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Most patients with celiac disease can eliminate their symptoms--at a price: lifelong adherence to a gluten-free diet. This means no wheat, rye, barley, and, until recently, no oats. Then some recent studies suggested that oats did not cause the intestinal inflammation characteristic of the disease, and thus oats are now often included in the celiac disease diet. This is good news for patients coping with severe restrictions on what they can and must not eat, but a study by Ludvig Sollid and colleagues in the launch issue of PLoS Medicine suggests that oats are not safe for all patients.
Like other chronic inflammatory diseases, celiac disease is caused by a complex interplay between genetic and environmental factors, but it is better understood than most. Long believed to be a relatively rare disorder, it is now thought to affect about one in 250 people worldwide. Clinical symptoms are present in less than half of patients and vary considerably, but patients with symptomatic disease have a higher risk of developing colon cancer and lymphomas. Genetically, almost all patients have one of two predisposing HLA molecules, which determine the context in which their immune system encounters foreign antigens, including gluten proteins found in wheat and other cereals. In individuals with celiac disease, the immune system mounts an abnormal response to gluten, which is characterized by gluten-reactive intestinal T cells and by inflammation and compromised function of the small intestine.
Ludvig Sollid and colleagues applied the current understanding of celiac disease and a range of molecular pathology tools to studying the response to oats of nine patients with celiac disease. The researchers found that intolerance to oats exists at least in some patients with celiac disease, and that those patients have the same molecular reaction to oats that other patients have to wheat, barley, or rye. This strongly suggests that oats are not safe for all patients with celiac disease, but given the small number of patients and the fact that they were not randomly selected, future studies are needed to determine the frequency of oats intolerance.
Citation: Arentz-Hansen H, Fleckenstein B, Molberg O, Scott H, Koning F, et al. (2004) The Molecular Basis for Oat Intolerance in Celiac Disease Patients. PLoS Med 1 (1): e1.
CONTACT:
Ludvig Sollid
University of Oslo
Rikshospitalet
Oslo, Norway
+47-2307-3811
+47-2307-3510 (fax)
lmsollid@labmed.uio.no
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