locations in the oat container need to be taken to reduce the risk of missing any possible contamination. Also, each sample should be tested in duplicate.
Published in Canadian Celiac magazine, May 2020. Lead author: Dr. Dominica Gidrewicz, CCA Professional Advisory Council
Oats Statement – 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 email@example.com
- 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
Canadian Celiac Association
May 29, 2015
Page updated: May 15, 2020