The following guidelines are recommended
when starting pure and uncontaminated oats in the diet of a patient with coeliac
disease according to the Canadian Coeliac Society:
(1). The patient’s coeliac disease
should be well controlled on a gluten-free diet and the patient should have no
gastrointestinal complaints.
(2). It is recommended that adults
receive no more than 50-70 grams (1/2-3/4 cup dry rolled oats) and children
receive no more than 20-25 grams (1/4 cup) of pure uncontaminated oats daily.
(3). 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 flatulence.
These symptoms should resolve within a few days.
(4). There are case reports of
individuals with celiac disease relapsing from the consumption of pure
uncontaminated oats. Patients should be warned of this possibility. They should
discontinue the oats and contact their physician if symptoms persist.
(5). The physician or a dietitian should
review the diet to ensure that the patient is not consuming foods that contain
gluten.
(6). Screening with an IgA-tissue
transglutaminase (tTG) or IgA-endomysial antibody (EMA) may not identify the
rare patient who reacts to oats. These tests are not sufficiently sensitive for
detecting “mild” dietary indiscretions, especially over a short period of
challenge i.e. < 100-1000 mg gluten/day. A positive EMA or tTG will help
confirm oats sensitivity but a negative one will not exclude oats sensitivity.
(7). It is worthwhile rechallenging
patients if they wish to try oats again. Development of symptoms at the time of
the second challenge would strongly suggest intolerance to oats.
Extensive patient research suggests intolerance to oats occurs but is
rare. The mechanism for this is unknown.
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