“When I went gluten free and made other dietary changes, I regained control over my digestive system,” explains Hanks, a holistic nutritionist who specializes in chronic disease management. “I’m regular, healthy, and no longer have to be near a bathroom at all times.” Hanks isn’t alone. Many people with inflammatory bowel disease (IBD) — ulcerative colitis or Crohn’s disease — report an improvement in their symptoms after cutting out gluten. Around 8 percent of people with IBD report having a gluten-free diet, and of these, according to a study published in 2014 the journal Inflammatory Bowel Diseases. Overall, nearly 66 percent of them saw an improvement in their symptoms. Thinking about trying a gluten-free diet? Here’s what you need to know.
Gluten and IBD: What’s the Connection?
Researchers have long suspected a link between celiac disease — an immune reaction caused by eating gluten — and IBD. One 2020 analysis published in May 2020 the journal Gastroenterology, found that people with celiac disease are 9 times more likely to have IBD than people without celiac. “Both celiac disease and IBD are autoimmune diseases. Sometimes when there is chronic inflammation and autoimmunity, people could tend to have more than one condition,” explains Marvin Singh, MD, director of integrative gastroenterology at the Susan Samueli Integrative Health Institute at the University of California in Irvine. When a person with celiac disease consumes gluten, an immune response is triggered in the small intestine. This can result in diarrhea, bloating, constipation, nausea, and vomiting, as well as fatigue and weight loss. Considering IBD also causes many of these symptoms, it’s easy to see how poorly managed celiac disease could make a person’s gastrointestinal (GI) symptoms worse. But what about people like Hanks and others with IBD who don’t have celiac disease? Even without a celiac diagnosis, it’s still possible to have a gluten sensitivity or intolerance, which experts call non-celiac gluten sensitivity (NCGS). For those with NCGS, consuming gluten can still trigger symptoms such as bloating, abdominal pain, diarrhea, and constipation as well as rashes, headaches, and feeling foggy, according to Mayo Clinic. For people with IBD and NCGS, “Eating gluten can cause them GI distress or increase their symptoms,” says Dr. Singh. The problem is, there’s no test to diagnose NCGS, says the American Academy of Allergy, Asthma & Immunology. So determining whether you have it amounts to cutting out gluten and seeing how it makes you feel.
Can Going Gluten Free Ease Your IBD Symptoms?
While there’s no cure for IBD, for some people cutting out gluten may be a helpful part of symptom management. If you have IBD and celiac disease, you should eliminate gluten from your diet. It won’t make your IBD go away, Singh explains, but it will help reduce inflammation in your small intestine, which in turn should offer some improvement in your GI symptoms. The answer for people who have IBD but not celiac disease is less clear. While the evidence hasn’t definitively shown that gluten worsens IBD symptoms, most people with IBD find that certain foods tend to trigger flare-ups. And cutting those irritants out of your diet can go a long way toward helping you feel better, according to Mayo Clinic and the Crohn’s & Colitis Foundation. For some people, gluten might be one of those irritants. According to the 2014 research, 56 percent of the survey participants reported experiencing less bloating when they went gluten free; 46 percent reported a decrease in diarrhea; 41 percent had less abdominal pain, and 38 percent had fewer flare-ups. Other small studies have also noted self-reported improvements in symptoms, but in some cases, researchers haven’t been able to measure or explain the improvement, according to a review published in April 2021 the journal Intestinal Research. In other words, there’s some research that supports a connection between a gluten-free diet and improved IBD symptoms in people without celiac disease, and plenty of individuals have noticed an improvement, but for now the evidence isn’t nearly robust enough to recommend that everyone with IBD stop eating gluten. This is what a 2021 review published in Molecular Nutrition & Food Research concluded.
Going Gluten Free With IBD
If you don’t have celiac disease but suspect gluten could be triggering your IBD symptoms, there’s no harm in trying a gluten-free diet to see if it helps. But you’ll need to take careful steps to make sure you’re avoiding gluten completely for a set amount of time to truly understand whether it triggers your symptoms, Singh explains. It’ll likely take at least two weeks of eating gluten free to notice any potential benefits, and “Many will need a longer period like four to six weeks,” he says. Before cutting out gluten, get the green light from your gastroenterologist and plan to see a dietitian who specializes in IBD, Singh recommends. They can help you identify the sources of gluten in your diet and read food labels to find less obvious sources of gluten, such as packaged sauces and salad dressings. They can also help you fill any nutritional gaps in your diet that might come from cutting out gluten-containing foods, such as wheat-based pasta or bread. In some cases, those with a mild gluten intolerance are eventually able to reintroduce gluten into their diets in small amounts without a problem. “It depends how sensitive you are,” Singh says. “Oftentimes people might be able to tolerate a little bit of something, but when they cross the threshold of the amount they can take, they get symptomatic.”
