Does a Gluten-Free Diet Help with IBS Symptoms?
The majority of patients seen for IBS treatment are either on a gluten-free diet, or have tried such a diet with mixed success. Marketing campaings have promoted a gluten free diet for a variety of common digestive symptoms ranging from abdominal bloating and pain, gas and altered bowel habits. However, the evidence for the effectiveness of such a dramatic dietary approach in the treatment of IBS is rather sparse and inconsistent.
If you’ve been paying any attention to the bread aisle at your grocery store, you would have noticed how much it has expanded in the past few years with items labeled “gluten-free”. This is ideal for those diagnosed with celiac disease, which is an inherited autoimmune condition that is triggered by consuming foods containing gluten. Those affected by celiac disease often experience gastrointestinal symptoms such as bloating, diarrhea, unintentional weight loss and constipation after consuming gluten from wheat products and related prolamins from grains such as rye and barley due to the maladaptive response of the gut’s immune system to this protein and the gut, damaging the villi of the small intestine and if severe enough resulting in malabsorption of nutrients. Considering the prevalence of celiac disease is about one percent of the general population in the U.S., including both diagnosed and undiagnosed cases, there are clearly other factors causing the recent demand for gluten-free products.
“Gluten free diets have become the latest health food fad…”
Gluten free diets have become the latest health food fad, with more and more consumers decreasing their gluten intake regardless of their diagnosis or sensitivity to wheat products. A major contributing factor to the widespread adoption of this diet is the media’s role in sensationalizing a few studies claiming that avoiding gluten leads to weight loss, and improved cardiovascular and gut health. Various celebrities and athletes have touted the benefits of this diet which has created misconceptions about it’s nutritional effects and has accelerated it’s rise in popularity in the U.S. and much of the Western world.
Without any scientific research backing up many of these claims, more and more people without celiac disease are adopting a gluten free diet in hopes it will improve their overall health and physical appearance. In a 2017 survey of 1,000 consumers of gluten-free products in the United States and Canada, 46% of those surveyed reported they bought gluten-free products for reasons other than an allergy or medical condition. Many believe that gluten-free products are healthier and more natural, will help reduce inflammation and aid in weight loss. Although these widespread beliefs are not backed up by scientific research, they are not unlike previous health food fads where the media demonizes a single food item or nutrient. An article published in the Diabetes Spectrum journal, cites evidence showing significant downsides to following a gluten-free diet for those without a celiac intolerance. Gluten free products tend to be lower in fiber, iron, zinc, and potassium and without the consumption of whole grains, fiber and micronutrients, cutting out all gluten-containing foods can increase risks for nutritional deficiencies, especially in B vitamins, iron and trace minerals.
Since gluten gives bread that cohesive, stretchy texture that’s so satisfying, gluten-free products often contain more sugar, fat, salt and processed ingredients in order to make them taste like wheat-containing foods. As explained in a previous post in this newsletter, recent scientific evidence has demonstrated that the microstructure of Italian pasta is modified in a way that slows the gastric emptying and absorption of the pasta, resulting in a lower glycemic index compared to gluten free carbohydrates.
In addition, following a gluten free diet is significantly more expensive. A 2015 study from the same scientific journal mentioned above found that gluten-free bread and bakery items averaged about 267% more expensive than their gluten-containing counterparts. Those who follow a strict gluten-free diet have to be careful of items like certain sauces, “natural flavorings”, certain medications and even some toothpaste that may contain hidden gluten in their ingredient list.
“…the incidence of celiac disease has been increasing 7.5 percent per year over the past several decades.”
A 2020 systematic review and meta analysis of 50 studies done in Europe, North America and New Zealand on the incidence of celiac disease found the incidence of celiac disease to be increasing 7.5 percent per year over the past several decades. The rates of celiac disease diagnoses have increased mainly due to increased awareness and more accurate and accessible testing. Considering these increased incidence rates are specific to industrialized nations in the Western world, it’s worth looking deeper into environmental factors and food production of gluten-containing products. Wheat itself hasn’t changed much in the past 100 years, but how we’ve used it definitely has. Most bread and gluten-rich products sold in grocery stores in the U.S. are highly processed and contain preservatives, additives and high levels of sugar that keep them shelf-stable. As discussed in The Gut Immune Connection, in the last 75 years or so with the industrialization of agriculture came the development of processing methods which have loaded our diet with ultra processed foods packed with an unprecedented amount of sugar, preservatives, artificial flavors, emulsifiers and often added gluten, so called vital gluten. Specifically ancient grains, which have historically introduced beneficial MACs (Microbiome Accessable Carbohydrates) into our diet, a feast for our microbes, are now genetically selected and highly processed which has dramatically reduced their diversity and removed most of their indigestible fiber and micronutrient content. Wheat and other types of grains still remain a universal food staple due to their high nutritional value and versatility, but the recent gluten-free diet trend has created a misconception that wheat products are unhealthy.
“…living with strict dietary restrictions can be a limiting factor in social interactions and can cause food-related anxiety…”
While the rise in popularity of the gluten-free diet and wide variety in gluten-free products is great for those diagnosed with celiac disease, it is definitely not a recommendable option for those just looking to improve their overall health, or improve their IBS symptoms. It’s also important to acknowledge that one’s diet affects much more than just what is ingested; living with strict dietary restrictions can be a limiting factor in social interactions and can cause food-related anxiety when sharing a meal with others or trying new things. Such food-related anxieties and hypervigilance play a prominent role in many IBS patients who report food-related symptom flares. In contrast to the gluten free diet, a diet consisting of more polyphenols, plant-based fiber, phytonutrients, and complex anti-inflammatory molecules found in a largely plant-based diet will not only feed your microbes and provide your body with high quality macro and micronutrients, but the enjoyment of such a diet without worries is likely to decrease your gut symptoms as well.
Juliette Frank is a UCLA student majoring in Public Affairs with a minor in Food Studies. Her interests include the interrelation between food systems, digestive health and the environmental impacts of food production.