Most people feel better once they start their gluten free diet, especially if they had been suffering the symptoms of coeliac disease for years. But sadly, some people still complain of coeliac disease symptoms or get a relapse even though they are established on the diet.
Apart from the obvious acute symptoms when we get glutened, are there other reasons to explain why some of us still feel poorly when established on a gluten free diet?
I decided to look into this further and I came across the following reasons in a brilliant article written by Jeremy Woodward, MA, PhD, FRCP (2013) titled The Management of Refractory Coeliac Disease in Therapeutic Advances in Chronic Disease.
I have summarised the possible reasons of ongoing symptoms below:
1. Incomplete dietary exclusion of gluten. It is possible that gluten is still being consumed through hidden gluten in foods or by cross- contamination.
2. Due to differences in the sensitivity to gluten between individuals. Although most people can tolerate the 20ppm threshold of gluten in products labelled as gluten free, some sensitive individuals cannot tolerate this amount.
3. Due to symptoms unrelated to gluten, for example bloating and pain could be due to IBS.
4. Due to secondary causes of symptoms like other food intolerances or a co- existing condition.
5. Due to auto-immune conditions that are associated with coeliac disease.
6. Due to an incorrect diagnosis of coeliac disease. The gold standard for diagnosing coelaic disease in dults is still an antibody blood test followed by an endoscopy.
7. Due to refractory coeliac disease. If all the above issues have been eliminated, refractory coeliac disease might be investigated. A very small number of people with coeliac disease do not respond to treatment with a gluten free diet, or they respond to start with, but then symptoms return at a later date. This is called refractory coeliac disease and it is rare. According to coeliac UK, people with refractory coeliac disease remain unwell and still get symptoms six months to one year after starting a gluten-free diet.
So, if you still suffer from symptoms, a visit to your doctor or dietitian might be warranted.
It would be nice to hear your views and experiences on this topic.
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