Ever wondered about gluten and your IBD? Here is all you need to know

 
 

What is gluten?

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, even ones that would not be expected such as soy sauce and some processed meats.

Some common foods that contain gluten

  • Wheat (wheatberries, durum, emmer, semolina, spelt, farina, farro, graham, KAMUT® khorasan wheat and einkorn)

  • Barley

  • Rye

  • Spelt

  • Wheat pasta (white and wholegrain)

  • Bread

  • Cakes

  • Biscuits

  • Most breakfast cereals

  • Many sauces and marinades (including gravy)

  • Some flavourings

  • Many ready meals

  • Some sausages and other processed meats

  • Baking powder (if it uses wheat starch)

  • Some readymade soups

  • Some salad dressings

  • Soy sauce

  • Beer

Problems with gluten

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

Anyone who suspects they have an issue with gluten should first get tested for coeliac disease, which is a blood test that can be done via a GP. This must be done before attempting to remove gluten from the diet because for a coeliac blood tests to be accurate the person must have been exposed to gluten for at least 6 weeks prior to the test. Typically, 3-10g per day is enough (2g is a slice of bread). It is important to determine whether you have coeliac disease or not as this will determine how strict you would need to be on a gluten free diet.

Statistics show that a gluten free diet is tried by around 20% of 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 suggests that a gluten free diet could have a beneficial effect in some people with IBD, at a symptom level, but more research is needed to see if it has an impact on inflammation and on understanding the mechanisms behind how gluten may influence IBD.

What to do

Before you rush to remove gluten from your diet though there are some very important things to consider:

  1. Get help - you should only do this under the guidance of a qualified nutrition professional as there are risks associated with a gluten free diet.

  2. Malnutrition risk - malnutrition is already a worry for people with IBD and many gluten free foods are deficient in several nutrients, including dietary fibre, folate, iron, niacin, riboflavin, and thiamine. These and many other nutrients are important for our health and for recovery so you need to make sure you are getting these from other foods and a nutritionist can help with this.

  3. Fibre - If you remove gluten you may be removing important fibre – in fact, research has shown that in healthy individuals, removing gluten may have a negative impact on the health of their gut and the diversity of microbes in their intestines which help to keep us healthy and these microbes are important in IBD too. So, it is important that this is replaced with other fibre containing foods to ensure a healthy balanced diet.

  4. Gluten free is not always healthy - many processed gluten-free products can contain higher levels of trans fat and additives, compared to gluten-containing foods which may have a negative impact on our health and gut health so just switching over to these may not be the most beneficial way to follow a gluten free diet.

  5. Gluten free products can be expensive – if you opt for lots of gluten free alternative products this can make the weekly shop more expensive so its important to get guidance on how to best follow a gluten free diet so its better for your health and your wallet!

  6. Restricted diets can decrease quality of life – gluten is found is so many everyday foods and if you are already on a very restrictive diet it may not be the right thing for you at the moment. If done without help and guidance it may also cause stress and anxiety which we know has a negative impact on our IBD (read more about that here).

  7. Gluten may only be one piece of the puzzle – I’m often talking about ‘pieces of the puzzle’ because its never one thing that’s going to be the magic pill that solves your problems when it comes to IBD and nutrition. We need to look at all the pieces of the puzzle, including foods, nutrients, deficiencies, gut health, sleep, stress, movement and how all these interlink to help or hinder your progress. Its also important we are not always focused on what we need to remove from our diets but rather what we can be including that may be supportive. Ultimately my aim with all my clients is to improve their quality of life and help them achieve nutritional balance through the least restrictive diet possible.

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.

Disclaimer: All content found on the nalmclinic.com website, including: text, video, or other formats have been created for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your doctor, consultant or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

We are all wonderfully unique and what works for one person may not work for another so please seek help and advice to work out the right way forward for you.

Clemmie Macpherson