Why oats fit into a healthy gluten-free diet

Luud Gilissen

OATS2020, Birmingham, 2015

Context – Health care costs

Price-increases of health care costs

● Health care budget in NL: ~100 B€/year

Price-increases of medicines (€/$) (some examples)

● Daraprim (antidepressivum): 1,- 13.50 750.- (1 tablet)

● Parnate (antidepressivum): 110.- 1,500,- (per month)

● Lemtrada (leukemia multiple sclerosis): x 40

● Cycloserine (tuberculose): 500,- 10,800.- 1,050

Are all medicins necessary and healthy?

● Paroxetine (antidepressivum) is not effective but gives only strong and

harmful side-effects and is suspect (600.000 users in NL over 14 years)

● Quackery?

Context - Pharma

Strong interconnections:

Pharma Health Insurance Comp

Hospitals Government

Strong lobby:

● Pharma EU

How to reduce health care costs?

Context - Pharma

Strong interconnections:

Pharma Health Insurance Comp

Hospitals Government

Strong lobby:

● Pharma EU

How to reduce health care costs?

Context - Reducing Health Care Costs

Much more focus on prevention

Promotion of healthy food (and life style) as naturalmedicines, e.g. whole-grain (bran containing) foods(Huang et al 2015; Wu et al 2015)

But:

Context - Our Food World today (the illusion of choice)

Playing field for prevention

Help!

Playing field for prevention

Help!

Content

Nutrition and health

● Compounds

● Claims and Patents

Potentials in gluten-free

● Scientific arguments

● Regulation

The Dutch Oat Chain

Conclusions

Oats: nutritious and healthy

Maintenance of healthy constitution

Improvement in cases of chronic diseases

Starch: low glycaemic index; helps in diabetes, obesity

Fibre (beta-glucan): lowering blood cholesterol

Lipids: unsaturated; reducing heart disease risk

Fibres + Lipids + Starch satiety

Proteins: fit into human needs (WHO); safe in coeliac disease

Phenolics (avenanthramides): anti-inflammatory

Official EFSA health claims applicable to

oats

Beta-glucans [3g/day] contribute to the maintenance of normal

blood cholesterol levels (EU 432/2012)

Consumption of beta- glucans from oats or barley as part of a

meal [4g/30gCarb] contributes to the reduction of the blood glucose

rise after that meal (EU 432/2012)

Oat grain fibre contributes to an increase in faecal bulk (EU

432/2012)

Reducing consumption of saturated fat contributes to the

maintenance of normal blood cholesterol levels (EU 432/2012)

Oat beta-glucan [3g/day] has been shown to actively lower/reduce

blood cholesterol. High cholesterol is a risk factor in the

development of coronary heart disease (EU 1160/2011).

Patent claims related to beta-glucan

Promoting cardiovascular health

Lowering cholesterol / treatment

of hypercholesterolemia;

prevention of hyperlipidaemia

Treatment of diabetes

Treatment of obesity / weight

management

Promoting gastrointestinal health

Use as vaccine or

immunostimulantThe beta-glucan patent landscape

Authorized USA health claims that oat products may

utilize

Oat soluble fibre and the reduced risk of coronary heart disease

Whole-grain claims based on authoritative statements

● On risk of heart disease and certain cancers

Potential claim evidence for

● Oats and diabetes risk reduction and diabetes management

● Oats and satiety and weight loss effects

● Whole grains and weight management

● Oats and blood pressure effects

Oats and Coeliac disease (CD)

Chronic inflammation of the small

intestine

● Increased 4x during the last 50 years (current prevalence: 0.5-2%)

● Genetic predisposition (HLA-DQ2/8)

● Gluten (seed storage proteins) from wheat, rye and barley

Major symptoms of CD in childrenChronic bowel ache and diarrhoeaGrowth retardation

Major symptoms of CD in adultsChronic fatigue, headache, bowel complaintsReduced fertility; miscarriageDermatitis herpetiformisOsteoporosisDeafnessNeuropathyIntestinal cancer (lymphoma)

Gluten digestion

Healthy small intestine Inflamed small intestine (flat mucosa)

Oats and Coeliac disease (CD)

• Oat is safe to >99% of people with CD (Pulido et al., 2009 [systematic review])

• Consumption of oats stimulates digestion in people with CD (Kaukinen et al.,

2013; Gatti et al., 2013): “the more and the longer, the better”

• 100 g/day: no intestinal damage oats can safely be included in GFD (Hardy

et al., 2015)

T-cell stimulation (Koning et al., 2005)

Oats and Coeliac disease (CD)

Comino et al (2015) Role of oats in celiac disease. World J Gastroenterol. 2015 Nov 7;

21(41): 11825–11831:

.... However, it is extremely important to remember that in vitro studies have shown that the immunogenicity of

oats varies depending on the cultivar used. Future clinical studies should be directed to the development of clinical

trials with varieties previously identified as safe by reliable in vitro methods, such as moAb G12-based

immunotechniques.

Londono et al (2013) Avenin diversity analysis of the genus Avena (oat) – Relevance for

people with celiac disease. Journal Cereal Science 58:170-177:

● Intact immunogenic gluten fragments in wheat, barley and rye are all absent from oat

● Immunotechniques based on G12 and R5 are unable to detect intact epitopes, and antibody signals as established for gliadins in wheat, rye and barley should not be extrapolated beyond these species

● Large scale ‘clinical trials’ without any harm/complaints take place every day through consumption of oats by coeliac patients

● Consumption of oats is stimulated by Coeliac Patient Associations

Avenin genes

Epitope variants in oats

R5 and G12 cross-reactivity

Oats and Coeliac disease (CD)

EC Regulation 41/2009, Art 3.3. Oats contained in foodstuffs for people intolerant to

gluten must have been specially produced, prepared and/or processed in a way to avoid

contamination by wheat, rye, barley, or their crossbred varieties and the gluten content

of such oats must not exceed 20 mg/kg.

A new Commission regulation sets out gluten labelling rules that will apply EU-wide when

the current provisions are repealed on 20 July 2016: .... Nevertheless, it points out that

most people with intolerance to gluten can include oats in their diet without adverse

effect on their health, adding that, “This is an issue of ongoing study and investigation by

the scientific community. However, a major concern is the contamination of oats with

wheat, rye or barley that can occur during grain harvesting, transport, storage and

processing. Therefore, the risk of gluten contamination in products containing oats should

be taken into consideration with regard to the relevant information provided on those

food products by food business operators.”

Oats and Celiac Disease

EC Regulation 41/2009 allows oats to be labelled and sold

as gluten-free provided a gluten contamination below 20

ppm

Establishment of a contamination-free and sustainable food

production chain based on oats in NL:

World-wide increasing interest in Gluten-Free

The Dutch Oat Chain

Start in 2006 in framework of CDC

Partnership

● Seed company oat growers

● Oat breeding company

● Gluten-free miller

● Breakfast cereal company (with gluten-free ‘daughter’ company)

● Gluten-free bakery

● ‘Gluten Free Competence Centre’

● Oat as basic ingredient

● Product innovations: breakfast – bakery – candy – pasta

● (Gluten-free) microbrewer

● Wageningen UR

Experimental yields

2009: 7.9 mt

2010: 8.2 mt

2011: 7.8 mt

2012: 9.7 mt

2013: 8.0 mt

2014: 8.2 mt

HACCP protocol

Strict rules for gluten free oat cultivation

● Farmer is certified for cultivation of cereals

● No wheat, rye or barley has been grown on the parcel in five preceding years

● Registration of the oat cultivation (location, variety, area [ha], yield, delivery)

● Cultivation is at least once inspected on occurrence of wheat, barley, rye

● Oat variety is in agreement with the customer

● Sowing-seed is guaranteed free from contamination and is certified as such

● Oat cultivation area is sufficiently separated

● Machines for sowing and harvesting are carefully cleaned

● Delivered products to customer are fully traceable

● Registration of complaints on the product – measures taken for improvement

● Production of oat-based foods is only allowed in GF-certified companies

GF Oat Products on the NL market since 2011

Some examples

Batter-based oat bread: Mam’s Havermikske (FreeOf)

Koyt beer

(old Dutch oat-based beer)

style)

Conclusions on Oats

Robust, complete, versatile,

healthy and coeliac-safe

Fits well in a healthy gluten-

free diet

Contributes to reduction of

health care costs

Challenge for innovations

in gluten free and general

products and recipes

Growing interest from

(inter)national

food companies in Dutch

gluten-free oats

Thanks

Celiac Disease Consortium (2004-2013)

● Frits Koning

PRI – Wageningen UR

● Hetty van den Broeck Jan Cordewener Twan America Ingrid van der Meer Jan Schaart Elma Salentijn Diana Londono Aurelie Jouanin Ed Hendrix René Smulders

Refs:

Gilissen LJWJ, Van der Meer IM, Smulders MJM (2014) Reducing the incidence of allergy and intolerance tocereals. Journal of Cereal Science 59: 337-353

Londono DM (2014) Laying the foundations for dough-based oat bread. Thesis, Wageningen