Why oats fit into a healthy gluten-free diet - Luud Gilissen - Oats 2020

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 natural
 medicines, 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
    immunostimulant
                                        The 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)                            Major symptoms of CD in children
                                                 Chronic bowel ache and diarrhoea
       ● Gluten (seed storage proteins)          Growth retardation
                                            Major symptoms of CD in adults
          from wheat, rye and barley             Chronic fatigue, headache, bowel complaints
                                                 Reduced fertility; miscarriage
                                                 Dermatitis herpetiformis
                                                 Osteoporosis
                                                 Deafness
                                                 Neuropathy
                                                 Intestinal cancer (lymphoma)

Gluten digestion

Healthy small intestine   Inflamed small intestine (flat mucosa)

Oats and Coeliac disease (CD)

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

•   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)

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

                                   World-wide increasing interest in Gluten-Free

 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:

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

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