Grain Toxicity and Celiac Disease

The following extracts give an excellent understanding of grains and their effect upon celiacs or anyone following the Gluten-Free diet.


Table of Contents

Grain Toxicity Based upon Taxonomy by Don Karsada
Someone thinks Spelt is Different from Wheat by Don Karsada
Oats discussion as collected by Bill Elkus
Oats and Celiac Children by J. Murray
Wild Rice by Don Karsada
Oats activate mucosal immune response by Karoly Horvath
Grains, Seeds, and Beans as compiled by Joanne Hameister
Oct 96 update on Oats by J. Murray
Rice Vitamin Enrichment by Mike Jones
DH Article, May 20, 1998 from NEJM
Taxonomic Relationship of Major Cereal Grains from Beth McLoughlin

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Grain Toxicity Based upon Taxonomy

From: Donald D. Kasarda (kasarda@PW.USDA.GOV)
Date: August 27, 1991

Ms. Phyllis Brogden, Co-chairperson
Celiac Sprue Support Group, Greater Philadelphia Area

Dear Phyllis,

Since you, Elaine Hartsook, Mary Alice Warren, Annette Bentley, and Elaine Monarch have all asked me from time-to-time about the safety for celiac patients of some particular foods, I thought I would just put together a general statement for you covering a number of the concerns. I am supplying copies to the other group chairpersons. These are my opinions based on quite a few years of research in the area of proteins as they relate to celiac disease, but, of course, do not necessarily represent those of the Agricultural Research Service, U. S. Department of Agriculture. You may use any of the information that seems of interest in your newsletters, but if you attribute it to me, it would probably be best to indicate that the opinions are mine as a researcher and are not intended to define USDA policy.

The only plants demonstrated to have proteins that damage the small intestines of people with celiac disease are those from wheat, rye, barley, and oats (and the man-made wheat-rye cross called triticale). These species are members of the grass family and are quite closely related to one another according to various schemes of plant classification (taxonomy). However, not all members of the grass family damage the intestines of celiac patients. Rice and corn, for example, are apparently harmless.

Many other grains have not been subjected to controlled testing or to the same scrutiny as wheat, rye, barley, oats, rice, and corn in relation to celiac disease. If we accept corn and rice as safe, then members of the grass family that are more closely related to these species (on the basis of taxonomy) than to wheat are likely to be safe. Such grasses include sorghum, millet, teff, ragi, and Job's tears, which appear to be reasonably closely related to corn. In some cases, there are protein studies in support of this conclusion, although the studies are not sufficiently complete to provide more than guidance. Scientifically controlled feeding studies with celiac patients would provide a better answer. However, such studies are not likely to be carried out in the next few years because of high costs and the difficulty of obtaining patient participation (such studies would likely involve intestinal biopsy). In lieu of feeding studies, further studies of protein (and DNA) would provide the next best way to evaluate my suggestion that millet, sorghum, teff, ragi, and Job's tears are not likely to be toxic in celiac disease.

The scientific name for bread wheat is Triticum aestivum-the first part of the name defines the genus (Triticum) and the second part, the species (aestivum). Species falling in the genus Triticum are almost certain to be harmful to celiac patients. Grain proteins of these species include the various types characteristic of the gluten proteins found in bread wheats (including the alpha-gliadins) that cause damage to the small intestine in celiac disease. Some Triticum species of current concern include Triticum spelta (common names include spelt or spelta), Triticum polonicum (common names include Polish wheat, and, recently, Kawmut), and Triticum monococcum (common names include einkorn and small spelt). I recommend that celiac patients avoid grain from these species.

Rye (Secale cereale) and barley (Hordeum vulgare) are toxic in celiac disease even though these two species are less closely related to bread wheat than spelta and Kawmut. They belong to different genera, Secale and Hordeum, respectively, and lack alpha-gliadins, which may be an especially toxic fraction.

You have asked especially for my opinion regarding spelta and Kawmut. Evidently there have been anecdotal reports suggesting a lack of toxicity in celiac disease for spelta and Kawmut. Controlled tests would be necessary to draw a firm conclusion. I don't consider anecdotal reports as reliable for the following reasons.

The diagnosis, sometimes self-diagnosis, of celiac disease is occasionally made without benefit of reasonably rigorous medical or clinical tests, especially intestinal biopsy. Individuals who are "diagnosed" in this way without rigorous testing may not actually have celiac disease. Claims that particular foods cause this latter group no problems in relation to their celiac disease could cause confusion.

Furthermore, celiac patients who report no problems in the short run with spelta or Kawmut might experience relapse later. There is now adequate evidence that when celiac patients on a "gluten-free" diet (that is, a diet free of any proteins or peptides from wheat, rye, barley, and oats) have wheat reintroduced to their diets, times-to-relapse vary enormously among individuals, ranging from hours to months, or even years. And this is for wheat, presumably the most toxic of all cereal grains to celiac patients.

Additionally, the relapse may not be accompanied by obvious symptoms, but be recognized only by physicians through observation of characteristic changes in the small intestinal tissues obtained by biopsy. The reasons for the enormous variability of response times are not known. It may be speculated that they have something to do with the degree of recovery of the lining of the small intestine on a gluten-free diet, the degree of stress that the patient had been experiencing (including infections), and individual genetic differences.

As I have indicated, all known grain species that cause problems for celiac patients are members of the grass family. In plant taxonomy, the grass family belongs to the Plant Kingdom Subclass known as monocotyledonous plants (monocots). The only other grouping at the Subclass level is that of dicotyledonous plants (dicots). Some other species about which celiac patients have questions actually are dicots, which places them in very distant relationship to the grass family. Such species include buckwheat, amaranth, quinoa, and rape. The seed of the last plant listed, rape, is not eaten, but an oil is pressed from the seeds that is becoming commonly used in cooking. This oil is being marketed as canola oil. Because of their very distant relationship to the grass family and to wheat, it is highly unlikely that these dicots will contain the same type of protein sequence found in wheat proteins that causes problems for celiac patients. Of course, some quirk of evolution could have given rise in these dicots to proteins with the toxic amino acid sequence found in wheat proteins. But if such concerns were carried to a logical conclusion, celiac patients would have to exclude all plant foods from their diets. For example, buckwheat and rhubarb belong to the same plant family (Polygonaceae). If buckwheat were suspect for celiac patients, should not rhubarb, its close relation, be suspect as well?

It may be in order to caution celiac patients that they may have undesirable reactions to any of these foods-reactions that are not related to celiac disease. Allergic reactions may occur to almost any protein, but there is a great deal of individual variation in allergic reactions. Also, buckwheat, for example, has been claimed to contain a photosensitizing agent that will cause some people who have just eaten it to develop a skin rash when they are exposed to sunlight. Such reactions should be looked for, but for most people, buckwheat eaten in moderation apparently does not cause a problem. (Buckwheat is sometimes found in mixture with wheat, which of course would cause a problem for celiac patients.) It seems no more necessary for all people with celiac disease to exclude buckwheat from their diets because some celiac patients react to it than it would be for all celiac patients to exclude milk from their diets because some celiac patients have a problem with milk.

In conclusion, scientific knowledge of celiac disease, including knowledge of the proteins that cause the problem, and the grains that contain these proteins, is in a continuing state of development. There is much that remains to be done. Nevertheless, steady progress has been made over the years. As far as I know, the following statements are a valid description of the state of our knowledge:

o Spelt or spelta and Kawmut are wheats. They have proteins toxic to celiac patients and should be avoided just as bread wheat, durum wheat, rye, barley, oats and triticale should be avoided.

o Rice and corn (maize) are not toxic to celiac patients.

o Certain cereal grains, such as various millets, sorghum, teff, ragi, and Job's tears are close enough in their genetic relationship to corn to make it likely that these grains are safe for celiac patients to eat. However, significant scientific studies have not been carried out for these latter grains.

o There is no reason for celiac patients to avoid plant foods that are very distantly related to wheat. These include buckwheat, quinoa, amaranth, and rapeseed oil (canola). Some celiac patients might suffer allergies or other adverse reactions to these grains or foodstuffs made from them, but there is currently no scientific basis for saying that these allergies or adverse reactions have anything to do with celiac disease. A celiac patient may have an allergy to milk, but that does not mean that all celiac patients will have an adverse reaction to milk.

I hope this information will be helpful. Please contact me if you need further details or clarifications.

Sincerely,
Donald D. Kasarda
Research Chemist
Crop Improvement and Utilization Research Unit
KASARDA@PW.USDA.GOV

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Someone thinks Spelt is Different from Wheat

Date: Mon, 3 Jul 95
From: Donald D. Kasarda (kasarda@pw.usda.gov)

To: "Don Wiss" (donwiss@PANIX.COM)

As you say, there will always be skeptics. Spelt appears to differ from ordinary bread wheat mainly in a gene that makes the outer coat adherent (more like oats) rather than free-threshing. Some people seem to think this means Spelt is a more primitive wheat than bread wheat, but it could even be the other way around. On analysis by gel electrophoresis, the proteins appear to be almost identical to those of certain bread wheat varieties and as far as gluten proteins are concerned, the known-to-be-toxic (in celiac disease) alpha gliadin type has been found both by protein analysis and by DNA analysis in Spelt. However, allergy probably/mostly involves different proteins from the gluten proteins.

With regard to people's judgement as to whether or not they can tolerate spelt, I will relate a recent experience. An M.D. allergist called me to ask about spelt because his wife who is allergic to wheat (respiratory distress and skin weals/rash), but apparently does not have celiac disease, felt that she could tolerate spelt very well and wheat not at all. The allergist tended to agree that this seemed to be so. I said I doubted it (mentioned the 1-in-a-million chance), but figuring that even a 1-in-a-million chance can occur, decided to carry out a blind experiment with their cooperation. We made six extractions of proteins, three from different spelt varieties (obtained from the most knowledgeable spelt research station in the country--in Wooster, Ohio) and three extractions from whole wheat flour that we purchased in the supermarket. We supplied the coded samples blind to the allergist and he fed the 6 samples (about 1 per month) to his wife and noted her response. He then supplied the results to me. When I decoded the results, the times that she reacted were about 50:50 spelt/wheat and the strongest reaction, requiring a shot of epinephrine to quell the response, was to one of the spelt samples!

I haven't the slightest doubt about the harmfulness of spelt to celiac patients, but allergy is a highly variable response and, although I am doubtful, I would have to allow for a slight chance that ordinary wheat might have a protein (a non-gluten protein) that some people are allergic to that has been lost from spelt.

Don

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Oats discussion as collected by Bill Elkus

Date: Sat, 4 Nov 1995
From: Bill Elkus (Bill_Elkus@JEFCO.COM)

As promised, the following are comments from professionals on the CEL- PRO list about oats. Our own __personal__ decision from reading the NEJM article and the CEL-PRO discussion is to not yet add oats. Here are the factors which concern us:

a) Oats seem to have a particularly significant cross-contamination problem with wheat. The oats research project obtained specially pure oats which are not readily available to us, the regular celiacs of the world.

b) The NEJM study had patients with only small amounts of oats eaten per day, and only for six months. It could be that larger amounts and/or longer periods of time will show significant damage.

c) Only intestinal damage was checked. Damage can also occur in other systems of the body, and we all know that our personal feelings are not valid indications of whether a food is causing celiac-related damage.

On the other hand, newly diagnosed celiacs with flat jejunal lesion showed recovery of the mucosal architecture whether or not oats was included in the gluten-free diet. We all certainly hope that future research will validate and extend the NEJM oats study.

The listowners of CELIAC take no 'official' position on this issue -- our job is to make the information available to you so that you can make an informed decision. So here is their discussion, with minor editing and the names removed at their request, so that each of you can judge for yourself ....

The Listowners

-----Edited CEL-PRO discussion follows. ----
***Disclaimer - this is NOT medical advise, it is a general discussion of the oats issue. See your own doctor for application to your particular situation ***

~~~~~~~~~~~~~~~~~1~~~~~~~~~~~~~~~~~

I will start off the oats discussion by commenting that this is probably the single most comprehensive study of the effects of a grain on celiacs. The earlier evidence for oats as a deleterious agent in celiac disease was based a very small # of patients or case studies. reading the report in the NEJM this week would suggest that oats are safe for most uncomplicated celiacs. There are however some reservations about the study. Severe celiac disease was an exclusion, there were some drop outs in both the oats and the control groups and patients with complications were excluded. If the findings are general is able to the whole population of celiacs then it would certainly make life a lot easier.

I have a concern about whether oat flour is reliably free of contamination with barley/ wheat. Also what would happen if we challenged a celiac with high doses of oat flour, greater than the 50g used in this study. Also would oat flour protein produce any of the subtle changes seen in the rectum with enema challenge.

~~~~~~~~~~~~~~~~~2~~~~~~~~~~~~~~~~~

Here in Finland [where the NEJM study was done] there are mixed feelings about oats. Our colleagues from Kuopio have done a very good study, and in fact the study is going on. Five year follow-up results will tell us more, the authors are this autumn rebiopsing the coeliacs eating oats. Within our Celiac Disease Study Group we have discussed this, and we are going to discuss the item within the expert team of the Finnish Coeliac Society. At this point I want to say some words regarding children.

Today we are not going to allow coeliac children to eat oats. We are first going to perform a study, our ethical committee has accepted our protocol. We are also going to look at minor jejunal changes in the *normal* mucosa revealed by immunohistochemistry. Again, the oats producer will provide us the oats for the study (same deep-freezed tested batch through the whole study). If no harm is seen, oats will be accepted also for children and this is important in our country, we by tradition consume oats. Then another story is whether all oat flour products at our market are clean. This is a real practical problem and we will study this. As you probably know, in Ireland the oats was contaminated, Dr. Conleth Feighery and colleagues used in their study oats from a German producer, tested not to be wheat contaminated (from the fields and mills). The Irish study pointed at the same direction as the Finnish one (9 adult coeliacs challenged with 50 g of oats for 3 months), oats was tolerated. The authors also looked for immunological activation in the mucosa, no changes were seen (paper presented at the 8th International Congress of Mucosal Immunology, San Diego, July 1995, abstract Srinivasan et al. Oats cereal is not immunogenic in coeliac disease. Clin Immunol Immunopathol 1995;76 (part 2):S72).

~~~~~~~~~~~~~~~~~3~~~~~~~~~~~~~~~~~

I would agree with [#2 above] about caution. I would like to see the longer follow up data before telling my patients they can eat gluten. If oats have a weak deleterious effect it may take a lot longer than wheat to produce changes that are apparent on microscopy. Could the use of the gluten reduced starch have had a confounding effect on the study. The symptom scores seemed not to be very discriminatory in that the control group in remission had a similar score to the newly diagnosed celiacs.

[editors note - the Finnish study was of celiacs who consumed low- gluten wheat starch. As we know, this is an issue of considerable controversy. Many European countries consider this perfectly safe, but in the US most celiac groups do not. It the US groups are correct, then celiacs consuming wheat starch and oats might have abnormal results compared with celiacs consuming no wheat starch and no oats, but the Finnish study would not have discovered that since it compared the oats group to control group which also consumed wheat starch]

The low amount of avedin 1.2g of avedin/ 60 grams of oats is not very much by comparison and may take a lot longer to generate damage. I am uncomfortable with the conclusions of the authors that it would help compliance to give patients the oat option with the knowledge that there is only a little protein in it. Are they likely to be any more compliant or will they just add oats to their unrestricted diet. If I am going to recommend to patients that they can eat moderate amounts of oats it will be to patients who are most likely to be compliant with the dietary restrictions on wheat, barley and rye, and who will come back for follow up. These are probably not the patients likely to benefit most from easing restrictions. Five year follow up data would be more reassuring. Also the comments about purity of the oats is important to keep in mind. It would have been interesting to look at the serological markers in these patients.

~~~~~~~~~~~~~~~~~4~~~~~~~~~~~~~~~~~

I just got back from a meeting in Europe on the epidemiology of Celiac Disease. There was a big discussion within the scientific community present at the meeting about the NEJM paper on oat tolerance in CD. We all had a mixed feeling about the conclusions of the study and my position is entirely in line with [the authors of #1, #2 and #3] comments.

~~~~~~~~~~~~~~~~~5~~~~~~~~~~~~~~~~~

The results of Kuopio group published in NEJM are probably changing our dietary recommendations. [The author of #1] has recently discussed the situation in children. The study has been carried out in adults, and in adults the demand to change dietary recommendations is strong, as we have noticed during the last days.

I think adult celiac patients can switch to oats containing diet under strict follow-up. The amount of oats tolerated, the long-term effect of oats, and the importance of gliadin contamination has to be investigated, however.

I recommend to my CD patients that they should undergo gastroscopic examination 1-2 years after starting oats-containing diet. Some antecedent information of the mucosal architecture should be available as well. If not, a duodenal biopsy should be taken even before starting of oats. By this way we also can observe possible minorinflammatory changes such as an increase in IEL or alpha-beta T-cell receptor bearing lymphocytes.

If this arrangement sounds too laborious, at least a strict follow-up by physicians and dietitians are essential. The follow-up comprises general well-being, signs of malabsorption and EmA or AGA analysis.

~~~~~~~~~~~~~~~~~6~~~~~~~~~~~~~~~~~

I would agree with [author of #5] that it may be reasonable to introduce to certain well controlled and already compliant patients. 50 grams is quite a small amount and 6 months is not long. I agree that in those patients that follow up biopsy possibly including a more sensitive markers for reaction that simple architecture is needed.

However I fear that limiting intake to 50 grams, the issue of contamination, compliance with follow up will be difficult in our setting due to cost and other factors. Many patients with celiac disease have little or no follow up.

Is any one aware of the % of patients who don't follow up? This is a difficult if not impossible question in the US due to people moving, health insurance mandated changes in doctor etc.

~~~~~~~~~~~~~~~~~end~~~~~~~~~~~~~~~~~

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Oats and Celiac Children

Date: Tue, 12 Dec 1995
From: J. Murray (jomurray@BLUE.WEEG.UIOWA.EDU)

I have noticed that some people refer to using oats in celiac children as though that were generally acceptable. I do not believe that to be so. There have been some studies that have shown oats to damaging to children with celiac disease. The preliminary report in the new England journal of medicine I do not interpret as a license to eat oats for all or even many celiacs. The study looked at a small amount of specially prepared oats in adults without severe celiac disease. No conclusions can be drawn about children from this study.

I am not recommending to my patients that they can eat oats. There needs to be a lot more information available before oats can be used freely if at all by celiacs. If a patient want s to use oats I suggest that follow up biopsies would be prudent. No body knows if the antibody tests available will be sufficient for the purpose.

Joe Murray
Not medical advice

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Wild Rice

From: Donald D. Kasarda (kasarda@PW.USDA.GOV)
Date: Tue, 2 Jan, 1996

I am not personally knowledgeable about wild rice, but my previous statement still stands as follows:

"At least according to Hitchcock, Manual of the Grasses of the United States 1950, wild rice belongs to the tribe Zizanieae whereas oats belongs to the tribe Aveneae. I see no obvious relationship between wild rice and oats in Hitchcock's taxonomy."

Furthermore, in Hitchcock's taxonomy, wheat, rye, and barley are in Tribe 3, oats in Tribe 4, rice in Tribe 9, while Zizanieae is the name of Tribe 10, millets are mostly in Tribe 12, sorghum is in Tribe 13, and maize (corn) in Tribe 14. The tribe number in taxonomy has a limited relationship to evolutionary relationship, but it is moderately safe to say that species with neighboring tribe numbers are more likely to be closely related than those with more distant numbers. Of course, taxonomies are not perfect, but in the absence of detailed molecular analysis of all possible proteins from all possible species, which we are not likely to have in the foreseeable future, they are about the best we have to go on.

On the basis of Hitchcock's taxonomy then, I would say that wild rice and rice are moderately closely related (approximately as close as wheat is to oats), but both are fairly distant in relationship to wheat, rye, barley, and oats.

As usual, there is always a potential for contamination with wheat (as someone else pointed out) and there is always the problem of human sensitivity (of a different type from that responsible for celiac disease) to many different components of the diet. Some people are allergic to rice and corn and probably some are allergic to wild rice as well, possibly through IgE immunoglobulin-mediated responses (celiac disease does not seem to involve IgE antibodies in any fundamental way and may somewhat arbitrarily be distinguished from an allergy in that respect).

This is not meant to be medical advice. I am a wheat protein chemist, not an immunologist. Perhaps someone specializing in immunology will comment on the question of allergy vs. celiac disease and the extent to which they can be distinguished. If any taxonomists read the list, they may wish to comment on my interpretation of tribal relationships within the grass family (Gramineae)

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Oats activate mucosal immune response

From: Karoly Horvath, M.D. (khorvath@UMABNET.AB.UMD.EDU)
Date: Fri, 24 May 1996

There is an other work supporting that oat prolamines are not innocent for the celiac small intestine.

The Journal of Pediatric Gastroenterology and Nutrition (1996;22:414) published the abstracts of the forthcoming ESPGAN Meeting (June 4-8, Munich, Germany). Troncone et al will present their work:

"Oat prolamines activate mucosal immune response in the in vitro cultured treated coeliac mucosa"

The conclusion is that "oat prolamines are able to activate the T-cell mediated mucosal immune response in the coeliac jejunum, and represent a warning against the inclusion of oats in the diet of coeliac patients."

Karoly Horvath, M.D.
Baltimore

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Grains, Seeds, and Beans

This is a handy reference of the GF status of various grains, seeds, and beans as compiled by Joanne Hameister and edited by the Listowners.


Little scientific information is available on the safety of any grain other than wheat, barley, rye, corn and rice. Each person must determine their personal view as to the appropriateness of all other grains. Some (but not all) US celiac groups recommend the avoidance of the following group of grains, however as Don Kasarda writes (see #1 above) there is no more scientific reason to exclude these than many other "acceptable" grains and vegetables. Perhaps the reported reactions to these grains by some celiacs was due to cross-contamination rather than non-GF status.

African Millet
Aramath Amaramthas candata
Broomcorn Millet
Buckwheat Fagopyrum esculentum
Buckwheat, Rye Fagopyrum tataricum
Italian Millet
Millet
Millet, African
Millet, Broomcorn
Millet, Italian
Millet, Pearl
Millet, Spiked
Pearl Millet
Quinoa
Rye Buckwheat Fagopyrum tastaricum
Spiked Millet
Teff Eragrositis tef


Not Gluten-Free

Abyssinian Hard Wheat Triticum durum
Barley Hordeum vulgare
Bulgar (Bulgar Wheat/Nuts)
Bulgar Wheat
Durum Wheat Triticum
Einkorn Wheat Triticum monococcum
Hard Wheat, Abyssinian Triticum durum
Kamut Triticum polinicum (Pasta wheat)
Nuts, Wheat
Oats Avena stativa
Rye, Secale sereale
Semolina Triticum
Spelt Triticum spelta
Triticale X triticosecale
Wheat Triticum aestivum
Wheat Nuts
Wheat, Abyssinian Hard triticum
Wheat, Blugar
Wheat Durum Triticum
Wheat, Einkon Triticum mononoccum


Traditionally considered Gluten-Free by Celiac Support Groups

Acorn Quercus Prinus/emoroyi/lobata
Adzuki Bean
Almond Nut Prunus amygdalus
Arrowroot Maranta arundinacea
Artichokes Articiocco
Bean
Bean, Adzuki
Bean, Hyacinth
Bean, Lentil
Bean, Mung
Bean Romano (Chickpea)
Bean Tepary
Besan (Chickpea)
Carageenan Chondrus crispus
Cassava Manihot esculenta
Chickpea
Corn Zea mays
Cornmeal Zea mays
Cornstarch Zea mays
Cowitch
Cowpea
Flax Usitatissimum linn
Grits, Corn Zea mays
Hyacinth bean
Lentil
Maize Zea mays
Maize, Waxy Zea mays
Manioc Manihot esculenta
Mung Bean
Nut, Acron Quercus prinus/emoroyi/lobata
Nut, Almond Prunus amygdalusm
Pea
Pea, Chick
Pea, Cow
Pea, Pigeon
Pigeon, Pea
Potatos Solanum tuberosum
Rice Oryza zativa
Rice, Wold Oryza fatua/spontanea
Romano Bean (chickpea)
Sago Palm metroxylon sagus
Seed, Sesame
Seed, Sunflower
Sesame Seed
Sorghum Sorgo soreg/L.syricus
Soy Glycine max
Soya Glycine max
Soybean Glycine max
Sunflower seed
Tapioca Manihot esculenta
Tepary Bean
Waxy Maize Zea mays
Wild Rice Oryza fatua/spontanea

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Oct 96 update on Oats by J. Murray

Dr Joseph was asked for an update on the status of using oats in the GF diet, follows are his comments to the Tri-County Celiac Sprue Support Group.

A lot of time was devoted to the oats question at the Tampere conference. As you know, there was a Finnish study published in the New England Journal of Medicine doing a six-month follow-up on patients with CD that had been eating oats. The study compared their intestinal biopsies after six months with CD patients on a regular GF diet. Note that in this case GF has a different meaning, because they allow wheat starch as part of the GF diet there, which is generally not recommended in this country. The same percentage in both groups still had intestinal damage, and the two groups had similar symptoms. There have also been a couple of other studies in Sweden and Denmark, confirming these findings.

However, we need to consider a couple of things. In the study they used a batch of oats that was specifically grown for the study. These oats were examined in the field and it was verified that there were no contaminating grains such as barley or wheat also growing there. These oats were then specially milled and specially stored for the study. Finally, these oats were tested using the most sensitive methods available for any wheat contamination.

There were several presentations at the conference about testing commercial sources of oats in different European countries. About 10% of commercial oats and wheat-free oat-containing foods were found to have significant traces of wheat gluten in them. These tests have not been done in the USA, so we don't know how pure the oats would be in our country. Some of the largest cereal plants in the world are in Cedar Rapids, my home. I know people who work there and there is a lot of cross-contamination in that large setting of wet-milling and dry-milling of oats and other grains. So it is probably not safe for celiacs to consume oats that are commercially available in the USA.

Oats, rye, and barley, and to some extent, wheat; are all grown in the same fields, often in rotation one year after another. So there will always be some "wild" shoots sprouting from the seeds of the previous year's crop to contaminate the current crop. This problem does not occur with rice because rice is cultivated in an entirely different way.

Another point to consider: The studies that were done used 50 grams of oats per day, which is a little under two ounces. That is not very much, and may not have been at a high enough level to cause any significant intestinal damage in only six months.

So unless you can get a hold of a batch of oats as pure as that used in the Finnish study, oats are probably not safe for celiacs.

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Rice Vitamin Enrichment

From: Michael Jones (mjones@digital.net)
Subject: Rice Vitamin Enrichment

Steve Veach VeachSF@earthlink.net, in post about grain carriers used to insert vitamins into enriched white rice, wrote:

>This carrier is typically grain based or corn based, but most (if not all
>rice manufacturer get their vitamin enrichment raw material from outside
>suppliers, whom they do not require to specify primary ingredients in most
>cases there are exceptions.

>The bottom line is that ANY vitamin enriched rice product may contain
>gluten unless the manufacturer knows otherwise.

A few years ago, I did some research into the matter because of this possibility of a problem. I contacted the two major US suppliers of enrichment material and verified that corn is used as the carrier by most rice companies. A few use rice starch, but that is a higher priced option. But the rice company has the option of requesting any carrier and that does include wheat starch. The company that had 90 percent of the US market at the time of my research was not using any carriers that would be a problem for Celiacs.

The second company was not as helpful and they admitted that wheat starch was used as a carrier. Luckily these products were not being sold in the US market.

Another friend also did some research with a person in the California rice industry who seemed highly knowledgeable about the enrichment situation. He said he has talked with celiac patients and groups about this a great many times over the years.

>First of all, there is a Federal standard for enrichment, but only 6
>states have regulations requiring enrichment of rice: NY, NJ, TX, NM,
>AZ, and CA. California follows the Federal standard. There is an
>exception in California for glucose-coated rice, which does not have to be enriched.

>He said there are two types of enrichment mixtures used, one that is
>starch-based and one that is not. The latter would be completely gluten-
>free and the former would be gluten-free if corn starch is used and that
>is usually the case. However, there is no requirement for corn starch
>and so it is always possible that some rice somewhere contains wheat
>starch. His company, when using a starch-based (powdered enrichment
>mixture would always use the corn starch. They sell to a lot of people,
>who would put their own brand name on the rice, but typical labels would
>be Diamond G or Botan.

>However, according to my source, the maximum amount of enrichment material
>that would be added to 100 lbs of rice is 1 oz. If we assume that all the
>material is starch and that the starch is wheat starch, and that the
>maximum>amount of gluten that could be in the starch is 0.3%.

>One cookbook states that one cup of rice is equal to 3 servings. A cup of
>uncooked rice weights 7 ounces, so one serving is 2.333 ounces.
>Multiplying by 28 grams per ounce, one serving is 65 grams of rice. If 100
>pounds of rice 45,400 grams has one ounce 28 grams of enrichment material,
>then one serving of rice (65 grams would have .0403 grams = 40 milligrams
>of enrichment material. If the enrichment material was all wheat starch,
>at 0.3% gluten, one serving of rice would only have 0.12 milligrams of
>gluten.

>Many celiac experts feel 10 mg per day of gluten is safe and there are
>somethat will argue that 100 mg is ok. It would take 83 servings of rice
>that is, if the rice used wheat carrier, and it seems most do not to
>approach the 10 mg lower limit,which itself is about one 50th of a slice
>of whole wheat bread. To put it another way, one serving of rice would
>have about the same gluten content as one 4,000th of a slice of whole
>wheat bread! Now, many celiacs, myself included, have a zero gluten
>tolerance policy .... but this vis so little that one might say it is
>effectively zero.

>Finally, it is evidently possible to wash off the enrichment mixture quite
>easily from the rice by rinsing it in cold water until the wash water is
>clear. This should leave almost no trace of starch and gluten on the
>rice. This washing procedure to get rid of possible wheat starch was
>evidently worked out by some professor at Cal Poly. I also had the same
>discussions with Riceland and came away with the same warm feelings. In
>fact, I feel safe enough that I have rice everyday.

The bottom line is that many celiacs eat multiple servings of rice each day and the followup biopsies do not show any damage. In the US, this appears to be a non problem.

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DH Article, May 20, 1998

The May 14, 1998 edition of The New England Journal of Medicine -- Volume 338, Number 20 has an extremely interesting article on DH:

"Absence of Toxicity of Oats in Patients with Dermatitis Herpetiformis"

The author submitted this statement, which can be read in the magazine or viewed at the NEJM's WWW site:
http://www.nejm.org/public/1998/0338/0020/1470/1.htm

"To the Editor: In their report on the absence of a toxic effect of oats on patients with dermatitis herpetiformis, Hardman et al. (Dec. 25 issue) (1) conclude that moderate quantities of oats can be safely included in the diet of such patients. This conclusion is in agreement with the results of a recent study of adult celiac disease. (2) We believe, however, that it is currently unwise to advise gluten-sensitive patients that oats are safe."

The complete text is not included here due to copyright restrictions. It is followed by a rebuttal from:

The authors of the article are:

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Taxonomic Relationship of Major Cereal Grains

FAMILY                                             Gramineae
                                                  /         \
                                                 /           \
                                                /             \
                                               /               \
                                              /                 \
                                             /                   \
SUBFAMILY                             Festucoideae            Panicoideae
                                     /        |  \                |
                                    /         |   \               |
                                   /          |    \              |
                                  /           |     \             |
                                 /            |      \            |
                                /             |       \           |
                               /              |        \          |
                              /               |         \         |
TRIBE                  Triticeae           Aveneae   Oryzeae  Tripsaceae
                      /        \              |         |         |
                     /          \             |         |         |
                    /            \            |         |         |
SUBTRIBE      Triticineae         \           |         |         |
              /         \          \          |         |         |
GENUS     Triticum    Secale     Hordeum    Avena     Oryza      Zea
              |          |          |         |         |         |
SPECIES  T.aestivum  S.cereale  H.vulgare  A.sativa  O.sativa   Z.mays
           (WHEAT)     (RYE)     (BARLEY)   (OAT)     (RICE)    (CORN)
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Copyright 1999 by Michael Jones, Bill Elkus, Jim Lyles, and Lisa Lewis - All rights reserved worldwide.

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Disclaimer

This fact sheet has been designed to be a general information resource. However, it is not intended for use in diagnosis, treatment, or any other medical application. Questions should be directed to your personal physician. This information is not warranted and no liability is assumed by the author or any group for the recommendations, information, dietary suggestions, menus, and recipes promulgated. Based upon accepted practices in supplying the source documents, this fact sheet is accurate and complete. Products mentioned or omitted do not constitute endorsement.

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