Dietas libres de gluten y caseína en el TEA
Hasta el momento, no existe un tratamiento curativo para el TEA, pero en las últimas dos décadas, el papel del sistema digestivo en el desarrollo del TEA ha sido un tema de interés, a partir del hallazgo de la alta prevalencia de problemas y trastornos gastrointestinales en las personas con TEA.
Además, se ha descubierto que los niños con TEA presentan niveles más altos de citoquinas proinflamatorias tras la exposición a las proteínas alimentarias del gluten, la caseína y la soja, en comparación con los controles, hallazgos que han estimulado la investigación del posible vínculo entre la alergia alimentaria y el TEA.
Las teorías sobre los mecanismos de acción de la implicación del sistema inmunitario y el sistema gastrointestinal en el desarrollo de los TEA son numerosas e incluyen la implicación de la barrera intestino-sangre-cerebro, donde se ha propuesto que los subproductos de la microbiota intestinal, como los lipopolisacáridos y los ácidos grasos de cadena corta, modulan la producción de citoquinas.
Asimismo, se ha sugerido que los subproductos de la microbiota influyen en la síntesis de neuropéptidos como la serotonina, y se ha planteado la hipótesis de que los péptidos del gluten y la caseína aumentan la actividad del sistema opioide.
Se cree que estos neuropéptidos están implicados en el comportamiento social y la comunicación y, por tanto, pueden estar implicados en la patogénesis del TEA.
La dieta sin gluten ni caseína comenzó a ser utilizada por algunas familias hace un par de décadas como tratamiento para los síntomas del TEA, así como para intentar atajar los problemas gastrointestinales.
Sin embargo, una revisión Cochrane de 2008, basada en dos ensayos controlados aleatorios, concluyó que las pruebas de la eficacia de eliminar el gluten y la caseína de la dieta, basándose únicamente en el autismo como indicación, era inciertas. No se recomendaba seguir esta dieta.
En 2021, un grupo danés ha realizado otro metaanálisis, un estudio sobre los estudios realizados sobre las dietas libres de caseína y gluten en el autismo.
Para ello realizaron una búsqueda bibliográfica sistemática en Medline, Embase, Cinahl y la Biblioteca Cochrane hasta enero de 2020 para las revisiones sistemáticas existentes y los ensayos controlados aleatorios (ECA) individuales. Se incluyeron los estudios que habían investigado los efectos de esta dieta en comparación con una dieta regular en niños de 3 a 17 años diagnosticados con TEA, con o sin comorbilidades.
La calidad de las revisiones existentes identificadas se evaluó mediante la herramienta de medición para evaluar las revisiones sistemáticas (AMSTAR).
El riesgo de sesgo en los ECAs se evaluó mediante la Herramienta Cochrane de Riesgo de Sesgo, y la calidad general de las pruebas se evaluó mediante los Grados de Recomendación, Valoración, Desarrollo y Evaluación (GRADE).
Los principales resultados son:
- Se identificaron seis ensayos clínicos aleatorios ECAs relevantes, que incluyeron 143 participantes.
- No se encontró ningún efecto positivo de una dieta libre en gluten y caseína sobre los síntomas centrales del autismo según los informes de los médicos (diferencia de medias estandarizada [DME] -0,31 (IC. del 95%: -0,89; 0,27)
- No hubo mejorías sobre el nivel funcional de los chicos según los informes de los padres (diferencia de medias [DM] 0,61 (IC. del 95%: -5,92; 7,14))
- No hubo diferencias en las dificultades conductuales (DM 0,80 (IC. del 95%: -6,56; 10,16)).
- La dieta libre de gluten y de caseína puede desencadenar efectos adversos gastrointestinales (riesgo relativo [RR] 2,33 (IC del 95%: 0,69; 7,90)).
- La calidad de las pruebas fue de baja a muy baja debido al grave riesgo de sesgo, al grave riesgo de inconsistencia y al grave riesgo de imprecisión.
La principal implicación clínica del estudio danés es que no hay justificación para la introducción de una dieta libre en gluten y en caseína en los niños con TEA.
Sin embargo, las limitaciones de los estudios realizados hasta la actualidad dificultan la posibilidad de extraer cualquier conclusión sólida.
Se necesitan más ensayos clínicos aleatorizados de alta calidad.
Para leer más:
- Keller A, Rimestad ML, Friis Rohde J, Holm Petersen B, Bruun Korfitsen C, Tarp S, Briciet Lauritsen M, Händel MN (2021) The Effect of a Combined Gluten- and Casein-Free Diet on Children and Adolescents with Autism Spectrum Disorders: A Systematic Review and Meta-Analysis. Nutrients 13(2): 470. doi: 10.3390/nu13020470.
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