What if Your Gluten-Free Diet Isn’t Helping?
Changing to a gluten-free diet should provide relief from symptoms in a short time, although tiredness and lethargy may take longer to resolve. However, symptoms continue sometimes or even return after a period of good health. There are many reasons for this, and the information provided in this article is intended as a quick guide. See your GP or specialist for possible explanations for your individual case.
You need more time. If you’ve been recently diagnosed as a coeliac, you may simply need more time to recover, particularly if you have low iron levels or other deficiencies.
The diagnosis may be wrong. If you’ve self-diagnosed, you may have the wrong diagnosis. The only sure way to confirm coeliac disease is through blood tests and a small bowel biopsy.
You’re still eating gluten. The most common explanation for continued symptoms is continued exposure to gluten. Even with the best will in the world it’s still possible to make mistakes. It can take time and determination to fully understand the intricacies of food labelling, locate less obvious sources of gluten, and learn how to avoid contamination issues when cooking or storing food. A qualified dietitian can often pinpoint the problem for you.
Sometimes the belief that ‘a little won’t really hurt’ means that you’re continually exposed, and even small amounts of gluten on a regular basis will cause inflammation of the gut and a return of symptoms. You can’t argue with reality — it will always win. If you eat gluten, it will cause damage.
Your problem may not be gluten. If coeliac disease has been ruled out, recent research suggests that the symptoms people commonly blame on gluten are probably not caused by gluten at all. A common cause of symptoms in those with irritable bowel syndrome (IBS) is a reaction to foods high in FODMAPs (Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols).
High FODMAP foods include the carbohydrate component of some gluten containing grains, plus a range of other foods. Another symptom trigger in those with irritable bowel syndrome can be intolerance to preservatives, artificial colours or natural food chemicals (for example, salicylates, amines and/or glutamate).
It’s important to note that some unlucky people will have irritable bowel syndrome in addition to coeliac disease, and so will need to avoid gluten plus their other IBS food triggers. The guidance of your doctor and an experienced dietitian is essential when determining the presence of other food issues.
Other less common causes. Less common causes can include bacterial overgrowth in the small intestine, inflammatory bowel diseases like Crohn’s disease, cancer of the large bowel, and refractory coeliac disease where an individual has active coeliac disease even though there is no gluten in the diet. These are serious conditions requiring specialist diagnosis and treatment.