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.