Celiac disease or gluten sensitivity: does restrictive diet lead to deficiencies?

Nutritional deficits are possible especially in cases of poor food choices and unbalanced diets; nutrition in cases of gluten sensitivity and "FODMAP risk"

Those with celiac disease must eliminate gluten from their diet; those with non-celiac gluten sensitivity must reduce it to get better. Doing so, however, risks nutritional deficiencies if food choices are not well thought out, a recent review by McMaster University in Canada points out, saying that in both conditions it would be wise to be guided by a nutritionist.

No to self-diagnosis (gluten-free diets also make you fat)

Researchers point out that the dangers of nutritional deficiencies arise mainly from improper diets because, for example, in some cases the composition of gluten-free ready-made industrial products may include less protein and more fat and sugar than their counterparts with gluten. In addition, people often self-diagnose a sensitivity to gluten and also banish it because they think they will lose weight, but there is no relationship between the gluten content of the diet and weight loss, and even gluten-free diets can make people gain weight if they are not correct and balanced. That is why it is important first to arrive at a correct diagnosis, then to get advice from a nutrition expert; this is also necessary in the case of non-celiac gluten sensitivity, which is identified mainly by exclusion because the absence of specific tests allows its diagnosis only by blind stimulation tests, which are very complex and difficult in clinical routine.

Gluten sensitivity

Patients with non-celiac gluten sensitivity are neither wheat allergic nor celiac but have gastrointestinal (pain, meteorism, diarrhea, sometimes gastroesophageal reflux) or general symptoms (joint pain, fatigue, headache, clouded mind, anemia) after eating foods with gluten and mainly wheat derivatives. The problem is estimated to affect about 5 percent of the population, as suggested by studies with blinded testing, that is, administering gluten “covertly.” The problem and underlying mechanisms are complex, and self-suggestion may also play a role, with many people reporting symptoms after eating foods with gluten and self-diagnosing hypersensitivity. In addition, celiacs must follow a careful diet and cannot recover; those who are only sensitive, on the other hand, have more intense symptoms as the amount of gluten increases and can slowly resolve the disorder. Confusion on the subject has led to trivialization of the gluten-free diet, which is necessary for the celiac but may not be permanently and chronically necessary for those who are sensitive.

A new “culprit?”

According to new hypotheses, moreover, at the root of gluten-grain hypersensitivity may be an intolerance to fructan, one of the FODMAPs or polyols, mono-, di- and oligosaccharides found in many types of foods including fruits, vegetables, legumes, wheat, sweeteners, and fruit juices: FODMAPs are not absorbed and promote fermentation by intestinal bacteria, and this, especially in those who suffer from an irritable colon and have a lower than normal threshold for tolerating intestinal fermentation, leads to pain, bloating, and diarrhea. There are no specific tests to detect intolerance to FODMAPs, which are much more difficult to avoid than gluten because they are present in many food categories.Therefore, we talk about low FODMAP diets, which each patient builds together with the doctor and dietitian because there is a strong individual variability and someone may have discomfort after eating fruits and not vegetables or vice versa, or have symptoms only over a certain amount.

Green light for pediatric screening

On September 13, the Senate gave the green light to early screening, starting at age 3-4, and information campaigns throughout the country to prevent type 1 diabetes and celiac disease. The bill for the detection of type I diabetes and celiac disease in the pediatric population, voted unanimously, defers to a ministerial decree the establishment of criteria for the adoption of a nationwide multi-year screening program for the detection of antibodies to type 1 diabetes and celiac disease. It also provides for the establishment of an Observatory and stipulates the conduct of periodic information and awareness campaigns by the Ministry of Health. Screening will start from 2024 and is planned to spend €3.85 million for each of the years 2024 and 2025 and €2.85 million annually from the year 2026. The ministry will also promote periodic information campaigns on the importance of early diagnosis in pediatric age, with funds of 150,000 euros annually starting in 2024.

Source: https://www.corriere.it/salute/nutrizione/23_settembre_14/celiachia-o-sensibilita-glutine-dieta-restrittiva-porta-carenze-a58ac55c-f8a7-11ed-8bca-35ac6820436c.shtml