Dr Jason Tye-Din What’s the issue with oats in coeliac disease?
Wilhem Dicke, the celebrated Dutch physician who identified gluten as the causative antigen in coeliac disease, first suggested that oats were one of the toxic cereals alongside wheat, rye and barley. However, later studies employing oats free of gluten contamination have failed to consistently demonstrate clinical evidence of toxicity in coeliac disease. While oats in most countries are allowed as part of the gluten free diet, lingering safety concerns remain, especially as pro-inflammatory oat avenin-specific immune responses have been identified in some people with coeliac disease. How do we resolve this striking contradiction between oats immunity on the one hand, and reassuring clinical feeding studies on the other?
Adding further urgency to this unresolved dilemma is the emerging data around the limitations of the highly restrictive gluten free diet, with lower levels of fibre and whole grain and the potential for higher rates of metabolic and cardiovascular disease. Oats offer an attractive solution for these shortcomings as they provide a good source of quality protein, resistant starch and fibre, vitamins, minerals and phytochemicals and have favourable effects on lipids, glucose and insulin profiles. For people with coeliac disease, oats could enhance the palatability and diversity of the gluten free diet to improve quality of life, improve constipation caused by low fibre intake and potentially reduce the longer-term risk of cardiovascular disease and obesity/metabolic syndrome.
We took a new approach to examining oats safety in coeliac disease. In this presentation I will discuss our research utilising controlled feeding studies of oats and, for the first time, purified oat protein (avenin) coupled with clinical and novel immune assessments in people with coeliac disease. We found purified avenin can induce striking acute adverse symptoms and pro-inflammatory immune responses in some people with coeliac disease but, reassuringly, prolonged ingestion did not cause small intestinal mucosal or clinical deterioration. These findings provide important insights into the relationship between oats immunity and their clinical effects.
Jason Tye-Din MD, FRACP, PhD is a gastroenterologist with a clinical and research interest in coeliac disease. He heads the Coeliac Research Laboratory at the Walter and Eliza Hall Institute and runs a coeliac clinic at the Royal Melbourne Hospital. His research examines gluten immunity in adults and children after oral gluten challenge. He is interested in the immune and genetic basis for coeliac disease, oats safety, how gluten tolerance is lost and developing novel diagnostics and treatments.