Gluten-free Oats Research Articles

Considering a more sustainable gluten-free diet? Gluten-free cereals in European dietary practice

BackgroundThe inclusion of minor and pseudo-cereals enhances the nutritional quality of a gluten-free diet. Yet, affordability determines practical implementation. Environmental concerns should also be considered as moving towards a more sustainable diet. How do these aspects of sustainability manifest themselves in a special diet, such as gluten-free?MethodsAn international pilot survey among practicing dietitians was conducted during the Congress of The European Federation of the Associations of Dietitians (EFAD, Budapest, 2023). Respondents marked their recommendation for eight gluten-free cereals based on five criteria, including nutritional quality, accessibility/price, and climate change. Differences were analysed using Cohran’s Q and pairwise post-hoc tests (N = 38).ResultsThere were significant differences in the recommendation for cereals (p < 0.05 for each grain), with quinoa (89.5%), gluten-free oats (89.5%), rice (86.8%), and corn (65.8%) being the most recommended. Buckwheat (55.3%), millet (50.0%), amaranth (44.7%) and sorghum (26.3%) were less recommended. Although gluten-free oats were recommended overall, quinoa was recommended for its nutritional content, and rice and corn were recommended for accessibility/price. No cereal received a high recommendation for climate change.ConclusionsAccording to this pilot survey, nutritional content and accessibility/price were the most important criteria for evaluating gluten-free grains. Dietitians were willing to integrate climate change considerations into practice, but more information is needed. The recommendation for minor and pseudo-cereals contradicted the importance emphasised by the literature. Further research is needed to integrate these aspects, helping dietitians formulate recommendations.

Celiac Disease: An Academy of Nutrition and Dietetics Evidence-Based Nutrition Practice Guideline.

Celiac disease is an autoimmune disorder in which the immune system of genetically susceptible individuals elicits a reaction to gluten causing small intestine damage. If left undiagnosed and untreated, the resulting nutrition malabsorption can lead to anemia, bone disease, growth faltering, or other consequences. The condition is lifelong and lacks a cure; the only treatment is lifelong adherence to a gluten-free diet (GFD). This diet is challenging to follow and adversely influences quality of life; however, it is essential to ensure intestinal recovery and prevent future negative health consequences. The Academy of Nutrition and Dietetics convened an expert panel complemented by a celiac disease patient advocate to evaluate evidence for six topics, including medical nutrition therapy; the GFD; oat consumption; micronutrients; pro-/prebiotics; and the low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols diet. This publication outlines the Academy of Nutrition and Dietetics Evidence Analysis Library methods used to complete the systematic review and guideline development, and summarizes the recommendations and supporting evidence. The guidelines affirm that all individuals with celiac disease should follow a GFD (1C, Imperative) that may include gluten-free oats in adults (2D, Conditional). Children should follow a nutritionally adequate GFD that supports healthy growth and development (Consensus, Imperative) and does not unnecessarily restrict gluten-free oats (Consensus, Conditional). The guidelines indicate nutritional care should include routine nutritional assessment (Consensus, Imperative) and medical nutrition therapy (Consensus, Imperative). At this time, the guidelines do not support a recommendation for the addition of the low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols diet (2C, Conditional); prebiotic or probiotic supplementation (2D, Conditional); or micronutrient supplementation (in the absence of nutritional deficiency) (Consensus, Conditional). The 2021 Celiac Disease Evidence-Based Nutrition Guideline will assist registered dietitian nutritionists in providing appropriate evidence-based medical nutrition therapy to support people with celiac disease in achieving and maintaining nutritional health and avoiding adverse celiac disease consequences throughout their lives.

Gluten cross contact in oats: retrospective database analysis 2011 to 2023

It is long-established that oats are at substantial risk for cross contact with gluten-containing grain. Specially processed gluten-free oats, whether purity protocol or mechanically/optically sorted, made it possible for this grain to be included in a gluten-free diet in the U.S. Gluten Free Watchdog (GFWD) (Manchester, Massachusetts, United States) has been assessing the gluten content of labeled gluten-free foods since 2011. In 2022, there was an apparent increase in the number of oat products testing with quantifiable gluten at or above 5 mg/kg or parts per million (ppm). The purpose of the present study was to assess the levels of gluten in foods containing oats to determine if there were any trends. In this retrospective database analysis, GFWD product test reports from April 2011 to May 1, 2023 were searched using the term “oat.” The search identified 213 individual packages of food that contained the word “oat” in the ingredients list. The test results for these packages of food were reviewed. Of these, 24 (11%) tested with quantifiable gluten greater than or equal to 5 mg/kg (ppm). The percentage of oats testing with quantifiable gluten varied per year but spiked in 2022 at 35%. It is not possible to know for certain what caused this increase. The drought during the oat growing season of 2021 could be a major factor. This drought impacted oat crops in both the US and Canada and led to one of the worst oat crops going back over 150 years. One limitation of this study is that it was a retrospective analysis. Different numbers of oat products were tested each year and these were often different brands of oats and different oat formulations. To assess the level of gluten cross contact in oats going forward a much larger prospective study should be conducted.

Prevalence of vomiting and nausea and associated factors after chronic and acute gluten exposure in celiac disease

BackgroundVomiting and nausea seem to be relatively specific symptoms related to gluten ingestion in treated celiac disease. However, the overall prevalence and associated factors of these symptoms after chronic gluten exposure at celiac disease diagnosis and acute re-exposure during gluten challenge remain obscure.MethodsMedical data on 815 adult celiac disease patients were collected at diagnosis from the medical records and through supplementary interviews. An additional 74 patients underwent a three-day (10 g/day) gluten challenge (wheat, barley, rye or a combination of the three grains) while in remission. Prevalence of vomiting/nausea and associated factors were evaluated in both cohorts. A literature review was conducted to summarize earlier studies.ResultsTwenty-eight (3%) patients presented with vomiting at diagnosis. They were less often screen-detected and suffered from extra-intestinal symptoms, and had more often abdominal pain (71% vs. 49%, p = 0.021), diarrhea (61% vs. 40%, p = 0.031), weight loss (36% vs. 17%, p = 0.019) and childhood symptoms (61% vs. 33%, p = 0.002) than those without vomiting (n = 787). The groups were comparable in other clinical-demographic data and in genetic, serological, and histological findings. Short-term gluten challenge provoked vomiting/nausea in 14/74 (19%) patients. They consumed gluten-free oats less often than those without these symptoms (64% vs. 92%, p = 0.017), whereas the groups did not differ in clinical-demographic features at diagnosis, presence of comorbidities, duration of gluten-free diet, or in other symptoms or grain used ingested during the challenge. According to the literature, prevalence of vomiting/nausea at celiac disease diagnosis has varied 3–46% and during gluten challenge 13–61%.ConclusionsIn chronic gluten exposure at celiac disease diagnosis, vomiting was associated with other gastrointestinal symptoms and onset of symptoms already in childhood, whereas regular consumption of oats may increase the tolerance against vomiting/nausea after acute re-exposure in treated celiac disease.

A Novel Deep Multi-Image Object Detection Approach for Detecting Alien Barleys in Oat Fields Using RGB UAV Images

Oat products are significant parts of a healthy diet. Pure oat is gluten-free, which makes it an excellent choice for people with celiac disease. Elimination of alien cereals is important not only in gluten-free oat production but also in seed production. Detecting gluten-rich crops such as wheat, rye, and barley in an oat production field is an important initial processing step in gluten-free food industries; however, this particular step can be extremely time consuming. This article demonstrates the potential of emerging drone techniques for identifying alien barleys in an oat stand. The primary aim of this study was to develop and assess a novel machine-learning approach that automatically detects and localizes barley plants by employing drone images. An Unbiased Teacher v2 semi-supervised object-detection deep convolutional neural network (CNN) was employed to detect barley ears in drone images with a 1.5 mm ground sample distance. The outputs of the object detector were transformed into ground coordinates by employing a photogrammetric technique. The ground coordinates were analyzed with the kernel density estimate (KDE) clustering approach to form a probabilistic map of the ground locations of barley plants. The detector was trained using a dataset from a reference data production site (located in Ilmajoki, Finland) and tested using a 10% independent test data sample from the same site and a completely unseen dataset from a commercial gluten-free oats production field in Seinäjoki, Finland. In the reference data production dataset, 82.9% of the alien barley plants were successfully detected; in the independent farm test dataset, 60.5% of the ground-truth barley plants were correctly recognized. Our results establish the usefulness and importance of the proposed drone-based ultra-high-resolution red–green–blue (RGB) imaging approach for modern grain production industries.

Association of concomitant autoimmunity with the disease features and long-term treatment and health outcomes in Celiac disease.

Celiac disease (CeD) is often accompanied by other autoimmune diseases (AID). However, the association of co-existing autoimmunity with the presentation and treatment success in CeD is unclear. We investigated these issues with a large and well-defined cohort of Finnish patients. Adult CeD patients (n = 806) were collected from multiple heath care sites via nationwide recruitment. They were interviewed, underwent measurement of CeD autoantibodies, and filled out questionnaires to ascertain quality of life (PGWB) and gastrointestinal symptoms (GSRS) after a median of 9.7 years on a gluten-free diet. Data were supplemented retrospectively from patient records. The results were compared between CeD patients with and without a coexisting AID. Altogether 185 patients had CeD+AID and 621 had CeD only. At CeD diagnosis, patients with CeD+AID were older (median 42 vs. 36 years, p = 0.010) and had more joint symptoms (9.1 vs. 4.2%, p = 0.011), whereas the groups were comparable in sex, family history of CeD, other presenting symptoms, proportion of screen-detected subjects, and severity of duodenal lesion. During follow-up on gluten-free diet, CeD+AID patients experienced poorer general health (median score 12 vs. 14, p < 0.001) in PGWB, more overall gastrointestinal symptoms (2.1 vs. 1.9, p = 0.001), and constipation (2.0 vs. 1.7, p < 0.001) in GSRS, whereas there was no difference in histological and serological recovery, dietary adherence, use of gluten-free oats, smoking, and presence of regular follow-up. Co-existing AID was not significantly associated with the baseline features or with most long-term outcomes in CeD. However, the increased prevalence of gastrointestinal symptoms and reduced poorer self-perceived health during treatment indicates these patients' need for special support.

Quantification of Barley Contaminants in Gluten-Free Oats by Four Gluten ELISA Kits.

Pure oats are generally accepted to be safe for most celiac patients, and consumption of oats provides advantageous dietary fibers. However, oats can be contaminated by gluten proteins from wheat, barley, and/or rye. The analytical challenge lies in the reliability of the quantification method and how to maintain the contamination level under a gluten-free food threshold of 20 mg/kg. In this study, we investigated barley-spiked oat flour samples at four levels using four gluten ELISA kits. The largest recovery variance was with the R5 kit that gave 5–6 times overestimation; the G12 kit cross-reacted with oat proteins and gave 4–5 times overestimation at all spiked levels. The Total Gluten and Morinaga kits gave satisfactory recoveries. Total barley hordeins were isolated and characterized to be used as a common calibrator in all four kits aiming at harmonizing the results and to test the kits’ performance. Immunoblotting of total hordein isolate revealed that Total Gluten and Morinaga antibodies provided an overall detection, while R5 and G12 antibodies recognized specific hordein groups leading to a larger difference when wheat and barley were used as the calibrant. Calibration with total hordein isolate corrected the overestimation problem and decreased the variability between the four gluten kits.

Celiac Disease Management in the United Kingdom Specialist Pediatric Gastroenterology Centers-A Service Survey.

The 2012 European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) guidelines on celiac disease (CD) recommended a no-biopsy pathway (NBP) for symptomatic children with high immunoglobin A (IgA)-based anti-tissue transglutaminase (TGA-IgA) titers, positive anti-endomysial antibody and human leukocyte antigen (HLA)-DQ2/DQ8 status. We aimed to understand variations in practice amongst specialist pediatric gastroenterology centers (SPGIC) in the United Kingdom (UK). A survey questionnaire was sent to all UK SPGIC (n = 29) providing endoscopy services for CD diagnosis. It was divided into four main subgroups: analyzing diagnosis of CD through adherence to the ESPGHAN (2012) guidelines, post-diagnosis care and long-term follow-up and discharge from pediatric services. All 29 responded. NBP was implemented in 28 of 29 centers. Five of 29 centers had already stopped HLA-DQ2/DQ8 testing for NBP diagnosis. Twenty six of 29 centers were performing endoscopy on screening-identified children (mostly asymptomatic, "at-risk" patients). Diagnosis was communicated by a doctor in 65% SPGIC (n = 19). Most centers (n = 23) waited 6-12 months post-diagnosis to start gluten-free oats. Routine vitamin D supplementation was commenced by 4 of 29 centers. All centers repeated TGA-IgA to assess normalization but at varying times post-GFD. Follow-up was with a combination of doctors/dieticians (n = 26). Eleven of 29 centers discharged their patient to primary care. There was excellent uptake of ESPGHAN guidelines (2012) in the UK and adherence to guidelines is generally good. Despite published evidence and pragmatic advice from the British Society of Paediatric Gastroenterology Hepatology and Nutrition and National Institute for Health and Care Excellence, significant differences remain in diagnostic and ongoing management practice and are opportunities for research and directive evidence-based follow-up guidance.

Nutrition and Sensory Evaluation of Germinated Cereals and Pseudocereals

Our study is focused on comparison of nutritional, functional and sensory properties of buckwheat (Fagopyrum sagitatum), naked gluten-free oats (Avena sativa), and quinoa – Chilean gooseberry (Chenopodium quinoa). The input material was raw seeds of the mentioned types of cereals and pseudo-cereals, which were subjected to a germination process under defined conditions and subsequently processed into a form of dried groats or flakes. Basic nutritional parameters were determined for samples of non-germinated seeds and final products, supplemented by determination of antioxidant activity. β-Glucans were evaluated in gluten-free naked oats. Their content in the final product decreased by 43.7%, yet it reached favourable values of 2.2 g per 100 g of product. A significant increase in energy content by approximately 6.4–9.2% was found. This increase was influenced by an increase in the carbohydrate content of all final products. As with raw seeds, germinated seeds of the monitored cereals and pseudo-cereals treated by drying have a low content of fats, saturated fatty acids, sugars and they are a good source of protein and fibre. A significant increase in antioxidant activity was observed only in flakes of germinated gluten-free oats. The sensory evaluation of the final products was favourable. On drying, the germinated seeds of the examined samples acquired a brittle structure, which together with the taste was the best evaluated property of the final products. The products represent a new, nutritionally interesting alternative to regular nutrition and gluten-free diets.

Oats as a Safe Alternative to Triticeae Cereals for People Suffering from Celiac Disease? A Review.

Oats represent a promising alternative to small-grain cereals from Triticeae group (wheat, barley, rye) for persons suffering from any form of gluten intolerance, especially celiac disease (CD), since oat-specific prolamins avenins reveal generally lower gluten content and immunoreactivity. Recent studies on avenin molecular structure revealed large genetic variability in avenin sequences affecting the spectrum of gluten peptides produced by hydrolases in human digestive tract. The aim of the present review is to summarise recent knowledge obtained in laboratory studies focused on the effect of avenin-derived peptides on reactivity of crucial components of human immune system such as dendritic cells (DC) and T-cells. The other part of the review summarises the results of clinical studies with CD patients including oat products in their diet. Since different clinical studies revealed contradictory results regarding potential safety of oats for CD patients, the focus has to be directed at genetic variability in oat avenins. Identification of avenin isoforms with minimum CD immunoreactivity will open up ways leading to designing novel oat cultivars suitable for CD patients. Knowledge on immunoreactivity of gluten peptides together with breeding new oat cultivars revealing minimum avenin immunoreactivity with respect to CD as well as application of food processing technologies leading to gluten content reduction should result in development of gluten-free oats safe for celiacs.

Microbial production of essential and toxic compounds among oat-using CeD and NCGS patients

AbstractThe recent development of diagnostic methods and current well-being trend have increased the awareness of gluten-related diseases, such as celiac disease (CeD) and non-celiac gluten sensitivity (NCGS), 1% and 6 % of general population, respectively. Currently for both CeD and NCGS, the only effective treatment is a life-long gluten-free diet, which makes adequate intake of fiber challenging. Despite of improving gut function, dietary fibers promote the growth of gut beneficial microbes. They are in charge of production of numerous compounds, which are essential for human health, such as enzymes and short chain fatty acids (SCFA). Moreover, dietary fiber has an effect on ammoniacal nitrogen levels and beta-glucuronidase activity, which are harmful for human in high concentrations. Gluten-free oats are an excellent source of dietary fiber and they have exceptionally good nutritional properties.In this observational study, SCFA production, ammoniacal nitrogen levels and beta-glucuronidase activity of oat-using CeD patients, NCGS patients and healthy controls were compared. SPME-GC-MS method was developed for SCFA analysis and the other biomarkers were analyzed by spectrophotometer.There were no significant differences between groups on propionic acid and butyric acid production, only the percentage of acetic acid of total SCFAs was higher in control group compared to NCGS group, (p = 0,03). Neither was there significant differences between groups in ammonia production or beta-glucuronidase activity.It has been scientifically proven that pure oats are suitable for celiac disease and gluten-sensitive patients, but they are not commonly used outside of Scandinavia. Our results stated that oat-using CeD and NCGS patients, whose disease is in balance, have gut microbiota capable of healthy production of essential SCFAs and normal levels of harmful compounds.

Intestinal microbiota analysis supports inclusion of gluten-free oats to diet of subjects with celiac disease or gluten sensitivity

AbstractGluten-related disorders form the umbrella term for all conditions related to gluten ingestion, such as celiac disease (CeD) and non-celiac gluten sensitivity (NCGS). A life-long exclusion of gluten from diet is currently the only effective treatment in remitting the symptoms of these diseases. However, a life-long, strict GFD is challenging to maintain due to social and economic burdens. In addition, it may lead to restricted and nutritionally suboptimal diet. Thus, the possibility of using nutritious and fiber-rich oats would diversify the GFD, improving general palatability, sensory properties such as texture and fiber-content of the diet. Pure oats are being grown and produced following strict agricultural practices to minimize any contamination with other cereals. Indeed, consumption of pure, uncontaminated oats would allow a wider selection of foods for individuals with gluten related disorders. However, the inclusion of oats into GFD is not globally applied yet. The aim of this study was to evaluate the effect of daily consumption of oat products on intestinal microbiota composition and activity in subjects with gluten-related disorders. Subjects with CeD (n = 19) or NCGS (n = 10) and healthy volunteers (n = 14) were recruited to the study. Study subjects completed food diaries for four days preceding fecal sample collection. Intestinal microbiota composition was characterized using 16S MiSeq sequencing. The total energy intake was comparable between the study groups. However, NCGS subjects consumed more energy (E %) from protein and less from carbohydrates when compared to healthy controls (p = 0.025 and p = 0.045, respectively). Dietary fiber intake was relatively high in all subjects and no differences were observed between the study groups (p = 0.79). Total microbiota profiles were comparable between CeD, NCGS and healthy controls. In addition, no differences were observed in microbiota richness or diversity between the study groups. Phylum-level microbial abundances exhibited high inter-individual variation, but did not differ between the study groups. To conclude, microbiota markers demonstrated that oat consumption was safe and beneficial for subjects with CeD or NCGS. Oat consumption was shown to enrich available gluten-free diets and to increase dietary fiber intake to the recommended levels.

Manufacture of Gluten Free Oats for Gluten Compliance at the Serving Level: An Attainable Industrial Standard

Manufacture of Gluten Free Oats for Gluten Compliance at the Serving Level: An Attainable Industrial Standard

The Use of Visual Examination for Determining the Presence of Gluten-Containing Grains in Gluten Free Oats and Other Grains, Seeds, Beans, Pulses, and Legumes.

Obtaining representative test samples for antibody-based testing is challenging when analyzing whole grains for gluten. When whole grains are ground into flour for testing, confocal microscopy studies have shown that gluten tends to exist as aggregates within the starch background, making single-sample testing inaccurate and complicating the ability to arrive at an accurate average from multiple samples. In addition, whole-grain products present a unique risk to gluten free consumers, in that any contamination is localized to specific servings rather than being distributed across the product lot. This makes parts-per-million values less relevant for whole-grain products. Intact grains, seeds, beans, pulses, and legumes offer an alternative opportunity for gluten detection, in that contaminating gluten-containing grains (GCGs) are visible and identifiable to the trained eye or properly calibrated optical sorting equipment. The purpose of the current study was to determine a Gluten Free Certification Organization threshold level for the maximum number of GCGs within a kilogram of nongluten grains sold as specially processed gluten free product and to determine the feasibility of this threshold by evaluating visual examination data from two major oat processors.

Manufacture of Gluten Free Oats for Gluten Compliance at the Serving Level: An Attainable Industrial Standard.

Manufacture of Gluten Free Oats for Gluten Compliance at the Serving Level: An Attainable Industrial Standard.

Discrimination of gluten-free oats from contaminants using near infrared hyperspectral imaging technique

Oat is considered as a good addition to the gluten-free diet, but it is a challenge to keep the oats segregated from other gluten-rich grains, such as wheat, barley, and rye. Therefore, oat-processing industry demands better detection tools for identifying and screening oat grain. The research goal of this study was to investigate the potential of near infrared (NIR) hyperspectral imaging for non-destructive and accurate discrimination of oats from barley, wheat, and rye. A procedure was developed to classify six grains (oat, dehulled oat, barley, dehulled barley, wheat and rye) using NIR hyperspectral imaging in the wavelength range of 900–1700 nm coupled with multivariate data analysis. The reflectance spectra were analyzed using Principal Component Analysis (unsupervised) and Partial Least Squares Discriminant Analysis (supervised) classification models to discriminate single oat kernels. Good results of dehulled oats grain prediction (99%) were achieved using only few selected key wavelengths (1069, 1126, 1189, 1243, and 1413 nm). Our results establish that NIR hyperspectral imaging has potential for application in on-line oat grain quality control and inspection at the different stages of industrial processing.

Definition of the “Purity Protocol” for Producing Gluten‐Free Oats

Several oat processors in the United States and Canada operate under what is referred to as a Purity Protocol for the provision of gluten‐free oats. This term is derived from a Health Canada position statement that indicated that pure oats, which they defined as oats that are harvested, transported, stored, processed, and manufactured under good manufacturing practices (GMPs) to minimize the presence of gluten, can safely be consumed by some persons with celiac disease. While proprietary definitions of the appropriate GMPs have been used in industry for many years, no independent definition of the requirements to make a Purity Protocol claim has been published. This paper provides a consensus definition of the Purity Protocol requirements based on input from the four largest Purity Protocol oat processors in North America. This definition provides transparency to gluten‐free consumers and allows for auditing of a Purity Protocol claim.

The Use of Visual Examination for Determining the Presence of Gluten-Containing Grains in Gluten Free Oats and Other Grains, Seeds, Beans, Pulses, and Legumes.

Obtaining representative test samples for antibody-based testing is challenging when analyzing whole grains for gluten. When whole grains are ground into flour for testing, confocal microscopy studies have shown that gluten tends to exist as aggregates within the starch background, making single-sample testing inaccurate and complicating the ability to arrive at an accurate average from multiple samples. In addition, whole-grain products present a unique risk to gluten free consumers, in that any contamination is localized to specific servings rather than being distributed across the product lot. This makes parts-per-million values less relevant for whole-grain products. Intact grains, seeds, beans, pulses, and legumes offer an alternative opportunity for gluten detection, in that contaminating gluten-containing grains (GCGs) are visible and identifiable to the trained eye or properly calibrated optical sorting equipment. The purpose of the current study was to determine a Gluten Free Certification Organization threshold level for the maximum number of GCGs within a kilogram of nongluten grains sold as specially processed gluten free product and to determine the feasibility of this threshold by evaluating visual examination data from two major oat processors.

Celiac Disease and Gluten-Free Oats: A Canadian Position Based on a Literature Review.

This paper provides an overview of the latest scientific data related to the safety of uncontaminated oats (<20 ppm of gluten) in the diet of individuals with celiac disease (CD). It updates the previous Health Canada position posted on the Health Canada website in 2007 and a related paper published in 2009. It considers a number of recent studies published between January 2008 and January 2015. While recognizing that a few people with celiac disease seem to be clinically intolerant to oats, this review concludes that oats uncontaminated by gluten-containing cereals (wheat, rye, and barley) can be safely ingested by most patients with celiac disease and that there is no conclusive evidence that the consumption of uncontaminated or specially produced oats containing no greater than 20 ppm gluten by patients with celiac disease should be limited to a specific daily amount. However, individuals with CD should observe a stabilization phase before introducing uncontaminated oats to the gluten-free diet (GFD). Oats uncontaminated with gluten should only be introduced after all symptoms of celiac disease have resolved and the individual has been on a GFD for a minimum of 6 months. Long-term regular medical follow-up of these patients is recommended but this is no different recommendation to celiac individuals on a GFD without oats.

Oats in a strictly gluten-free diet is associated with decreased gluten intake and increased serum bilirubin

Summary Background and aims To investigate clinical, nutritional, and laboratory parameters during oats challenge and to cross-sectionally examine the levels of plasma bilirubin in a cohort of coeliac disease patients. Methods Intestinal biopsies, gastrointestinal symptom registration, standard blood tests, anthropometry, weighed food records, and calculations of nutrients and gluten were performed in 19 patients before and after oats challenge (50 g/day). To further investigate bilirubin levels, blood samples were analysed in 136 patients (82 oats consumers) and 141 healthy controls. Results Three of 19 patients developed gastrointestinal symptoms during oats challenge. Compliance with gluten-free diet was good. Dietary fibre intake increased after oats inclusion ( p p Conclusions Gluten-free oats were associated with recommended levels of dietary fibre, and calculated gluten intake was reduced by more than 50%. Gluten-free oats induced higher levels of the anti-oxidant bilirubin in treated coeliac disease patients. This may have positive health implications.