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

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