Does going gluten-free really help IBS?


A fodmap-rich diet may have more of an impact on IBS than gluten, but psychological factors seem to play a more important role in this chronic condition. — TNS

Irritable bowel syndrome (IBS) affects around three to five percent of the world’s population, and involves symptoms such as stomach pain, diarrhoea and constipation.

Many sufferers avoid certain types of food and often exclude gluten.

However, a large new study from Chalmers University of Technology and Uppsala University in Sweden, does not show a relationship between high intake of gluten and increased IBS symptoms.

The researchers did find that a certain type of carbohydrate called “fodmaps” can aggravate intestinal problems; however, the overall results indicate that they also have less influence than previously thought.

Fodmaps is an abbreviation for “fermentable oligosaccharides, disaccharides, monosaccharides, and polyols”.

They are found in a variety of foods, including dairy products, cereals, mushrooms, fruits and vegetables.

“IBS is a very complex disease involving many factors, but our results indicate that the effects of specific diets are not as great as previously thought,” explains lead author and Chalmers food science PhD student Elise Nordin.

Rice pudding test

In the new study, which included 110 people with IBS, the researchers examined how people were affected by serving them rice puddings prepared in different ways.

One variety was rich in gluten, while the other contained large amounts of carbohydrate of the fodmaps variety.

A neutral one was also served as a placebo.

The participants ate the three types of rice puddings in random order for one week per category, with a week’s break in between.

Otherwise, they all had a diet with minimal fodmaps content and no gluten.

Blood and stool samples were provided weekly, and the participants also completed questionnaires about their perceived symptoms.

The study, published in the American Journal of Clinical Nutrition, was doubleblind, meaning that neither the participants nor the researchers knew who ate which rice pudding and when.

“Diet studies are difficult to conduct doubleblind, as it can often be obvious to the participants what they are eating,” says Nordin.

“This is a big obstacle, as knowledge that something has been added to or removed from the diet can affect the result.

“The fact that we succeeded in creating diets that were completely blind, together with the large number of participants, makes our study unique.”

The participants’ gastrointestinal systems were provoked through high doses (1.5 times the daily intake of a normal population) of fodmaps (50g) or gluten (17.3g).

The fodmaps aggravated the symptoms, but not to the extent that the researchers had expected based on results from previous studies.

Gluten, however, was found to have no measurable negative effect on the subjects’ perceived symptoms.

“Our results are important and indicate that the psychological factor is probably very important.

“IBS has previously been shown to be linked to mental health.

“Simply the awareness that one is being tested in a study can reduce the burden of symptoms,” says Uppsala gastroenterology professor Dr Per Hellström, who held medical responsibility for the study.

In previous studies, researchers have mainly excluded fodmaps from the participants’ diets and this has shown a clear reduction in IBS symptoms.

However, these studies have had few participants and have not been conducted doubleblind, which makes it difficult to objectively evaluate the results.

Different metabolisms, different diets?

Many IBS patients exclude gluten from their diet, despite the lack of scientific evidence.

Results from previous research are inconsistent.

Foods rich in gluten, such as bread, are often also rich in fodmaps.

One theory has therefore been that it is the fodmaps in these foods, not the gluten, that causes the IBS symptoms.

This shows the importance of studies separating the effect of fodmaps and gluten.

This study is part of a larger project in which the researchers are looking for biomarkers in the intestinal flora or the blood to be able to predict health outcomes.

The researchers want to investigate whether individuals can be divided into metabotypes, i.e. groups based on how individuals’ metabolism and intestinal flora respond to different diets, and whether these groups show different IBS symptoms.

“Finding objective biomarkers that can determine if an individual belongs to a certain metabotype for IBS symptoms could make life easier for many individuals with IBS.

“There are many indications that it is possible to use objective markers for more individually-tailored dietary advice,” says Chalmers Division of Food and Nutrition Science head Prof Dr Rikard Landberg.

This study also clearly shows large individual variation when it comes to how different people are affected by a specific diet.

“Even if at group level we only see a moderate effect from fodmaps and no effect of gluten pro- vocation, it may well still be the case that some individuals react strongly to these foods.

“That is why it is important to account for individual differences,” says Nordin.

The study was funded by Formas, a Swedish government research council for sustainable development, and the Swedish Research Council.

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