Gluten & IBD
What is Gluten?
Gluten is a protein in wheat, barley, rye, regular soy sauce
What are the facts?
- Commonly avoided in IBD patients based on symptom relief
- Microscopic colitis- around 50% also have celiac
- With celiac- you will need to remove gluten to avoid GI damage.
- Research is mixed, but growing support for temporary elimination in IBD as a whole
- In microscopic colitis- more support for removal or testing for celiac
What we know about it
- In some animal studies- increased risk for ileitis (last part of SI)
- In animal studies- increased intestinal permeability (can be a risk factor for flare)
- In 2020 a large study showed a 1.4 increased risk of colon cancer (proximal type)
Can a gluten free diet improve IBD symptoms?
- One study found symptom improvement in 65% of the patients with IBD who tried a gluten free diet
- In the same study, 40% reported less severe & frequent flares and less fatigue
Who should make changes?
- Those that have Celiac should DEFINITELY avoid gluten containing foods
- Those with Microscopic Colitis should have a celiac test and consider an elimination period without gluten since the rates are much higher in this group
- Those with Crohn’s or Ulcerative Colitis should consider a trial elimination or just simply focus on including more gluten free grains (buckwheat, sorghum, millet, teff, rice, quinoa, oats etc)
The Bottom Line:
Symptom free doesn’t mean there isn’t inflammation present. Symptom improvement is only one goal, we would also like to see inflammation reduction too. More evidence is leaning towards gluten being a potential inflammatory trigger (even if it doesn’t trigger symptoms).