Gluten and inflammatory bowel disease (IBD)
Gluten, wheat and IBD
When you have inflammatory bowel disease (IBD) knowing what foods and drink affect your symptoms can be a bit of a minefield.
Some people with IBD have reported that gluten can cause a negative effect on their symptoms. Here we take a look at some of the reasons why that may be to help you make your own decision about whether it may be having an effect on your symptoms.
What is gluten?
Gluten is a protein found in wheat, barley, rye and triticale. It makes bread fluffy and dough sticky. It is a common ingredient in many foods - including a lot that you wouldn’t expect.
It is commonly found in:
It is also added to a lot of processed foods (and is even in some beauty products!) so always check the packaging if you are avoiding gluten from your diet.
- Cakes and pastries
- Malt containing foods (such as vinegar)
- Soy sauce
- Oats may contain traces of gluten
Problems with gluten
For some people gluten can cause gut problems. These include:
- Coeliac disease - an autoimmune disease in which the body’s immune system attacks itself when gluten is eaten. This causes bloating, diarrhoea, nausea, wind, constipation, tiredness, sudden or unexpected weight loss (but not in all cases), hair loss, anaemia and damage to the gut lining which can hinder absorption of nutrients. It affects around 1 in 120 people1, however only around 24% of these have been diagnosed
- Wheat allergy - a reaction to proteins in wheat caused by the immune system. Symptoms include hives or skin rash, nausea, vomiting, diarrhoea, indigestion, stuffy or running nose, sneezing, headaches, asthma. Some people suffer anaphylaxis (impaired breathing and shock which can be life-threatening)
- Intolerance/sensitivity - the symptoms can be similar to coeliac disease but it is not an autoimmune condition and no damage to the gut is caused
Cutting gluten (or wheat if you are allergic to wheat) completely out of your diet should stop symptoms. Gluten can stay in your body for some time and it may take at least 30 days for your symptoms to fade. This should only be done with the advice of your doctor.
Some people who suffer from problems when eating gluten also suffer from similar issues with dairy.
Gluten and IBD
Many people with IBD (both Crohn’s disease and ulcerative colitis) avoid gluten from their diet after finding it is a ‘trigger’ food for them.
There are various reasons as to why this may be:
- You may have undiagnosed coeliac disease. Coeliac disease is an autoimmune condition - and so is inflammatory bowel disease. If you have one autoimmune condition then you are more likely to have another. A study in 2011 also showed that people with Crohn’s disease are more genetically predisposed to coeliac disease2.
- You have undiagnosed gluten allergy or sensitivity
- You have leaky gut syndrome and gluten is contributing to it. Leaky gut is a condition in which the small intestine membrane has become porous (or leaky) allowing toxins, microbes, undigested food particles and antibodies to pass through and travel around your body in your bloodstream. If people are sensitive to gluten then the delicate intestinal membranes can be irritated by gluten which can contribute to leaky gut. Symptoms of leaky gut include bloating, gas, cramps, food sensitivities and aches and pains. It has also been linked with conditions such as eczema, inflammatory arthritis and chronic fatigue
- The wheat that we are eating today is different from the wheat our grandparents ate (and their grandparents before them). We have developed wheat to be more hardy when it’s growing. This means that around 5% of the proteins found in our wheat today are new and our guts may not have adapted to processing them which could cause some people problems
Many people with IBD have tried cutting gluten out of their diets. A cross-sectional study3 in the United States in 2014 found “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 IBD flares. In patients currently attempting a gluten free diet, excellent adherence was associated with significant improvement of fatigue”.
Recently, at United European Gastroenterology (UEG) Week 2016 - held in October 2016 in Vienna - researchers presented findings from a study into a family of proteins in wheat. The researchers said that amylase-trypsin inhibitors (ATIs) - have been shown to trigger an immune response in the gut that can spread to other tissues in the body. They say ATIs have been suggested to exacerbate rheumatoid arthritis, multiple sclerosis (MS), asthma, lupus, and nonalcoholic fatty liver disease, as well as inflammatory bowel disease4.
If you decide to eliminate gluten and/or wheat from your diet it should be done under the guidance of a dietician and it is important to cut it 100% from your diet for at least 30 days. If you are sensitive to gluten then even a tiny amount of it could cause an immune response which could trigger the symptoms you were experiencing. If you find that there is no change in your symptoms then you may not be sensitive to gluten and can reintroduce it.
When some people stop gluten they find that they go through a period of ‘gluten withdrawal’ which can cause symptoms such as brain fog, stomach ache, headaches, dizziness. These symptoms are temporary as your body adapts (and may indicate that you have a sensitivity to gluten).
When first going gluten free many people just switch their normal products for the gluten free versions of products. It is important to bear in mind that these products are highly processed and are not necessarily nutritious. Some people also feel worse from eating them due to some of the ingredients used in them (such as additives and grains).
Going gluten free can seem overwhelming at first, but you will quickly learn what healthy substitutes you can make for your favourite foods and how to cook gluten free. Visit our recipe section for some inspiration.
Recipes you may like
- Alberto Rubio‐Tapia, Robert A. Kyle, Edward L. Kaplan, Dwight R. Johnson, William Page, Frederick Erdtmann, Tricia L. Brantner, W. Ray Kim, Tara K. Phelps, Brian D. Lahr, Alan R. Zinsmeister, L. Joseph Melton III, Joseph A. Murray. Increased Prevalence and Mortality in Undiagnosed Celiac Disease. Gastroenterology. 2009 Jul;137(1):88-93. doi: 10.1053/j.gastro.2009.03.059. Epub 2009 Apr 10. PMID: 19362553
- Festen EA, Goyette P, Green T, Boucher G, Beauchamp C, Trynka G, Dubois PC, Lagacé C, Stokkers PC, Hommes DW, Barisani D, Palmieri O, Annese V, van Heel DA, Weersma RK, Daly MJ, Wijmenga C, Rioux JD. A meta-analysis of genome-wide association scans identifies IL18RAP, PTPN2, TAGAP, and PUS10 as shared risk loci for Crohn's disease and celiac disease. PLoS Genet. 2011 Jan 27;7(1):e1001283. doi: 10.1371/journal.pgen.1001283. PMID: 21298027
- 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 Jul;20(7):1194-7. doi: 10.1097/MIB.0000000000000077. PMID: 24865778
- Article in Medical News Today - http://www.medicalnewstoday.com/articles/313514.php