En los últimos años han surgido una gran variedad de productos “sin gluten”, “libres de gluten” o “gluten free”. Muchas personas se han unido a la tendencia de practicar una dieta libre de gluten, muchas veces sin contar con la información adecuada.
Primeramente, es importante conocer que el gluten es una proteína compleja de origen vegetal, la cual se encuentra en varios tipos de granos, tales como el trigo, cebada y centeno. En algunas personas, el gluten provoca una enfermedad autoinmune del intestino que se conoce como enfermedad celiaca. Ésta provoca inflamación en el intestino delgado, la cual con el tiempo ocasiona que se atrofien las vellosidades intestinales y por lo tanto exista una mala absorción de los nutrimentos. Otros síntomas de esta enfermedad varían de manera individual, incluyendo dolor abdominal, gases, indigestión, vómitos, estreñimiento y/o diarrea. La deficiencia en absorción de nutrimentos se manifiesta como pérdida de peso, debilidad y fatiga. Otros padecimientos que se asocian a la enfermedad celiaca incluyen osteoporosis, anemia por deficiencia de hierro, desórdenes del sistema nervioso y del hígado. Aproximadamente el 25% de los pacientes celiacos presentan una inflamación de la piel conocida como dermatitis herpetiformis, que ocasiona dolor y comezón.
La enfermedad celiaca es difícil de diagnosticar debido a que los síntomas son variables y consistentes con una variedad de causas diferentes. La manera de confirmarla es a través de un análisis de anticuerpos contra el gluten y una biopsia intestinal que confirme la presencia de vellosidades atrofiadas.
De manera similar, existen personas que padecen sensibilidad al gluten. Los síntomas a nivel gastrointestinal son dolor abdominal y diarrea. Sin embargo, la fisiopatología es diferente en este caso ya que no hay producción de anticuerpos ni atrofia de las vellosidades intestinales, y no se desencadenan mecanismos alérgicos. Los síntomas en general no son tan intensos comparados con los de la enfermedad celiaca.
Actualmente, el único tratamiento que existe para la enfermedad celiaca y la sensibilidad al gluten es evitar consumir alimentos que contengan esta proteína. De acuerdo con la Clínica Mayo (Rochester, N.Y.), una dieta libre de gluten debe excluir los productos que contienen trigo, cebada y centeno. Los alimentos tales como panes, pastas, cereales, galletas, pasteles y botanas industrializadas contienen gluten a menos que especifiquen lo contrario. Si bien hay opiniones divididas al respecto, los productos que contienen soya y avena también suelen eliminarse. A veces el gluten se puede encontrar en productos inesperados, tales como medicamentos, cosméticos, cátsup y helado, en donde se añade como agente estabilizante. Prácticamente todas las cervezas contienen gluten debido a que usan cebada y trigo malteados como materias primas, y algunos vinos lo usan como agente clarificante en su proceso de producción.
La utilidad de una dieta libre de gluten en pacientes con desórdenes intestinales distintos a la enfermedad celiaca, tales como el intestino irritable, aún se encuentra en estudio y puede ser controversial. El autismo en niños frecuentemente se asocia con sensibilidad al gluten y su restricción en la dieta ha resultado favorable.
Por otra parte, existen muchas personas que restringen el consumo de gluten en su dieta sin haber sido diagnosticadas como celiacas, debido a la percepción de que una dieta libre de gluten es más saludable. En realidad, muchos de los alimentos que contienen gluten suelen contener también muchas calorías y grasa, tales como pasteles, galletas y botanas industrializadas. Si bien el concepto de restringir el gluten en personas no celiacas pareciera no tener mérito a nivel científico, el evitar los alimentos ya mencionados trae como consecuencia el realizar elecciones más saludables a nivel de estilo de vida.
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