At the time of diagnosis of Celiac Disease, the premise that should be followed is: eat gluten-free, eat a healthy and balanced diet, and avoid cross contamination and inadvertent gluten intake. However, there are certain conditions that are responsible for ongoing symptoms, even after starting the Gluten Free Diet:
Gluten intake continues
In many times, it can happen that gluten intake continues due to foods that contain gluten that go unnoticed in our diet. Also, a common belief is that a small gluten intake is not harmful. Thus, we find three profiles of people:
- The person who thinks: “A little bit won’t hurt me”
- The person who finds it difficult to detect gluten-free products.
- Asymptomatic celiacs, who, since symptoms do not appear, tend to present more transgressions in the diet.
It is important to remember that the intake of small amounts of gluten (greater than 20 ppm) are capable of keeping the inflammatory process active. In this way, even being asymptomatic, celiac patients maintain a deterioration in their intestinal health, despite the absence of symptoms.
Newly diagnosed celiacs and, frequently, celiac patients with gluten sensitivity, present with atrophied intestinal villi. This causes the enzyme responsible for digesting lactose, lactase, to be “gone”, causing intestinal discomfort that causes symptoms to persist.
It is common that at the time of diagnosis of Celiac Disease, patients have been exposed to gluten for a long period of time. This delay in the diagnosis of celiac disease may have caused these patients to have gone through a period of malabsorption of nutrients, vitamins and minerals (iron, vitamin D, vitamin B12, etc.). Thus, other nutritional deficiencies can appear when Celiac Disease is diagnosed, which can cause symptoms to persist.
Other food sensitivities or intolerances
Some symptoms such as fatigue, joint pain, rashes or digestive problems can manifest as a result of intolerance to other foods you are consuming. Some foods that can generally be problematic are dairy products, soybeans, eggs, tree nuts, nightshades, and corn.
Intestinal Bacterial Overgrowth (SIBO)
Intestinal bacterial overgrowth (SIBO) is an overgrowth of bacteria in the small intestine that causes problems in the digestive system and well-being of a person. This intestinal bacterial overgrowth can occur for several reasons: poor motility in the intestine, low stomach acid, or poor pancreatic enzyme function.
Dukowicz, A. C., Lacy, B. E., & Levine, G. M. (2007). Small intestinal bacterial overgrowth: a comprehensive review. Gastroenterology & hepatology, 3(2), 112–122.
Lactose intolerance. Coeliac UK. Available on: https://www.coeliac.org.uk/information-and-support/coeliac-disease/conditions-linked-to-coeliac-disease/lactose-intolerance/
López, C. (2017). Carencias nutricionales asociadas a la dieta sin gluten. Asociación de Celíacos y Sensibles al Gluten. Available on: file:///C:/Users/biome/Downloads/RSG06_CARENCIAS%20(1).pdf