Should you go gluten free if you have IBS?

Welcome to episode 16 of the Inside Knowledge with me, Anna Mapson.

Today is all about gluten, gluten free diets and wheat. And what is the difference between all these different foods? Where should you focus your attention if you want to try and make changes to your diet? It’s a question that I get a lot from people.

Should I go gluten free?

To be honest, a lot of my clients arrive at the beginning of their gut reset and they are already gluten free. And so, I talk to clients about this a lot and I thought you guys, podcast listeners, might also like to listen in to my thoughts on the matter. So I thought I’d start just by talking about what is actual gluten.

What is gluten? 

 You probably know that it is a key component of grains, and if you think about a kernel of grain, the majority of it is made up of starch, and we’re going to get into that as well, because these also have an effect on your digestion. The main protein that is in the kernel is Gluten and, well, we call it gluten, but it’s actually lots of different proteins.

Some of the main ones are gliadin and glutenin, and these are the ones that have the biggest effect on your digestion. Good things about gluten is that it makes bread stretchy and cakes chewy and stretchy and all that nice fluffiness that you get in a lovely fresh loaf of bread.

That is from the gluten, so there is like a big purpose that we found in this natural grain and we’ve harnessed it.

What foods contain gluten?

It’s sometimes added to food products to help with texture to help with moisture retention. Or sometimes flavouring as well so you might see gluten added to a lot of foods where you wouldn’t naturally think that a protein from a grain would be necessary. But they’ve kind of used it in food products and that’s why a lot of products do contain gluten.

It’s just naturally found in any foods that contain grains such as wheat, rye, spelt barley.

These are the most common grains that we normally use.

Why would I feel better on a gluten free diet?

Some people do feel better when they go on a gluten-free diet. Now whether they’ve got IBS or not, some people do, and this is down to a number of things. Sometimes it can be that they’ve just changed the way that they eat.

It’s a typical eating pattern in the UK for people to have a cereal for breakfast, a sandwich for lunch, and then pasta for dinner. Which is three main wheat containing meals per day. It means that you’re not getting as much variety because you’re eating so much wheat. And it also means that there could be digestive consequences of eating so much.

Because there are certain things in the grains, the gluten is one, but there’s also the starches, and then there’s a third thing called amylase trypsin inhibitors, which is another sort of non gluten protein, which can also have an impact on the way that you digest the food.

So these are ways people could feel better.

It might be down to reducing the fructans in the wheat, and that’s one of the FODMAPs, so we’ll come on to that in a moment.

What about Non-Coeliac Gluten Sensitivity?

There is also a condition called Non-Coeliac Gluten Sensitivity. So this is for people who don’t have coeliac disease, but do have a severe reaction to gluten containing foods.

And just as a reminder, coeliac disease is an autoimmune condition where your immune system actually attacks your own tissues, like your small intestine tissues, when you eat gluten. So this is a serious… condition that must be treated with a 100% gluten free diet.

But going back to the non celiac gluten sensitivity, um, the problems are with it that there’s no biomarker to test for it.

So when you test for coeliac disease, we’re looking for specific antibodies that your immune system has created in response to gluten containing foods. But with non coeliac gluten sensitivity, there are no biomarkers.

Some of the problems with studies that people have done to try to understand more about the condition mean that people who had coeliac disease weren’t properly ruled out of some of the studies.

Sometimes they didn’t differentiate between gluten and other components in the wheat, like fructans or, like I mentioned before, those amylase tryptin inhibitors, that could also be creating issues.

How does gluten affect the gut?

If we look at what gluten actually does, like, why is it a problem for people who might be sensitive to gluten?

Well, in some studies… They’ve shown that eating gluten might increase bowel frequency in people who have diarrhoea predominant IBS.

So it may add to your frequent bowel movements or loose bowel movements. But like I said, sometimes these studies, they haven’t differentiated between gluten and wheat, and this is partly the problem with understanding a bit more of the data.

And the best thing to do is to do some trials on yourself. There might also be some cases where eating gluten increases the permeability of our gut. So we’ve got this really tight barrier between the gut, the inside of what we’re putting into our body, and then the tissues and the cells that are like in, the rest of our body.

So sometimes eating gluten can increase the permeability and potentially the hypersensitivity of the gut.

But some of the problems with this is that it’s difficult to blind participants in a study to whether they’re eating bread or not, or if you do it on yourself, whether you’re eating gluten containing foods.

The nocebo effect

And what we have, you might have heard of the placebo effect. There’s also something called the nocebo effect, which is when you expect for there to be a negative consequence to eating a certain food. And that does stimulate a negative response, even if you haven’t eaten the food.

So this is sometimes where the power of our mind in IBS can have such a large consequence on our digestive capacity and capability.

So sometimes there is a physiological condition, that can be changed by eating grains.

Is it the gluten or fructan content?

But I also want to really make it clear that there is a difference between gluten and the way that affects your body and then the starch, which is the majority of each grain and how that affects it.

The FODMAP content of foods

So in the low FODMAP diet, we have, um, And if you haven’t heard of the low FODMAP diet, I will be doing an episode on that very soon because I keep referring to it and I’m aware if you are only a podcast listener and you haven’t looked at my website where there is a lot of information about the low FODMAP diet, but if you haven’t, then you might not be familiar with this IBS diet.

So the low FODMAP diet removes a lot of fermentable carbohydrates from our diet. It’s not intuitive, so it’s really difficult to follow on your own. It includes things like peppers and apples, cabbage, onions and garlic and some of the more common IBS foods. But also some of the foods which are not quite so typical in terms of what you might think would set off your symptoms.

Fructan in wheat can trigger IBS symptoms

 Fructan is one of these FODMAPs that is very high in grains. Like rye and spelt and wheat. So any bread, pasta, cakes, biscuits will have high levels of fructan and that is the main starch and that is one of the FODMAPs.

So what we know from lots of research into FODMAPs is that that can stimulate Rapid fermentation by your gut microbes, which can create gas and bloating.

It can trigger diarrhoea episodes and can make you get all of those IBS symptoms that are so, unfortunately, familiar to you if you’ve got IBS.

Should we remove all gluten? 

So, if some people feel better on a gluten free diet, then why would we just not cut it out of our diet anyway, just to give it a go, just to see if it might work?

Well, there are lots of reasons.

1. Missing a diagnosis

Firstly, there’s a risk of misdiagnosing a more serious condition. For people who haven’t yet seen a doctor, I would say this is your first step is to go to get an IBS diagnosis, if possible, from your doctor and as part of that diagnosis, they should be Ruling out coeliac disease.

The problem with coeliac disease testing is that you must be eating sufficient gluten for 6 weeks. And it’s about 1 2 slices of bread, 1 2 times a day for 6 weeks. Now if you’ve already given up gluten and you feel better, you don’t want to start putting that back in your body again in order to just get a test.

But it does mean that you might not… be identifying coeliac disease if you’ve never been screened for it. So that is really important to do is before you give up gluten make sure that you get that Coeliac disease test.

The other thing is, there are some risks about sort of self diagnosing a gluten insensitivity.

2. Gluten free products cost more

One is more like a practical thing, that gluten free products are much more expensive and normally much smaller. So you get a lot less product for a lot more money. And if anyone is on a gluten free diet, you will know. Smaller little hot cross buns and smaller crackers, but they’re like twice as expensive.

So there’s a cost and there’s an… impact on you.

3. Extra diet complexity

And then there’s also, a Mental load, I would say, of having to avoid foods that you don’t necessarily need to. it takes up a lot of mental processing to always be avoiding foods when you want to eat out, when you want to go and buy a ready meal or something from a shop, when you want to eat with friends.

 Being gluten free can just add another layer of complexity, and so it might not necessarily be…

4. Eating gluten free can reduce fibre intake

And then from a nutrition perspective, the fourth risk, I suppose, about self diagnosing gluten sensitivity is that you’re probably reducing down your fibre quite a lot. So gluten free products tend to be much lower in fibre.

They also tend to be lower in B vitamins like thiamine, folate, and then also some minerals such as iron, and maybe calcium and other things. So this is down to reduced cereal content in the foods.

Gluten free products are often made with semolina, with rice flour, other things that just tend to try to mimic the texture of bread and pasta products.

And if you’re someone who eats, like, just naturally gluten free products because you’re avoiding gluten, such as rice, corn, potatoes. The other thing, there is just less fibre in those compared to grains.

Aim for 30g of fibre per day for gut health

Whole grains do make up a large percentage of our 30 grams a day target that we are recommended to try to get.

Most people in the UK are somewhere between 18 and 19 grams of fibre. The aim is to try to get somewhere more like 25 to 30 grams depending on the size of your diet.

Gluten free products aren’t always good for IBS

Gluten free products may also contain a bit more fat or refined sugar because they’re trying to recreate products. They’re trying to make them tasty and actually some of that taste and the texture comes from the gluten.

So, sometimes there are additional things that are added that could actually be maybe stimulating your digestive symptoms.

Eating a healthy gluten free diet

So if you’ve got this far in the podcast and then you’re thinking, but what do I do about it? Let’s get into how to actually eat a healthy gluten free diet and is there any difference in things like sourdough or ancient grains?

So I’m going to explain a bit about that now.

Try the low FODMAP diet first

One of the first things I would say is, if you have in the past tried gluten free or you’ve lowered gluten and you felt better, what I would suggest you trial first is to do the low FODMAP diet. So that’s the diet I mentioned where we’re stripping out all of these fermentable carbohydrates.

This is not gluten free diet, but it does… reduce down the amount of fructans, that’s that fermentable starch that can cause bloating, sometimes cramping and pains and diarrhoea and all kinds of things in people who have IBS.

If you’ve tried the low FODMAP diet, and one thing I would say is if you’ve tried it on your own, I know it can be so difficult to follow, so if you’ve tried it under the guidance of somebody who has trained in the FODMAP diet and it hasn’t worked, then you could try a gluten free diet.

As I mentioned before, if you haven’t already had a test for coeliac disease, definitely before you go gluten free, make sure that you have tried to have that test to rule out coeliac disease. If you are gluten free, key things you must consider are firstly your fibre intake.

Increase your fibre intake

You must try to eat more fibre than you would be used to. You can think about whole grains such as quinoa or buckwheat or oats and these are a good way to bulk up your fibre without gluten.

Can I eat oats on a gluten free diet? 

Now oats for some people who have coeliac disease, you can get gluten free oats but the proteins are very very similar and some people will cross react to oats as well.

So, That might be an issue for you if you have coeliac disease. For people who are gluten sensitive, oats are often okay, particularly if you choose gluten free oats.

Is quinoa gluten free?

Now, the other thing I wanted to mention is about quinoa is although it is naturally gluten free, it’s often cross contaminated with gluten.

So if you are being very strict about gluten elimination, sometimes you need to choose gluten free products such as gluten free lentils, gluten free quinoa. Now this is particularly for people who have celiac disease because 20 parts per million, so imagine a million marbles and only 20 of them are a different color, like what all of the rest are red all of those 20 can damage the intestines of people who have celiac disease.

So this is why it’s so important to know whether you need to be that strict or do you just need to be avoiding gluten most of the time and you’re okay. This is where the definition is really, really critical.

DNA testing for the coeliac disease gene

I also wanted to say if you’ve got to the stage where you have removed gluten, you don’t want to bring it back in, one of the things you can do is to get a DNA test to show whether you have the genes that could potentially lead you to a predisposition to having celiac disease.

Anyway, to get back to the things to focus on, yeah, so fibre.

Definitely try to focus on fibre through lots of fruits and vegetables, other non gluten containing whole grains, and, nuts and seeds where you can get those in as well. And then other minerals to focus on would be zinc and iron, and your B vitamins. They’re widely available, but basically it’s just eating a wide variety and a broad and balanced diet as possible.

Even if you are going to be gluten free, so you can be as healthy as possible.

Watch out for added ingredients in gluten free products

And then do watch out for, you know, those increased fats or refined sugars in gluten free products, because it can stack up. If you’re eating a lot of gluten free pasta, gluten free biscuits, gluten free cereals, actually sometimes the additional fats, salts and sugars can really add up.

Is sourdough bread better for IBS? 

Now the one thing I do hear quite a lot, which I just wanted to finish on, was what about different grains? Is there less gluten in some grains compared to others? What about sourdough? Does that affect the gluten content.

Well, the key thing is with sourdough is that it ferments away some of the starches and breaks down some of the carbohydrate element of the grain.

Okay, so if you’re having sourdough and you feel okay eating sourdough bread or sourdough pizza, but you can’t manage normal bread, it’s probably more likely to do with the fructans, and that’s a FODMAP issue, that’s not a gluten issue.

If you don’t get reactions to sourdough bread, I would say you don’t have a problem with gluten.

So that’s really important because again, you want to think about, am I avoiding wheat or actual grains, and I can then help them to be fermented to reduce down the fructan content, or do I need to avoid all products that contain gluten and therefore switch to gluten free bread.

What about ancient grains like spelt and einkorn? 

Then also the other thing I wanted to mention which is a bit of a common misconception is that some grains contain less gluten than others.

Whilst that is true to some extent, they’re pretty much similar. I found this really good study from 2019 in Germany, where they chose different types of wheat over four different locations. They had about 300 samples of different sorts of wheats to see is ancient wheat like spelt and einkorn better than common wheat like durum wheat and just the common wheat that we have in bread and pasta.

And what they actually found is that spelt has almost exactly the same gluten content as wheat.

It is a common misconception that ancient grains have got a lower gluten content.

Now, they might have slightly different gluten content, and that could affect you because there are four or five different types of gliadine. 

I think there’s three different types of gluten in so there are different types of the proteins and these could affect you in different ways.

So it’s not to say that there’s no benefit at all in changing the way that you eat and eating of different variety of grains It’s just that it might not necessarily again be all gluten that you need to avoid.

Summary

So to wrap up this episode, I guess my main points are

• changing your diet from a wheat carbohydrate heavy diet plan to a diet that contains more diversity and different types of grains and different types of foods can be beneficial, that’s the first thing.
• Secondly, if you’re going to go gluten free, please try and ensure that you’ve had a coeliac disease test and that that has been ruled out for you. Because if you feel better, you don’t want to have to go back on it and start eating it. Think about whether it is wheat for you, whether it is gluten. Because that will make a difference to whether you can eat gluten containing foods, rather than a lot of wheat. And that can make a difference, dramatically, to the variety, the diversity of your diet.
• One of my main aims for all my clients and all my podcast listeners is that you eat a broad and balanced diet that is as high in fibre as you can manage. And if you need better ways of increasing your fibre, I’m going to do other episodes coming down the line on how to increase your fibre in a way that feels comfortable for you because fibre is a real powerhouse of our digestion. And without we will really struggle to have a healthy gut.

If you’ve got questions about what I’ve said today about gluten, then please let me know. you can email me and you can also suggest ideas for future episodes if you’ve got something you’d like me to talk about. Right, that’s it for this week.

I will see you next week. Goodbye.