Gluten-Free Oats: What’s the Deal?

Recording and Resources from the April 2024 Webinar

Incorporating oats into a gluten-free diet is a controversial topic in the celiac disease community, but thanks to emerging research and new recommendations from the Dietitians in Gluten and Gastrointestinal Disorders (DIGID) group and the Academy of Nutrition and Dietetics, it’s now a little bit easier to make decisions about eating gluten-free oats.

Oats are found in many gluten-free products like granola bars, cookies, baked goods, granola, veggie burgers, and cereals. Historically there have been concerns about patients with celiac disease eating oats due to cross-contact with gluten and a possible immune response leading to intestinal damage. Although oats themselves do not contain gluten, they are often grown, processed, and transported alongside wheat, barley, and rye, which do. Additionally, some patients with celiac disease report experiencing symptoms similar to a gluten exposure even when eating gluten-free oats.   

Despite these concerns, ongoing research continues to suggest that most individuals with celiac disease can tolerate moderate amounts of gluten-free oats without triggering adverse symptoms. And, although the protein in oats (avenin) is similar in structure to the gluten protein, several studies have indicated that pure, uncontaminated oats do not cause an immune response leading to intestinal damage in patients with celiac disease. (María Inés Pinto-Sánchez, et al)

The New Research

At the 2022 International Celiac Disease Symposium in Sorrento, Italy, Dr. Melinda Hardy and Dr. Jason Tye-Din, MD from Australia presented their work on oats showing that avenin in purified oats induced an acute IL-2 (a blood protein that regulates immunity) response in patients with celiac disease. However, with continued consumption over time, this response didn’t lead to any harmful effects, and no patients showed damage in their intestinal tissue. This groundbreaking evidence suggests that patients who previously experienced symptoms from gluten-free oats may develop tolerance to them with sustained intake. 

In addition to being safe for most individuals with celiac disease, oats offer various nutritional benefits. They are an excellent source of dietary fiber and are rich in vitamins, minerals, and antioxidants. Incorporating oats into a gluten-free diet can boost the overall nutritional profile of a daily diet and offer diversity in meal options. 

 

How Should a Celiac Disease Patient Incorporate Gluten-Free Oats Into Their Diet? 

When introducing oats into a gluten-free diet, it’s important to pick products that bear a gluten-free label. That label ensures that the product meets the standards of the FDA Gluten-Free Labeling rule and contains less than 20ppm gluten.  

So how do gluten-free oats get to our grocery store shelves? There are two ways that oat manufacturers can produce safe gluten-free oats:  

  1. Mechanically or optically sorted oats are sorted by a combination of machines and humans to remove errant gluten-containing grains.  
  2. Purity Protocol oats are manufactured following a set of standards designed by the company to prevent the oats from coming into contact with gluten at all stages of the manufacturing process. It’s important to note that there is no standard definition for purity protocol and the standards vary by company.  

Regardless of how the oats are produced, all gluten-free oat products must adhere to the FDA Gluten-Free Food Labeling rule and contain less than 20ppm gluten. A “certification” label is not required, as all products with a “gluten-free” label must adhere to the FDA rule.  

New Dietitian Recommendations

In 2023, the DIGID group published new recommendations to support physicians and dietitians in counseling patients with celiac disease on how to include safe oats into a gluten-free diet. Their recommendations included an algorithm to determine if gluten-free oats should be included in the diet as well as recommendations for selecting gluten-free oat products. The bottom line? According to DIGID, including gluten-free oats should be individualized to each patient, and symptoms should be monitored closely by a gastroenterologist and dietitian, including complete annual blood work.  

When you’re thinking about including gluten-free oats in your diet, remember to consider these key points:  

  • Gluten-free oats are nutritious, delicious, and can be a part of a healthy gluten-free diet.  
  • The decision to include gluten-free oats in your diet should be made with input from your doctor and dietitian.  
  • The decision to eat gluten-free oats should be based on your symptoms, serology, and intestinal healing.  
  • Only eat oat products that have a gluten-free label.  
  • If you’re eating gluten-free oat products and experiencing symptoms, speak with your doctor or dietitian.  
  • Don’t be afraid to ask questions of food manufacturers so that you feel safe eating gluten-free oats.