¿Todavía tiene síntomas en su dieta sin gluten?

Debe ser simple: se le diagnostica enfermedad celíaca o sensibilidad al gluten no celíaca , no tiene gluten y termina con el problema: se siente nuevamente bien, sin síntomas persistentes.

Unfortunately, it’s frequently far from that easy. Studies and anecdotal evidence indicate that a fairly high percentage of people with celiac and gluten sensitivity — it’s not clear exactly how high, but possibly upwards of half — continues to have symptoms even though they believe they’re following a strict gluten-free diet.

This can be incredibly discouraging, and it frequently leads people to believe they’ve become intolerant to numerous other foods (soy usually heads the list, with corn and other grains not far behind). However, at least one study involving celiac patients shows that the majority actually are suffering the effects of ongoing gluten ingestion — not “additional intolerances” to various foods, or some other problem.

¿Por qué es tan difícil ser perfectamente libre de gluten?

El gluten está en todas partes, y en las personas celíacas y sensibles al gluten que reaccionan a cantidades muy pequeñas, puede ser casi imposible evitarlo. Puede esconderse en lugares que no espera, como medicamentos recetados y carnes gourmet. También puede aparecer en cantidades mínimas en alimentos que parecen sin gluten por sus listas de ingredientes.

En muchos casos, los productos “sin gluten” a base de granos son los principales sospechosos. Por ejemplo, un estudio de 2010 sobre el gluten en granos “libres de gluten” encontró una contaminación cruzada de gluten en cantidades que van desde apenas detectables (alrededor de 5 partes por millón) hasta casi 3,000 partes por millón (lo suficiente como para causar un glutening épico ).

Celiac disease experts, including Peter Green, MD, director of the Celiac Disease Center at Columbia University, say that helping patients with ongoing symptoms despite a careful gluten-free diet is a major priority. In 2011, Dr. Green said that a drug designed to mitigate the effects of cross-contamination would be a huge boon to celiac patients with ongoing symptoms.

So How Many People Are Affected By Continuing Symptoms?

That’s not clear, although there are some hints in the medical literature for people with celiac disease. (There aren’t any studies touching on gluten sensitivity, but anecdotal evidence indicates many of those with that condition also suffer from ongoing symptoms.)

En un estudio de 2003 publicado en el American Journal of Gastroenterology, los investigadores estudiaron a un grupo de adultos celíacos que habían estado libres de gluten entre los ocho y los 12 años. Encontraron que los sujetos con enfermedad celíaca informaron “significativamente más síntomas gastrointestinales que la población general”, como indigestión, diarrea, estreñimiento, dolor abdominal y reflujo.

De hecho, alrededor del 60% de los celíacos estudiados experimentaron síntomas frecuentes, en comparación con el 29% de la población general. Las mujeres tendían a ir peor que los hombres.

Otro estudio sobre “síntomas del tipo de intestino irritable” en personas a las que se les había diagnosticado la enfermedad celíaca hace un año o más encontró que más del 23% sufría síntomas intestinales continuos que eran lo suficientemente graves como para cumplir con los criterios para el síndrome del intestino irritable (IBS) , y la mas buscada ayuda por sus sintomas. El estudio encontró que las personas con síntomas de SII tenían más probabilidades de ser mujeres y de desviarse ocasionalmente de la dieta sin gluten.

En ese estudio, las personas con síntomas de IBS también tenían más probabilidades de tener un “trastorno mental probable”, según lo determinado por un cuestionario que buscaba signos de ansiedad y depresión. Sin embargo, se debe tener en cuenta que muchas personas con enfermedad celíaca reportan síntomas de ansiedad y depresión cuando ingieren pequeñas cantidades de gluten.

Another study looked at 112 patients referred to a London hospital with nonresponsive celiac disease (12 of whom, it turned out, didn’t have celiac disease after all). Of the remaining 100 people, the study found that 45% “were not adequately adhering to a strict gluten-free diet,” with slightly more than half of those inadvertently ingesting gluten and slightly under half intentionally cheating.

Finally, an unpublished study presented by Alvine Pharmaceuticals at a 2012 medical meeting found that a “large” (but unspecified) percentage of diagnosed celiacs continue to experience symptoms despite adhering to a strict gluten-free diet.

Those symptoms listed by subjects in the Alvine study sound like a laundry list of typical celiac complaints: flatulence, abdominal pain, fatigue, bloating, diarrhea, constipation, nausea, brain fog, headaches, and skin rashes. They’re also discouragingly frequent: 90% of those studied said they had at least one day of symptoms in a week’s time, and 44% said they experienced five to 10 different symptoms in a week.

What Can You Do If You Still Have Symptoms?

Your first step should be to consider a trip to your doctor to make certain you haven’t been misdiagnosed. In one of the studies mentioned above, 11% of those with diagnosed celiac disease and continuing symptoms turned out not to have celiac disease at all! Others may have both celiac disease and another condition that’s causing their continuing symptoms. Keep in mind, though, that even if you weren’t diagnosed correctly with celiac disease, you could still suffer from gluten sensitivity. The treatment is the same for both: a strict gluten-free diet.

If you’re confident gluten is your problem, then you probably need to examine your diet for hidden gluten. Start with the top offenders listed in my Gluten-Free Diet Dangers article (link above).

If you’re not consuming any of those, take a hard look at the rest of your diet: restaurant meals, lots of processed foods (even if they’re labeled “gluten-free”) and an over-abundance of “gluten-free” grain products might lead you to ingest more trace gluten than your body can handle. Pay particular attention to the testing levels for your favorite “gluten-free”-labeled products — you may need to eat only certified gluten-free products or to avoid most grains since they tend to be quite contaminated with gluten.

In some cases, you may need to look into whether you’re reacting to foods other than gluten — it’s common for people with celiac disease to also have lactose intolerance, for example, and many people report distinctly different reactions to soy and corn, both highly allergenic foods in their own right. In many cases, though, eliminating low levels of gluten will do the trick.

If all else fails, you may want to consider consulting with a dietitian who is well-versed on the gluten-free diet — that person may be able to spot problems you may have missed, such as inadvertent cross-contamination that results from a shared kitchen, or exposures at work.

Above all, don’t start to fear food — it absolutely is possible to eat a varied and interesting diet that also eliminates symptoms almost completely.