I’ve been asked many times by those with inflammatory bowel disease (IBD) what diet they should be on. One topic that is usually front and center is whether or not they should be gluten-free. This topic can be confusing for many people because there is so much misinformation out there. But let me distill it down so it’s easy to understand: here are three reasons you should be gluten- or wheat-free — and they don’t always have to do directly with IBD.
Celiac disease is an autoimmune condition in which the body attacks the lining of the small intestine when patients consume gluten, a protein found in wheat, barley, and rye. This causes pain, diarrhea, weight loss, headaches, and joint pain, among other symptoms. A diagnosis of celiac disease can be made through blood testing, endoscopy, and intestinal biopsy. Patients who have celiac disease have to completely remove gluten from their diets for the rest of their lives. If celiac disease goes undiagnosed, it can cause numerous other issues like vitamin and mineral deficiencies, infertility, gallbladder issues, neurological issues, bone loss, lactose intolerance, and other conditions.
Wheat allergy is a fairly common food allergy, and wheat is one of the top eight foods people are most likely to be allergic to. When someone has an allergic reaction to wheat, the symptoms can range from swelling, itching, rash, headache, GI upset, difficulty swallowing or heartburn to full-blown anaphylaxis, which can be life-threatening. While wheat allergy can be confused with celiac disease, it is not an autoimmune disease nor does it cause damage to the small intestine. It is a true food allergy. Most people with wheat allergy can also still eat foods made with barley and rye. Diagnosis of this allergy can be made by an allergist through blood testing or skin patch testing.
Wheat or gluten intolerance
Wheat or gluten intolerance is a delayed onset reaction to either wheat or gluten. It is not a true allergic reaction, so it does not have all of the same symptoms of an allergy nor does it come with the risk of anaphylaxis. Most of the symptoms in this type of intolerance are relegated to the gut and can include gas, bloating, pain, cramps, and diarrhea. Getting an accurate diagnosis of an intolerance can be difficult and often requires eliminating the possibility of wheat allergy or celiac disease. Elimination diets can aid in confirming a wheat or gluten intolerance. Once confirmed, patients must continue to remove or limit the offending item from their diets.
The bottom line
IBD’ers do not always need to remove gluten from their diets. In fact, removing gluten when you don’t need to can eliminate many healthy foods that are good sources of fiber, vitamins, and minerals. If you have IBD and find you fall into one of these above categories, then removing gluten or wheat is probably the right thing for you. Work with your physician to obtain an accurate diagnosis. A nutritionist or dietitian can help you to ensure that your diet changes don’t put you at added risk for nutritional deficiencies.