There is an abundance of research supporting oat safety in the majority of people with coeliac disease. The toxicity of oats is controversial and has led to differing recommendations as to their suitability in this group of people. Europe, Canada and the United States, do agree to the use of specially produced oats in the gluten-free diets of those with coeliac disease. This approach differs to current practice in Australia.

A study out of Finland assessed the suitability of oats after 10 years of consuming them as part of a gluten free diet for coeliac disease. It showed that about 80% of people were eating the specially produced oats. Their study did not find that the symptoms, blood antibody markers, or small bowel biopsy results differed significantly between those who ate oats long-term with coeliac disease, and those who did not. The research did conclude that those who ate oats recorded better quality of life scores.

1. Why might oats be desirable in a gluten free diet?

The texture, flavour and creaminess of oats, separates it from the quite earthy flavour of gluten free grains such as quinoa, buckwheat, sorghum, soy and other legume flours. This makes it a desirable product in breakfast cereals, snack bars and baked goods. Oats are a nutritious food packed with fibre, protein, important vitamins, minerals and antioxidants.

Below summarises the health benefits oats can add to those eating gluten free:

Fibre:

• • Gluten Free Diets commonly lack fibre. Many baked gluten free goods contain high percentages of starch or white rice flour, as these 2 options offer a taste-neutral experience vs the strong earthiness of common gluten free grains. Starch has no fibre and white rice is fibre poor.

• • Oats provide more β-glucan, a type of soluble fibre, than any other gluten free grain.

• • β -glucans form a thick gel that slows down the emptying of the stomach. This makes you feel full, which may help to control weight.

• • This gel also slows down the absorption of glucose into the blood stream. This helps to reduce blood glucose levels and regulate type 2 diabetes.

• • β -glucans can bind cholesterol and in turn lower the risk of heart disease.

• • β -glucans directly nourish the large bowel and the good bacteria living there.

• • Oat fibre helps with bowel regularity and may relieve constipation.

Other nutrients in oats:

• • Gluten free foods are often not fortified, and oats provide a necessary source of B-vitamins, magnesium and zinc, to name some of its important nutrients.

• • Oats provide carbohydrate

• • They also provide a high-quality vegetarian protein.

• • Oats, almost solely, have an anti-oxidant called avenanthramides, which may help lower blood pressure levels, by widening blood vessels to improve flow.

Growing regular oats:

Regular market oats are grown in the same soil in the season after wheat, rye or barley grains just grew there. A stray wheat plant can grow up in amongst the oats. If the same reaping equipment, storage, transport and packaging facilities have been used for all the grain types, then there are a lot of cross contact points to mix wheat, rye or barley grains in with the oats.

It has been shown that oats can contain between 1.5- 400 parts per million (ppm) of gluten from those grains.

When we look beyond the contamination of regular oats, we need to address whether the oats themselves are gluten free.

2. Are oats gluten free?

This is the crux of the debate around oats.

Some people like to teach that oats themselves are gluten free and the issue is that regularly grown oats are contaminated with wheat, rye and barley grains. So they highlight that the issue is contamination only. That is not the story that we currently teach in Australia.

Yes, regularly grown oats are contaminated with wheat, rye or barley grains (see more below), but the oat gluten itself, causes a problem for a small number of people with coeliac disease.

The oat gluten is called avenin, and has a very very different chemical structure, to wheat, rye and barley gluten.

• • Wheat, rye and barley gluten would lead to small bowel damage in everyone with coeliac disease.

• • Oat avenin gluten, has been shown to give an immune reaction in less than 10% of people with coeliac disease. Many times, this may be just inflammation, where the height of the villi is not altered, but sometimes there can be damage to the height of the villi as well. When the villi height starts to change, there is more likelihood of nutrient deficiencies from  malabsorption.

Ideally if oats were to be called gluten free you would like them to not lead to inflammation in anyone. Because they do affect a small number, Australia and New Zealand have held back from terming them gluten free.

However about 90% of people with coeliac disease are thought to be able to tolerate oats and NOT  get small bowel inflammation. There may be some in this group who get symptoms (but not bowel damage). This is because some people react with symptoms to the fibre or the fructan components in the oats.

3. How are oats specially produced for people with coeliac disease?

Internationally the term ‘GLUTEN FREE’ is used to designate the oats that people with coeliac disease can eat.  In the end product, they aim for less than 20ppm of gluten, the International food standard to label something gluten free. There are 2 current methods used to produce such oats.

1. 1. Many oats are specially produced following an ‘oat purity protocol’. This means that they are grown from pure oat seed, on land that has not grown wheat, rye or barley for at least 2 years, and the crop the farmer grows in the off season must be gluten free. Clean reaping, storage, transport and packaging facilities need to be used as well. This ensures that gluten containing grains do not mix with the oats. Samples of the oats are then tested to ensure there is no contamination of wheat, rye or barley grains within those oats. They must test to less than 20ppm of gluten.

1. 1. Some overseas companies invest in machines that sort oats to remove unsuitable grains by size or colour. The end goal being that they have less than 20ppm of gluten in the final market product.

 Only oats produced in ways to limit contamination are considered suitable for those with coeliac disease.

4. No oat or oat product is called gluten free in Australia or New Zealand.

Current food standard regulations do not allow oats to be called gluten free in Australia and New Zealand. The current terms used here to describe these specially produced oats are ‘wheat free’, ‘uncontaminated’ or ‘pure oats’.

By not calling oats ‘gluten free’ — oats, oat flour, oat milk and any other form of oat-derived ingredient, will not be found in a product labelled gluten free in Australia or New Zealand. Therefore, the gluten free food choices for those with coeliac disease who do not wish to include oats, will remain oat free.

Please note all restaurateurs and food caterers — because oats cannot be called gluten free in Australia and New Zealand — all foods produced under the description of gluten free, must remain free from oat products.

Note: The term Organic Oats — means those oats are produced only without pesticides.

Organic oats suitable for people with coeliac disease must state on the label BOTH — organic oats AND ‘pure, wheat free or uncontaminated’ oats.

Instead of this mouthful of choices, let’s continue with the term ‘pure’ oats.

5. It is your choice to include oats in your gluten free diet.

The addition of oats to a gluten free diet will be a personal choice.

If you wish to include oats, Coeliac Australia recommends this be done in conjunction with advice and support from your Gastroenterologist and healthcare team. You can find their updated position statement on oats here.

People in Australia and New Zealand can enjoy the benefit of oats in the diet by including the specially produced oats. Currently the market is small. If the product range does grow, ensure you read the ingredient labels to confirm all other ingredients used with the specially produced oats, are gluten free.

In some instances your healthcare team may feel that oats in the diet from diagnosis is a good idea, while they may suggest caution in different circumstances. Some people may be keen to embrace oats, while others are reticent, want to collect more information, or know that they can’t tolerate them.

Respect each other’s choices with this decision. The gluten free diet can be individualised to each person.

6. Oat introduction should be monitored by your healthcare team

It is strongly suggested that the addition of oats to the diet be done with the knowledge of your health care team so they can monitor your tolerance.  For the vast majority, symptomatic tolerance is a good indicator that you will tolerate oats. However, there are exceptions. This is why caution, monitoring and regular follow-up is recommended, to identify the less than 10% who genuinely react to oat avenin.

Blood tests are not good indicators of oat tolerance unfortunately.

The ideal way is to do this is by an oat challenge. This is best done after good health and villi markers have been restored, while eating a gluten free diet without oats.

• • If all is well, ‘pure’ oats can be eaten regularly (at least 5 days a week) as part of your gluten free diet.

• • In raw weight of oats — at least 50g daily for adults and 25g daily for children is suggested.

• • A small bowel biopsy is then done 3-6 months later to ensure the villous lining has not been further damaged by the oats.

This article is not intended to give personalised advice to you and your medical situation. It is a summary of the current issues surrounding pure oats in a gluten free diet for those with coeliac disease. When and IF, to add oats — and how to monitor them — is best discussed individually with your healthcare team.

7. Which oats are suitable

I teach my clients with coeliac disease that 20ppm, the international standard to label a food gluten free, is suitable for people with coeliac disease. Food Standards Australia New Zealand (FSANZ) currently has no legislation in place surrounding the production or labelling of special oats for those with coeliac disease. Advocacy around this is now taking place.

Therefore, we need to look to the international experience of 20ppm being acceptable, when we look at suitable products on the Australian shelves.

GF Gloriously Free (not gluten free) Uncontaminated Oats.

• • This Queensland company has a number of different products.

• • They respond easily to questions about their oats and how they are produced.

• • They purchase their oats from a Western Australian oat grower. 

• • This grower has an oat purity protocol in place and has built a processing plant at the oat farm in order to both grow and package oats in an environment free from wheat, rye or barley grain contamination.

• • They also test their oats. This company ensures there is no detectable gluten (<3-5ppm) in the final packaged oat product.  

• • This meets the Australian food standard for gluten free — BUT oats CANNOT be labelled gluten free in this country.

• • The GF on this product can be misread by unaware people and interpreted to be Gluten Free. Remember oat avenin is still in these oats and less than 10% of people with coeliac disease could still react to the avenin. This is why Australia is not calling oats gluten free at this time.

• • The GF on this product stands for GLORIOUSLY FREE. Restauranteurs, please don’t interpret this GF to mean that you can include these oats in products you are selling as gluten free. Please remember it is a personal choice to include oats in a gluten free diet, and food sold as gluten free should not contain oat ingredients in Australia and New Zealand.

Honest to Goodness Wheat Free Oats

• • This company says that their oats are grown and processed to ensure the entire production chain remains free of contamination of wheat, rye and barley.  

• • The product uses oats from Finland.

• • They test the oats which show no detectable gluten within the limits of the test (<3-5 ppm of gluten).

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  • They are also certified organic.

Bob’s Red Mill Wheat Free Oats:

• • This company packages oats using oat sorting machinery to remove other grains.

• • These are American grown oats that can be labelled gluten free, when sold in America.

• • This means that they contain less than 20ppm of gluten.

• • Bob’s Red Mill has re-labelled the oats as ‘wheat free’ for our Australian and New Zealand markets.

Red Tractor Wheat Free Oats:

• • Red Tractor are a group of Australian oat growers.

• • Only SOME of their products are labelled ‘wheat free’, so read your label carefully.

• • The company website claims that these 2 products are grown with strict farming protocols and are processed in facilities free from  gluten contamination.

• • However it is unclear if they  batch test and monitor contamination levels

• • Red Tractor also has a range of flavoured wheat free oats,

• • Their website says these are processed in a facility free from gluten contamination, but they omit saying they are also grown under strict farming protocols, like the above 2 products.

• • It is uncertain whether they batch test and measure contamination levels.

• • Hold off buying these flavoured versions until Coeliac Australia has completed their assessment of their products.

Splendor Gardens Organic, Pure, Wheat Free Oats:

• • Splendor Garden is a Canadian company selling organic, wheat free oats.

• • Their website says the oats are manufactured in wheat free facilities to ensure purity.

• • Because these oats can be labelled gluten free in Canada, where they are produced, this would indicate that they contain <20ppm gluten.

Carman’s Wheat Free Oats:

Carman’s wheat free oats cannot be eaten by people with coeliac disease as they carry a “May Contain” statement for rye and barley.

Don’t forget to periodically check the Coeliac Australia web site to find out which oats they are listing after their review of products.