Gluten and IBD - Mythbuster
The Myth: Going gluten free will cure your IBD
The Truth: It won’t cure it - some patients find some symptom improvement on a gluten free diet but current research suggest it does not reduce inflammation, improve disease severity or quality of life.
What is gluten and where is gluten found?
Gluten is a general name for the proteins found in wheat, rye, barley and triticale (a cross between wheat and rye). Gluten helps foods maintain their shape, acting as a glue that holds food together. Gluten can be found in many types of foods like bread, pasta, cakes, biscuits, pastries, many breakfast cereals, beer, and other less obvious foods like soy sauce, gravies, dressings, and some processed meats.
Problems with gluten and wheat
Coeliac disease - this affects around 1% of the population and is an autoimmune condition where the immune system attacks and damages the lining of the small intestine when gluten is eaten. It is possible to have IBD and Coeliac disease, however, overall there seems to be a lower risk of coeliac disease in inflammatory bowel disease patients than in the general population.
Wheat allergy - an allergic reaction to foods containing wheat. If someone with a wheat allergy eats wheat a reaction usually happens within minutes. The person may experience symptoms including swelling, itching or irritation of the mouth or throat, Hives, Headache, Difficulty breathing, Cramps, nausea or vomiting and sometimes anaphylaxis.
Gluten intolerance/non coeliac gluten sensitivity (NCGS) – someone with a gluten intolerance may experience symptoms after eating gluten, like bloating, pain, diarrhoea, constipation but sometimes also fatigue, brain fog, joint pain and other extraintestinal symptoms, but it is not an allergic reaction or an autoimmune condition. Some research suggests there may be an immune involvement and a weakening of the intestinal barrier but this is yet to be fully investigated. It is also possible that it is not the gluten causing the problem but instead something called fructans - gluten-containing foods also contain fructans, a type of FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols), which has been associated with gastrointestinal symptoms in IBS and IBD.
We can test for coeliac disease and wheat allergy but currently there is no way to test for gluten intolerance/NCGS.
Gluten and IBD
Statistics show that a gluten free diet is tried by around 20% of IBD patients (without coeliac disease). A large study of 1,647 people with IBD, found that 65.6% of all patients who attempted a gluten-free diet, described an improvement of their gastrointestinal symptoms and 38.3% reported fewer or less severe flare-ups between periods of remission. This, observational data (limitation: can’t prove cause and effect), suggests that a gluten free diet could be helping some people with IBD, at a symptom level, but other intervention data like this well designed clinic trial in patients with ulcerative colitis showed no improvement in blood markers for inflammation, disease severity, or quality of life when comparing a gluten free diet to placebo.
Take away
Following a gluten free diet may help with gastrointestinal symptoms in IBD in some people but the data does not support a universal GFD in people with IBD.
References:
Herfarth HH, Martin CF, Sandler RS, Kappelman MD, Long MD. Prevalence of a gluten-free diet and improvement of clinical symptoms in patients with inflammatory bowel diseases. Inflamm Bowel Dis. 2014;20(7):1194-1197. doi:10.1097/MIB.0000000000000077
Weaver, K. N., Herfarth, H., Gluten‐Free Diet in IBD: Time for a Recommendation?. Mol. Nutr. Food Res. 2020, 1901274. https://doi.org/10.1002/mnfr.201901274
I have written a free e-book to help you find a way forward for your everyday life with Inflammatory Bowel Disease. Whether you are right at the beginning of your journey with IBD or have been living with your condition for years and feel like you have tried almost everything, there are things you can do everyday, beyond the medication you are taking, to help you take back control.
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We are all wonderfully unique and what works for one person may not work for another so please seek help and advice before changing your diet to work out the right way forward for you.