Avena sativa / Haver
OatsScientific Name(s): Avena sativa L. Family: Gramineae
Common Name(s): Oats , Hafer (German) , ma-karasu-mugi (Japanese) , avena (Spanish)
Botany
Oats grow as hardy annual grasses able to withstand poor soil conditions in which other crops are unable to thrive and are best adapted to areas with a cool, moist climate; Russia, the United States, Finland, and Poland are the world's major oat-producing countries. The plant grows to approximately 61 to 91 cm in height and has straight, hollow, blade-like leaves. The flowers contain 2 or 3 florets and are clustered at the top of the plant. Oat grain grows enclosed in 2 hulls that protect it during development. It contains 3 main structures: the bran, endosperm, and the germ containing embryonic structures that can grow into a new plant. 1 , 2 , 3
History
Derived from wild grasses, the oat evolved into today's cultivated plant. The oldest known oat grains were found in Egyptian remains dating from approximately 2,000 BC. Scottish settlers introduced oats into North America in the early 17th century. Before being used as a food for humans, oats were used as a livestock feed in the form of grain, pasture, hay, or silage. Traditional medicinal uses of oats include the treatment of rheumatism, depression, chronic neurological pain, atonia of the bladder, and, externally, as a skin cleanser and emollient. 2 , 3
Chemistry
The dietary value of oats is very high compared with that of other cereals in the Gramineae family. Oats are a good source of soluble and insoluble fiber, manganese, selenium, phosphorous, tryptophan, thiamine, and vitamin E (mainly as alpha-tocopherol). The protein content is 15% to 20% higher than that of other cereal grains, 3 with approximately 10% consisting of storage proteins known as avenins. 4 These proteins belong to the prolamin group and are related to the gluten found in wheat. 4
Oat bran contains the soluble dietary fiber beta-glucan, a highly viscous soluble polysaccharide with a linear, unbranched structure composed of 4-O- and 3-O-linked beta-D-glucopyranosyl units. Other polysaccharides in oat include starch, araban, and xylan gums. Lipid content is high, especially in unsaturated triglycerides. Lipase, lipoxygenase, and superoxide dismutase are enzymes present in oats. 3
Phenolic esters, including avenacins, phenols (hydroxycinnamic, ferulic, p-coumaric, and caffeic acids), and other phenolic compounds (benzoic and cinnamic acids, quinones, flavones, flavonols, chalcones, flavanones, anthrocyanidines, aminophenolics, avenanthramides) have been identified. 3 , 5 , 6 , 7
Oats Uses and Pharmacology
The widespread use of oats and oatmeal preparations makes the findings of animal experiments largely redundant.
Cardiovascular
The FDA recognizes that beta-glucan may play a role in reducing the risk of coronary heart disease. 8
In vitro experiments using human aortic endothelial cells showed reduced monocyte adherence and decreased production of cytokines involved in inflammatory response with oat phenolic avenanthramide pretreatment. A role in reducing the risk of atherosclerosis has been suggested. 5
Clinical data
In a trial of overweight dyslipidemic adults (N = 30), oats had no effect on endothelial dysfunction over a 6-week period compared with placebo. Subgroup analysis (not powered for) suggested a beneficial effect. 9 A pilot study showed a reduction in systolic and diastolic blood pressure in 18 patients with mild or borderline hypertension who received oat cereal. Beta-glucan content of the cereal was standardized to 5.52 g/day. 10 However, these results were not confirmed by another small trial that showed no change in blood pressure despite a similar daily intake of beta-glucan. 11 In a larger trial of 97 patients with hypertension, beta-glucan administered for 12 weeks did not affect blood pressure except in subgroup analysis, which was not powered for in the study design. 12 A decrease in systolic pressure (but not diastolic) was reported in a 12-week trial of 206 healthy middle-aged volunteers who consumed three 30 to 40 g portions of whole grain foods daily. No changes in markers of inflammation were noted. 13
Celiac disease
The role of oats in the diet of patients with celiac disease is controversial and possibly compounded by results of older, uncontrolled trial data or the use of contaminated oats. 14 A smaller proportion of immunogenic storage proteins is found in oats than in wheat, barley, and rye, and oat-derived proteins are more readily digested by the protease enzymes in the gut. In addition, the proline found in oat avenin is more readily digested by protease enzymes, which results in rapid degradation of potentially harmful peptides and may help to prevent the initiation of an immune response against oats in the small intestine. 4 , 15 Some people with celiac disease possess avenin-reactive mucosal T cells that can cause mucosal abnormality. 16 , 17
Advantages of incorporating oats into gluten-free diets have been described and include the provision of nutrients including vitamin B 1 , magnesium, and zinc, as well as the health benefits of increased dietary fiber. 18 , 19 , 20
A long-term study of oat ingestion in adults with celiac disease showed no effect on duodenal villous architecture, inflammatory cell infiltration of the duodenal mucosa, or antibody titers after 5 years. 15 , 21 Similar results were obtained in children with newly diagnosed celiac disease. 20 , 22 Two systematic reviews, as well as the World Gastroenterology Organisation, and the Finnish, United Kingdom, and Canadian celiac associations consider that uncontaminated oats can be consumed by most patients with celiac disease. Because of the possibility for oat intolerance in some people, the reviewers suggest eliminating oats initially and only adding moderate amounts in well-established, gluten-free diets. The American Celiac Sprue Association regards the use of oats as not risk-free. 16 , 19 , 23 Studies suggesting that oats are safe in patients with dermatitis herpetiformis have also been published. 4 , 15 , 24 , 25 , 26
Diabetes mellitus
Meals high in soluble fiber have been shown to reduce the rise in postprandial blood glucose and insulin concentration, attributed in part to an increase in the viscosity of the contents of the stomach and small intestine, with a subsequent reduction in the rate of absorption of digested nutrients. 27 , 28 The results of studies of oats in diabetic patients are conflicting.
Clinical data
Fasting plasma glucose, insulin, and glycosylated hemoglobin (HbA 1c ) were unaffected by a dietary regimen containing oat bran (beta-glucan 3 g) concentrate in a number of trials. Dosages of beta-glucan in these trials ranged from 2.25 to 6 g/day over 6 to 12 weeks. 12 , 29 , 30 , 31 , 32 , 33
A slight effect on the glucose response curve was shown in a trial in healthy adults. 34 In a small trial of patients with mild type 2 diabetes, oat bran flour produced a lower glycemic response than glucose. 28 Similar responses were obtained in a few additional trials. 35 , 36 , 37 , 38
The use of a beta-glucan–enriched bedtime snack to reduce the prevalence of silent nocturnal hypoglycemia in children with diabetes mellitus has been investigated. 39 Children receiving the enriched snack experienced flattening of the blood glucose curve before midnight, but the incidence of hypoglycemia after 2 AM remained unchanged.
Hyperlipidemia
Oat fiber produces modest reductions in cholesterol levels and may exert a small positive effect on the risk of coronary artery disease, but the mechanism is unclear. Although evidence suggests that some soluble fibers bind with bile acids or cholesterol, resulting in an increased clearance of low-density lipoprotein (LDL) cholesterol, this action may be insufficient to account for the observed cholesterol reductions. Other proposed mechanisms include inhibition of hepatic fatty acid synthesis, changes in intestinal motility, and reduction in absorption of macronutrients, resulting in increased insulin sensitivity and satiety, with a consequent overall reduction in total energy intake. 32 , 40 , 41 , 42
Other factors to be considered when interpreting trial data include the solubility and molecular weight of beta-glucan, unfavorable changes during commercial preparation, storage conditions, and cooking processes. 41 , 43
Clinical data
A large number of studies have been conducted to evaluate the effect of oat bran supplementation on blood lipid levels, with results included in several meta-analyses. 40 , 41 Substantial heterogeneity among individual studies suggests that the effects of fiber are not uniform, possibly as a result of inconsistent dosages. Many, but not all, trials show reductions in LDL-cholesterol. 30 , 31 , 32 , 33 , 37 , 38 , 40 , 41 , 43 , 44 , 45 , 46 , 47 , 48 , 49 In addition, nonlinearity was observed at higher doses, suggesting a possible diminished adherence or biological maximum being reached at these doses. 37 , 40 , 41
The FDA has endorsed the relationship between inclusion of beta-glucan soluble fiber in the diet and a decrease in serum cholesterol, and advises a dosage of beta-glucan 3 g/day soluble fiber. A causal relationship with decreased cardiovascular disease has not been demonstrated. 41
Other uses
Addiction
An extract of oats is used in traditional Ayurvedic medicine to cure opium addiction, but a few older trials were conducted on the potential of oats in treating addictions with conflicting results. 50 , 51 , 52 A study in rats receiving increasing alcohol doses up to 8 g/kg/day demonstrated a protective effect of oats on gut leakiness associated with endotoxemia and liver injury. 53
Cancer
The avenanthramides from oats have been investigated for potential anticancer applications. 54 , 55
Dermatology
Despite their promotion for management of dry, itchy skin conditions, claims about the benefits of colloidal oat-containing preparations are largely based on older trials, 3 , 56 but the popularity of colloidal oatmeal in the management of pruritus is increasing. 56 , 57 , 58 Although listed in the United States Pharmacopeia, the FDA has added a caution to the skin protectant monograph regarding over-drying that may occur from prolonged soaking in colloidal oatmeal. 59 Additionally, the use of oatmeal-containing products may cause sensitization in children with atopic dermatitis. 60
Nutrition in the elderly population
Studies have shown that the addition of oats into diets of elderly persons increases bioavailability of vitamin B 12 , reduces laxative use, and supports the maintenance of body weight. 61 , 62
Weight loss
Clinical trials evaluating the effect of adding oats to energy deficient diets have largely found no additive effect. 46 , 49 , 63 Satiety is increased with the addition of fiber in some, but not all, studies. 64 , 65 , 66
Dosage
The recommended intake of beta-glucan for reduction of cholesterol is 3 g/day, an amount found in approximately 90 g of oats. 40 , 41 , 46 An estimate of decreases in LDL by 5 mg/dL (0.13 mmol/L) is produced by inclusion of 3 g/day beta-glucan in the average American adult. 46
Moderate dietary amounts of oats, 20 to 25 g/day in children and 50 to 70 g/day in adults, are suggested in celiac disease. 15
Pregnancy/Lactation
Generally recognized as safe when used as food. Avoid dosages above those found in food because safety and efficacy are unproven.
Interactions
Oat bran may decrease absorption of medications. In 2 patients with hypercholesterolemia, concomitant ingestion of 50 to 100 g of oat bran and lovastatin 80 mg resulted in an increase in LDL compared with taking lovastatin alone. 67 A similar interaction can be expected with other HMG-CoA reductase inhibitors and oat bran ingestion.
Absorption of iron is decreased with concomitant consumption of oats, attributed to the presence of phytic acid in the fiber fraction of cereals. 68
Adverse Reactions
Oat bran increases stool bulk, which may cause discomfort, and more frequent defecation may result in perineal irritation. 69 The increase in stool bulk has been used to advantage in stoma reversal. 70 Digestion of fiber by colonic bacteria may cause gaseous distention and flatulence. Adequate fluid intake is recommended to ensure hydration and dispersion of fiber in the GI tract. Contact dermatitis from oat flour has been reported. 71 A study linking life-threatening, recurrent, exercise-induced anaphylaxis with gliadin-containing grains, including oats, has been published. 72
A higher than expected incidence of oat sensitization in children with atopic dermatitis has been reported. 60
Bibliography
1. Avena sativa L. USDA, ARS, National Genetic Resources Program. Germplasm Resources Information Network - (GRIN) [Online Database]. National Germplasm Resources Laboratory, Beltsville, Maryland. URL: http://www.ars-grin.gov/cgi-bin/npgs/html/tax_search.pl . (07 July 2008)
2. Gibson L, Benson G. Origin, history, and uses of oat ( Avena sativa ) and wheat ( Triticum aestivum ). Iowa State University. Department of Agronomy. January 2002. http://www.agron.iastate.edu/courses/agron212/readings/Oat_wheat_history.htm . Accessed January 11, 2012.
3. Kurtz ES, Wallo W. Colloidal oatmeal: history, chemistry and clinical properties. J Drugs Dermatol . 2007;6(2):167-170.
4. Vader LW, Stepniak DT, Bunnik EM, et al. Characterization of cereal toxicity for celiac disease patients based on protein homology in grains. Gastroenterology . 2003;125(4):1105-1113.
5. Liu L, Zubik L, Collins FW, Marko M, Meydani M. The antiatherogenic potential of oat phenolic compounds. Atherosclerosis . 2004;175(1):39-49.
6. Chen CY, Milbury PE, Kwak HK, Collins FW, Samuel P, Blumberg JB. Avenanthramides and phenolic acids from oats are bioavailable and act synergistically with vitamin C to enhance hamster and human LDL resistance to oxidation. J Nutr . 2004;134(6):1459-1466.
7. Chen CY, Milbury PE, Collins FW, Blumberg JB. Avenanthramides are bioavailable and have antioxidant activity in humans after acute consumption of an enriched mixture from oats. J Nutr . 2007;137(6):1375-1382.
8. Food and Drug Administration, HHS. Food labeling: health claims; soluble dietary fiber from certain foods and coronary heart disease. Final rule. Fed Regist . 2003;68(144):44207-44209.
9. Katz DL, Evans MA, Chan W, et al. Oats, antioxidants and endothelial function in overweight, dyslipidemic adults. J Am Coll Nutr . 2004;23(5):397-403.
10. Keenan JM, Pins JJ, Frazel C, Moran A, Turnquist L. Oat ingestion reduces systolic and diastolic blood pressure in patients with mild or borderline hypertension: a pilot trial. J Fam Prac . 2002;51(4):369.
11. Davy BM, Melby CL, Beske SD, Ho RC, Davrath LR, Davy KP. Oat consumption does not affect resting casual and ambulatory 24-h arterial blood pressure in men with high-normal blood pressure to stage I hypertension. J Nutr . 2002;132(3):394-398.
12. Maki KC, Galant R, Samuel P, et al. Effects of consuming foods containing oat beta-glucan on blood pressure, carbohydrate metabolism and biomarkers of oxidative stress in men and women with elevated blood pressure. Eur J Clin Nutr . 2007;61(6):786-795.
13. Tighe P, Duthie G, Vaughan N, et al. Effect of increased consumption of whole-grain foods on blood pressure and other cardiovascular risk markers in healthy middle-aged persons: a randomized controlled trial. Am J Clin Nutr . 2010;92(4):733-740.
14. Delaney B, Nicolosi RJ, Wilson TA, et al. Beta-glucan fractions from barley and oats are similarly antiatherogenic in hypercholesterolemic Syrian golden hamsters. J Nutr . 2003;133(2):468-475.
15. Pulido OM, Gillespie Z, Zarkadas M, et al. Introduction of oats in the diet of individuals with celiac disease: a systematic review. Adv Food Nutr Res . 2009;57:235-285.
16. Garsed K, Scott BB. Can oats be taken in a gluten-free diet? A systematic review. Scand J Gastroenterol . 2007;42(2):171-178.
17. Lundin KE, Nilsen EM, Scott HG, et al. Oats induced villous atrophy in coeliac disease. Gut . 2003;52(11):1649-1652.
18. Kemppainen TA, Heikkinen MT, Ristikankare MK, Kosma VM, Julkunen RJ. Nutrient intakes during diets including unkilned and large amounts of oats in celiac disease. Eur J Clin Nutr . 2010;64(1):62-67.
19. Fric P, Gabrovska D, Nevoral J. Celiac disease, gluten-free diet, and oats. Nutr Rev . 2011;69(2):107-115.
20. Koskinen O, Villanen M, Korponay-Szabo I, et al. Oats do not induce systemic or mucosal autoantibody response in children with coeliac disease. J Pediatr Gastroenterol Nutr . 2009;48(5):559-565.
21. Janatuinen EK, Kemppainen TA, Julkunen RJ, et al. No harm from five year ingestion of oats in celiac disease. Gut . 2002;50(3):332-335.
22. Högberg L, Laurin P, Fälth-Magnusson K, et al. Oats to children with newly diagnosed coeliac disease: a randomised double blind study. Gut . 2004;53(5):649-654.
23. Haboubi NY, Taylor S, Jones S. Coeliac disease and oats: a systematic review. Postgrad Med J . 2006;82(972):672-678.
24. Reunala T, Collin P, Holm K, et al. Tolerance to oats in dermatitis herpetiformis. Gut . 1998;43(4):490-493.
25. Hardman CM, Garioch JJ, Leonard JN, et al. Absence of toxicity of oats in patients with dermatitis herpetiformis. N Engl J Med . 1997;337(26):1884-1887.
26. Picarelli A, Di Tola M, Sabbatella L, et al. Immunologic evidence of no harmful effect of oats in celiac disease. Am J Clin Nutr . 2001;74(1):137-140.
27. Würsch P, Pi-Sunyer FX. The role of viscous soluble fiber in the metabolic control of diabetes. A review with special emphasis on cereals rich in beta-glucan. Diabetes Care . 1997;20(11):1774-1780.
28. Tapola N, Karvonen H, Niskanen L, Mikola M, Sarkkinen E. Glycemic responses of oat bran products in type 2 diabetic patients. Nutr Metab Cardiovasc Dis . 2005;15(4):255-261.
29. Kabir M, Oppert JM, Vidal H, et al. Four-week low-glycemic index breakfast with a modest amount of soluble fibers in type 2 diabetic men. Metabolism . 2002;51(7):819-826.
30. Cugnet-Anceau C, Nazare JA, Biorklund M, et al. A controlled study of consumption of beta-glucan-enriched soups for 2 months by type 2 diabetic free-living subjects. Br J Nutr . 2010;103(3):422-428.
31. Chen J, He J, Wildman RP, Reynolds K, Streiffer RH, Whelton PK. A randomized controlled trial of dietary fiber intake on serum lipids. Eur J Clin Nutr . 2006;60(1):62-68.
32. Queenan KM, Stewart ML, Smith KN, Thomas W, Fulcher RG, Slavin JL. Concentrated oat beta-glucan, a fermentable fiber, lowers serum cholesterol in hypercholesterolemic adults in a randomized controlled trial. Nutr J . 2007;6:6.
33. Hallikainen M, Toppinen L, Mykkänen H, et al. Interaction between cholesterol and glucose metabolism during dietary carbohydrate modification in subjects with the metabolic syndrome. Am J Clin Nutr . 2006;84(6):1385-1392.
34. Tuomasjukka S, Viitanen M, Kallio H. The glycaemic response to rolled oat is not influenced by the fat content. Br J Nutr . 2007;97(4):744-748.
35. Behall KM, Scholfield DJ, Hallfrisch J. Comparison of hormone and glucose responses of overweight women to barley and oats. J Am Coll Nutr . 2005;24(3):182-188.
36. Weickert MO, Möhlig M, Schöfl C, et al. Cereal fiber improves whole-body insulin sensitivity in overweight and obese women. Diabetes Care . 2006;29(4):775-780.
37. Biörklund M, van Rees A, Mensink RP, Onning G. Changes in serum lipids and postprandial glucose and insulin concentrations after consumption of beverages with beta-glucans from oats or barley: a randomised dose-controlled trial. Eur J Clin Nutr . 2005;59(11):1272-1281.
38. Liatis S, Tsapogas P, Chala E, et al. The consumption of bread enriched with betaglucan reduces LDL-cholesterol and improves insulin resistance in patients with type 2 diabetes. Diabetes Metab . 2009;35(2):115-120.
39. Rami B, Zidek T, Schober E. Influence of a beta-glucan enriched bedtime snack on nocturnal blood glucose levels in diabetic children. J Pediatr Gastroenterol Nutr . 2001;32(1):34-36.
40. Brown L, Rosner B, Willett WW, Sacks FM. Cholesterol-lowering effects of dietary fiber: a meta-analysis. Am J Clin Nutr . 1999;69(1):30-42.
41. Poppitt SD. Soluble fibre oat and barley beta-glucan enriched products: can we predict cholesterol-lowering effects? Br J Nutr . 2007;97(6):1049-1050.
42. Ellegård L, Andersson H. Oat bran rapidly increases bile acid excretion and bile acid synthesis: an ileostomy study. Eur J Clin Nutr . 2007;61(8):938-945.
43. Kerckhoffs DA, Hornstra G, Mensink RP. Cholesterol-lowering effect of beta-glucan from oat bran in mildly hypercholesterolemic subjects may decrease when beta-glucan is incorporated into bread and cookies. Am J Clin Nutr . 2003;78(2):221-227.
44. Karmally W, Montez MG, Palmas W, et al. Cholesterol-lowering benefits of oat-containing cereal in Hispanic Americans. J Am Diet Assoc . 2005;105(6):967-970.
45. Robitaille J, Fontaine-Bisson B, Couture P, Tchernof A, Vohl MC. Effect of an oat bran-rich supplement on the metabolic profile of overweight premenopausal women. Ann Nutr Metab . 2005;49(3):141-148.
46. Maki KC, Beiseigel JM, Jonnalagadda SS, et al Whole-grain ready-to-eat oat cereal, as part of a dietary program for weight loss, reduces low-density lipoprotein cholesterol in adults with overweight and obesity more than a dietary program including low-fiber control foods. J Am Diet Assoc . 2010;110(2):205-214.
47. Ulmius M, Johansson A, Onning G. The influence of dietary fibre source and gender on the postprandial glucose and lipid response in healthy subjects. Eur J Nutr . 2009;48(7):395-402.
48. Wolever TM, Tosh SM, Gibbs AL, et al. Physicochemical properties of oat beta-glucan influence its ability to reduce serum LDL cholesterol in humans: a randomized clinical trial. Am J Clin Nutr . 2010;92(4):723-732.
49. Beck EJ, Tapsell LC, Batterham MJ, Tosh SM, Huang XF. Oat beta-glucan supplementation does not enhance the effectiveness of an energy-restricted diet in overweight women. Br J Nutr . 2010;103(8):1212-1222.
50. Anand CL. Treatment of opium addiction. Br Med J . 1971;3(5775):640.
51. Anand CL. Effect of Avena sativa on cigarette smoking. Nature . 1971;233(5320):496.
52. Bye C, Fowle AS, Letley E, Wilkinson S. Lack of effect of Avena sativa on cigarette smoking. Nature . 1974;252(5484):580-581.
53. Keshavarzian A, Choudhary S, Holmes EW, et al. Preventing gut leakiness by oats supplementation ameliorates alcohol-induced liver damage in rats. J Pharmacol Exp Ther . 2001;299(2):442-448.
54. Guo W, Kong E, Meydani M. Dietary polyphenols, inflammation, and cancer. Nutr Cancer . 2009;61(6):807-810.
55. Guo W, Nie L, Wu D, et al. Avenanthramides inhibit proliferation of human colon cancer cell lines in vitro. Nutr Cancer . 2010;62(8):1007-1016.
56. Meydani M. Potential health benefits of avenanthramides of oats. Nutr Rev . 2009;67(12):731-735.
57. Matheson JD, Clayton J, Muller MJ. The reduction of itch during burn wound healing. J Burn Care Rehabil . 2001;22(1):76-81.
58. Cerio R, Dohil M, Jeanine D, Magina S, Mahé E, Stratigos AJ. Mechanism of action and clinical benefits of colloidal oatmeal for dermatologic practice. J Drugs Dermatol . 2010;9(9):1116-11120.
59. Food and Drug Administration, HHS. Skin protectant drug products for over-the-counter human use; astringent drug products; final monograph; direct final rule. Direct final rule. Fed Regist . 2003;68(114):35290-35293.
60. Boussault P, Léauté-Labrèze C, Saubusse E, et al. Oat sensitization in children with atopic dermatitis: prevalence, risks and associated factors. Allergy . 2007;62(11):1251-1256.
61. Sturtzel B, Dietrich A, Wagner KH, Gisinger C, Elmadfa I. The status of vitamins B6, B12, folate, and of homocysteine in geriatric home residents receiving laxatives or dietary fiber. J Nutr Health Aging . 2010;14(3):219-223.
62. Sturtzel B, Mikulits C, Gisinger C, Elmadfa I. Use of fiber instead of laxative treatment in a geriatric hospital to improve the wellbeing of seniors. J Nutr Health Aging . 2009;13(2):136-139.
63. Beck EJ, Tapsell LC, Batterham MJ, Tosh SM, Huang XF. Increases in peptide Y-Y levels following oat beta-glucan ingestion are dose-dependent in overweight adults. Nutr Res . 2009;29(10):705-709.
64. Willis HJ, Eldridge AL, Beiseigel J, Thomas W, Slavin JL. Greater satiety response with resistant starch and corn bran in human subjects. Nutr Res . 2009;29(2):100-105.
65. Lyly M, Liukkonen KH, Salmenkallio-Marttila M, Karhunen L, Poutanen K, Lähteenmäki L. Fibre in beverages can enhance perceived satiety. Eur J Nutr . 2009;48(4):251-258.
66. Peters HP, Boers HM, Haddeman E, Melnikov SM, Qvyjt F. No effect of added beta-glucan or of fructooligosaccharide on appetite or energy intake. Am J Clin Nutr . 2009;89(1):58-63.
67. Richter WO, Jacob BG, Schwandt P. Interaction between fibre and lovastatin. Lancet . 1991;338(8768):706.
68. Bering S, Suchdev S, Sj⊘ltov L, Berggren A, Tetens I, Bukhave K. A lactic acid-fermented oat gruel increases non-haem iron absorption from a phytate-rich meal in healthy women of childbearing age. Br J Nutr . 2006;96(1):80-85.
69. Valle-Jones JC. An open study of oat bran meal biscuits (‘Lejfibre’) in the treatment of constipation in the elderly. Curr Med Res Opin . 1985;9(10):716-720.
70. Saunders RN, Thomas WM. Antegrade porridge enema to assess anorectal function after severe perineal sepsis. Ann R Coll Surg Engl . 2006;88(1):74-75.
71. Calzavara-Pinton PG, Tosoni C, Carlino A, Cattaneo R. Contact eczematous dermatitis caused by wheat and oats [in Italian]. G Ital Dermatol Venereol . 1989;124(6):289-291.
72. Varjonen E, Vainio E, Kalimo K. Life-threatening, recurrent anaphylaxis caused by allergy to gliadin and exercise. Clin Exp Allergy . 1997;27(2):162-166.
