Hypersensitivity to gluten has been discussed for years: according to some it is a real clinical problem, with symptoms similar but different from actual celiac disease, which affects a large portion of the population; skeptics, on the other hand, believe that it does not exist and is only a means of selling gluten-free products to a wider audience of consumers. Some time ago the studies of the gastroenterologist Gino Roberto Corazza of the Policlinico San Matteo in Pavia have shed some light, showing that non-celiac gluten sensitivity exists, but concerns a small fraction of the general population, nothing to do with the 6 % assumed in the past. As he explains Marco Silano, director of the Food, Nutrition and Health Operating Unit of the Istituto Superiore di Sanità, «auto-suggestion counts a lot, many after eating gluten-containing foods report stomach ache, drowsiness, fatigue and diagnose themselves with hypersensitivity. Studies have shown that by administering gluten in the form of a tablet, without being aware of it, the symptoms disappear in most cases ».

The diffusion

In fact, it is estimated that gluten sensitivity affects about 1% of the population. And it should not be confused with celiac disease, as Silano specifies: «In celiac the cause of intolerance is an immune reaction with genetic bases, in those sensitive to gluten it is possible to involve mechanisms of visceral hypersensitivity; moreover, the celiac must also avoid gluten “crumbs” and cannot recover, those who are only sensitive instead have a dose-dependent response (the symptoms are more intense as the amount of gluten increases, ed) and can slowly resolve the disorder by reintroducing cereals.

Diagnosis by exclusion

“Unfortunately, the confusion on the subject has led to trivializing the gluten-free diet, which is life-saving for the celiac but not for those who are hypersensitive. There is no marker, so the diagnosis is by exclusion because it is in fact necessary to be sure that it is not celiac disease; however it is good to remember that gluten is “heavy” for everyone and some digestive difficulties, especially if the meal is rich in it, must be taken into account ». In short, it is enough to reduce the intake if the symptoms are annoying and you have passed from an adequate diagnostic procedure, avoiding the do-it-yourself.

Non-absorbable compounds

“Furthermore, it seems that the sensitivity is referred to cereals in general rather than gluten only: new research suggests that at the base of the disorder there is an inability to digest fructan, one of the FODMAPn (polyols, mono-, di- and oligosaccharides found in many types of foods including fruit, vegetables, legumes, wheat, sweeteners, fruit juices) adds Silane. «These are non-absorbable compounds that favor fermentation by intestinal bacteria; this, especially in those who suffer from irritable colon and have a lower intestinal fermentation tolerance threshold than normal, leads to pain, swelling, diarrhea. There are no specific tests to identify intolerance to FODMAPs, which are much more difficult to avoid than gluten because they are present in many food categories: we therefore speak of diets with low FODMAP content, which each patient builds together with a doctor and dietician.

Individual variability

Excluding that it is not other intolerances, those with a sensitivity to gluten and / or FODMAPs must in fact understand which foods are more difficult to digest and which “dosages”, because there is a strong individual variability and someone may have discomfort afterwards having eaten fruit and not vegetables or vice versa, or having symptoms only beyond a certain amount. Stomach ache is a very individual condition, on which, moreover, elements such as stress have a great impact: everyone must therefore identify the right diet for themselves, listening to the symptoms and letting themselves be guided by the doctor to identify the real culprits “concludes Silano.

May 23, 2021 (change May 23, 2021 | 19:43)


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