The more difficult digestion, a swollen or sore belly. The thought immediately runs to a food intolerance and the most famous are those to dairy products and gluten, increasingly widespread also due to the change in lifestyle, which modifies the intestinal bacterial flora and, with this, the ability to tolerate foods. But you can become celiac as an adult or lactose intolerant perhaps after passing the door, so, out of the blue?
If the problem is lactose
The answer is yes in both cases, but for different reasons. Lactose intolerance, or the inability to digest this sugar present in milk and cheese, is the most frequent and due to a more or less total deficiency of the enzyme lactase, which is found in the intestine and breaks down lactose into two simple sugars that can be absorbed; if lactase is scarce, lactose accumulates, recalls liquids and is fermented by intestinal bacteria that produce gas. You can become intolerant at any moment of life, if for any reason the production of lactase becomes insufficient or completely ceases, explains Mario Di Gioacchino, elected president of the Italian Society of Allergology, Asthma and Clinical Immunology (Siaaic). The enzyme is produced in the small intestine and so for example any pathology that involves inflammation of the tissues or a deficiency in the functionality of this trait, such as a nickel allergy with intestinal symptoms or celiac disease, can lead to a lack of lactase and therefore the symptoms of the disorder. This is why in the case of a diagnosis of lactose intolerance it may be appropriate to investigate the conditions of the intestine with tests such as colonoscopy, fecal calprotectin (a generic marker of intestinal inflammation, ed), an enema of the small intestine (radiographic examination of the digestive tract after the introduction of a contrast agent to see the intestinal loops clearly, ed): if the lactase deficiency is due to an inflammatory problem, solving it can eliminate the symptoms of intolerance.
Getting used to lactose again
The amount of lactase then tends to decrease over the years, which is why the typical onset of lactose intolerance in early adulthood and the prevalence tends to increase with age. The production of lactase is also inducible in those who do not have a complete lack of the gene, a rare condition that makes them irremediably intolerant from birth: in other words, the body manufactures the enzyme also based on the consumption of the food for which it is needed and therefore, as Di Gioacchino specifies, If we completely stop eating dairy products, the quantity of lactase is gradually reduced; then, if they are reintroduced suddenly, the symptoms of intolerance may appear because the quantity of enzyme is not sufficient to digest them. the reverse is also true: in theory it is possible to get used to lactose again, for example after having resolved an intestinal inflammation, reintroducing it into the diet and thus allowing the restoration of lactase production. Not for an immediate process, it is necessary to gradually increase the dose to induce the synthesis of the enzyme.
A matter of training
For example, studies conducted by the US Purdue University proved this, according to which adults who discover they are lactose intolerant can train the intestine to digest it by introducing minimal amounts of milk at meals, two or three times a day, and gradually increasing the quantity. In many patients the deficiency of lactase is partial, but in others it is complete: in these cases even a minimal dose of lactose triggers the symptoms, explains Di Gioacchino. For those with a partial deficit, on the other hand, it is possible to identify a tolerable quantity of milk or cheese without discomfort: the ideal would be to be able to perform a lactose curve at the time of diagnosis, administering various quantities of milk in a controlled manner and observing the reactions, but anyone can identify for themselves their critical threshold not to be crossed or the foods that do not create problems. Yogurt, for example, often does not cause discomfort because it is naturally lower in lactose.
Tests for lactose intolerance
Anyone who thinks they have become lactose intolerant, even as an adult, must undergo apsevered diagnostic process without taking DIY initiatives as specific Di Gioacchino: Symptoms should be reported to the family doctor, allergist or gastroenterologist e undergo the breath test, the only test for a correct diagnosis. very simple, just exhale into a balloon after consuming lactose: the presence of gases indicative of the inability to digest this sugar is thus recorded in the breath.
Tests for gluten intolerance
Even for celiac disease, the diagnostic procedure is clear and well defined and must be followed at any time there is a suspicion of having become intolerant to gluten, because even celiac disease can appear at any age. In this case, yes it is an autoimmune disease for which a genetic predisposition is necessary, but not sufficient: it is estimated that only 3 percent of those with genes that make them susceptible to gluten intolerance develop the disease sooner or later. The presence of other autoimmune diseases and some environmental factors, including intestinal infections and the use of antibiotics seem to increase the risk.
Symptoms and consequences of celiac disease
The age of onset of celiac disease is growing and the way it manifests itself is also changing with symptoms increasingly different from the classic gastrointestinal ones: it is not uncommon to arrive at the diagnosis as adults, perhaps by investigating why you suffer from irritable bowel, anemia or fertility disorders, all of which are consequences of celiac disease. Suspecting it in the event of compatible symptoms is therefore more than appropriate, even well after the leaves, but as explained by Marco Silano, director of the Food, Nutrition and Health Operating Unit of the Istituto Superiore di Sanit, it is essential to follow the correct diagnostic path, without undergoing do-it-yourself exclusion diets: complex gluten to digest even for those who are healthy, so those with gastrointestinal disorders are always a little better off if they take it off the table. However, if you undergo tests while you are not eating gluten, some tests may be normal and delay a correct diagnosis. For a few years each Region must offer Centers of reference where it is possible to find experts and undergo approved and scientifically valid tests: the first step is the measurement of anti-transglutaminase antibodies in the blood, which are a very strong sign for the suspicion of celiac disease, together with the total immunoglobulin A dosage (the anti-transglutaminase antibodies are IgA, i.e. Immunoglobulin A, and 2-5 percent of celiacs have an IgA deficiency, so it is important to evaluate them in relation to the total, ed). In those who are positive for this marker, a duodenoscopy is performed with removal of the intestinal mucosa, which is then observed under the microscope: in celiacs the intestinal villi necessary for the absorption of nutrients are flattened and there is an infiltration of lymphocytes in the mucosa indicative of local inflammation, concludes Silano.
May 20, 2021 (change May 20, 2021 | 16:41)
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