Sensibilidad al trigo

Hasta un 30% de las personas que padecen SII podrían ser sensibles al trigo. Según la literatura científica existe un subgrupo de pacientes que presentan síntomas de SII que en realidad tienen sensibilidad al trigo. Parece que además este subgrupo tiende a padecer más anemia y pérdida de peso que los que padecen SII y suelen tener una historía clínica de alergias alimentarias en la infancia (1).

Aún no está muy claro qué componente del trigo ocasiona los síntomas. Aproximadamente un 80% del trigo está formado por gluten, pero también tiene otro componente que puede jugar un papel fundamental en la aparición de síntomas: los fructanos. 

Los fructanos forman parte de una grupo de hidratos de carbono llamados FODMAP. Éstos son fermentados rápidamente y mal-absorbidos, ocasionando un aumento de agua en el intestino y un aumento del tránsito intestinal. Los FODMAP llegan al colon mínimamente alterados, donde son fermentados por bacterias, ocasionando gases y distensión abdominal (2).

Este estudio (3) mostró como personas que padecían sensibilidad al gluten no celíaca y SII dejaron de tener síntomas al ponerlos en una dieta baja en FODMAP, lo cual apoya la teoría de que son los FODMAP los que generan los síntomas, más que el gluten. 

Existen otros componentes del trigo, como los inhibidores de amilasa-tripsina, que también podrían jugar un papel importante, activando el sistema inmune-innato y la liberación de citoquinas inflamatorias (4).

Es importante que las personas con sensibilidad al trigo sean derivadas a un dietista (tanto por el médico de cabecera como por gastroenterólogos) ya que en la consulta el dietista establecer una dieta adecuada (ya sean sin gluten o baja en FODMAP y evitar restricciones innecesarias que puedan estar limitando la calidad de vida de estos pacientes. Por ejemplo, las personas con celiaquía que siguen una dieta sin gluten, tienden a tener una dieta en la que las ingestas de fibra y calcio están por debajo de las recomendaciones (5). Otro de los riesgos asociados con estas dietas es el desarrollo de desórdenes alimentarios como ortorexia nerviosa, que es algo que el dietista también debe tener en cuenta. 

A día de hoy todavía no está claro qué componente del trigo es el responsable, por lo que se necesitan estudios bien planteados. Ésto es particularmente difícil ya que los pacientes deben ser "cegados" (no saber qué están comiendo, si lleva gluten o no, si lleva FODMAP o no, etc.) y deben seguir una dieta determinada, sin saltársela en ningún momento durante un período de tiempo largo.



 
1. https://www.ncbi.nlm.nih.gov/pubmed/22825366 
2. https://www.ncbi.nlm.nih.gov/pubmed/28244663 
3. https://www.ncbi.nlm.nih.gov/pubmed/23648697 
4. https://www.ncbi.nlm.nih.gov/pubmed/25925932 
5. https://www.ncbi.nlm.nih.gov/pubmed/15882378

El eje intestino-cerebro

La relación entre el intestino y el cerebro es algo que se está investigando en la actualidad, pero hemos sabido “desde siempre” que hay una relación entre estas dos partes. ¿Habéis conocido a alguien que cuando está de exámenes se le suelten las tripas? ¿Quizás has sentido alguna vez “mariposas en el estómago”? ¿O has tenido “el estómago cerrado” antes de una entrevista?

Las personas que padecen síndrome del intestino irritable tienden a tener digestiones pesadas, se sienten muy hinchados y son más susceptibles a padecer diarrea o estreñimiento. Estas personas también tienden a padecer más ansiedad y depresión que la media. Cuando el intestino está irritado, puede hacer nuestra vida de lo más desagradable. Y puede ocasionar una micro-inflamación del intestino, que tengamos mala flora intestinal o incluso intolerancias alimentarias. 

Es muy frustrante para estos pacientes ya que, al no haber pruebas, se les considera hipocondríacos o exagerados. El estrés es uno de los desencadenantes más conocidos y aceptados hasta el momento. 

Una de las teorías sobre el funcionamiento del eje cerebro-intestino bajo estrés es ésta: las circunstancias estresantes producen un ambiente más propicio para el desarrollo de ciertas bacterias (bacterias que en períodos de estrés no están o están en menos cantidad). Esto significa que, incluso cuando la situación estresante llega a su fin, podríamos seguir sufriendo los efectos de este cambio en la flora intestinal.

Quizás esto influirá a nivel cerebral la próxima vez que tengamos que hablar en público, y nuestro cerebro recordará lo que le pasó al intestino y lo mal que nos sentimos aquella vez. De hecho, un estudio hecho en dos especies distintas de ratones, una más tímida y la otra más atrevida, demostró que intercambiando la microbiota entre las cepas, su comportamiento también varió. La cepa normalmente más tímida se volvió más atrevida y viceversa. 

¿Puede regular hasta cierto punto nuestro comportamiento nuestra microbiota?

Thin Privilege: An Update

After another lively debate on Facebook regarding this topic I spent most of the other night thinking about it and my reaction to it. 
Is this where I suddenly repent and accept my thin privilege? No, it isn't. I still don't like the term, the concept and everything it entails and here is why.
When I read the original article and the comments associated with it it made me angry because deep down I didn't think I was getting any kind of privilege for being thin. Yes as a man, and although I really didn't want to bring race into it, a white man, I fully acknowledge the society we live in has been constructed in my favour. I accept that, and if it will change anything, which I doubt it will, I acknowledge that privilege. 

The comments I received mostly seemed to indicate that I was denying that "weight bias" "body diversity" "Sizeism" and so on existed, which was not the case. What I didn't like was first the assumption that people are "naturally thin", and that my life is easy because I am thin, You have no idea about my life just as I don't about yours, any assumption based on appearance is wrong. 
This point didn't seem to be accepted and I continued to receive anecdotes about people's lives and how they struggle with discrimination, which, at the risk of sounding like a stuck record I didn't deny existed.

After being directed towards research around weight bias and wages, a couple of points jumped out at me and made me rethink why I am reacting this way. 
In an article in the Journal of Applied Psychology (1) it was demonstrated that thinner women get paid more, not surprising, but the opposite was true for men. In fact, larger men get paid more up until the point of obesity. And a quote lifted from an article on Forbes (2) based on the study said. "Skinny men, indeed, are often regarded as nervous, sneaky, afraid, sad, weak, and sick, where men of well-proportioned build are associated with traits such as having lots of friends, being happy, polite, helpful, brave, smart, and neat." 

So is this really "Fat Vs Thin"? Or is it just another example of different rules for men and women?

I started thinking through my experiences in work and the times I've had to say "yes I do eat" or "no I am not addicted to heroin", did me being a thin man (as opposed to just thin) have something to do with this? 
Or the times I felt I wasn't taken seriously in staff meetings. I had always assumed it was because I was one of the youngest in the room (sadly no longer the case) but maybe it was because I was thin? 
While I can still find clothes that fit me in most shops I have noticed that I have had to drop down a size from M to S with no major change in body weight. It appears that provisions are being made to spare men's feelings by simply shifting everything up one size which is not happening for women. So is this really "thin privilege" or just plain old sexism? 
Is it possible that as a man "thin privilege" doesn't extend to me? Or at least not as much as it does for women? 

Rethinking where I stand on this topic I still reject the term thin privilege because I think it diverts away from the real issue which is what society expects of women. It looks like as a man I can put on a few kilos and not suffer any negative consequences, up to a point, whereas women cannot. And to me that is sexism not thin privilege. 

1. J Appl Psychol. 2011 Jan;96(1):95-112. doi: 10.1037/a0020860.
2. https://www.forbes.com/sites/freekvermeulen/2011/03/22/the-price-of-obesity-how-your-salary-depends-on-your-weight/#29a06bbb3d9a

Gluten Sensitivity: Does it really exist?

In previous articles we have explained the difference between coeliac disease, wheat allergy and a third condition known as Non-Coeliac Gluten Sensitivity (NCGS). To briefly recap, as the name suggests, NCGS appears to be a condition where people who are neither coeliac nor allergic to wheat still report symptoms of bloating, loose stools etc. when consuming gluten containing foods. The mechanisms behind the condition are unclear, the immune system doesn’t appear to be involved but some researchers have suggested that NCGS may be a step along the path towards coeliac disease (1). Whilst we were completing the Monash FODMAP course another possible explanation was put forward to explain why people who have no immunological response to gluten still report gastrointestinal issues when eating gluten containing foods. What was interesting was that the explanation called into question the very existence of the condition of NCGS.

In recent years gluten free eating has become very popular and lots of pseudo-conditions are attributed to gluten. Although NCGS isn’t what we would call a pseudo-condition it has been proposed that it might be part of IBS and the culprit isn’t gluten after all. 

Fructans are chains of varying length of the sugar fructose, they are universally malabsorbed because we do not have the required enzyme in our body to break the chains into smaller fructose units. This leads to the fructans passing to the large intestine where they are fermented by the resident bacteria. This fermentation and the resulting gas production is usually well tolerated by non-IBS people but people with IBS tend to be highly sensitive to the fermentation of fructans and experience painful bloating and bowel distention. Foods that contain fructans are vegetables such as onion and garlic and of course wheat.

Monash University state that there is a lack of evidence that has managed to separate the effects of gluten from fructans so it is unclear which food component they are reacting to. Therefore, they do not recognise NCGS as a condition in itself and propose that people who report problems with gluten may in fact be IBS sufferers reacting to the fructans in wheat (2).

Now, this all sounds well and good, people can now relax and realise they weren’t sensitive to gluten after all. However, the problem lies in the practicality of it all. Finding a food that contains gluten but no fructans is virtually impossible, the only one we have found so far is sourdough bread or “masa madre” as it’s known here in Spain. During the fermentation process of sourdough bread, microorganisms such as Lactobacilli feed on the fructans and reduce their content in the finished product. The end result is that people who previously thought they were gluten-sensitive could enjoy sourdough bread, providing coeliac disease has been correctly excluded.

In conclusion, it appears that there is a lack of strong evidence to declare that NCGS is a condition in itself and people who report symptoms may be in fact IBS sufferers who are particularly sensitive to fructans. Aside from wheat, people who suspect they may fall into this category also need to keep in mind, onion, garlic, leeks and chickpeas.

For any more information on IBS or the Low FODMAP diet please get in touch via info@gabinetederueda.es

References 

1. Francavilla MD, et al. 2014, Clinical, Serologic and Histologic Features of Gluten Sensitivity in Children. The Journal of Paediatrics; 164: 463-7

2. https://www.monashfodmap.com/blog/the-truth-behind-non-celiac-gluten/