Science bite: Gluten-free diet in Irritable Bowel Syndrome

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Science biteHowdy folks! Apologies for the long interval between Science Bites. Since I’ve taken on a Board of Directors role at Specialty Health, my work volume has really increased, and it’s left me very little time to write. Add to this the fact my mom was in the hospital for nearly three weeks (we almost lost her), and I’ve just been damn busy. Lots of interesting happenings in the ancestral health scene – I’ve talked to three different TV production companies who are interested in exploring this whole concept – so great stuff brewing, just not a lot of spare time!

Ok, that’s my excuse as to my writing hiatus, but now let’s get down to bid-ness.

Today’s Science Bite: Gluten-free diet in Irritable Bowel disease

Today, I’d like to look at a fantastic paper studying the effects of a gluten free diet on folks with IBS. Read the paper here

Study Type: Randomized controlled trial, cross over design, non-metabolic ward, but all foods were either prepared or eaten at the clinic. This does not guarantee that the study participants did not cheat on the plan, but this is an outstanding compromise between trying to ensure exactly what participants ate and minimizing study costs. IMO this is an outstanding study design, and one that should be more broadly utilized.

Number of participants: 43 (only 2 men, which makes sense given the genetic factors associated with autoimmunity, celiac disease and IBS…I’ll get to that later).

Study design: Participants ate either a rice based gluten free (GF) or gluten containing diet (GCD). Cals were set to be isocaloric (no weight loss or gain)

Inclusion criteria: diagnosis of IBS, currently consuming gluten.

Exclusion criteria: Recently consuming a GFD, indications that a GFD has been previously beneficial, diagnosis of celiac disease. This is smart study design in that the researchers were trying to just look at your average person who has no knowledge of GFD’s, and has not tinkered one way or another. Additionally, they tried to control for the overt state of celiac disease, which is notably common in folks with IBD. This is important as many people still ONLY associate problems with gluten to celiac disease.

What the researchers were looking for: Bowel function, transit time, and several indicators of intestinal/colonic barrier status. Additionally, HLA (human leukocyte antigen) screening for the HLA-DQ2 and HLA-DQ8 haplotypes were assessed. I’ll get to the relevance of looking at this later.

Results

Stool frequency: the GFD showed a decreased stool frequency relative to the GCD. This was more pronounced in the HLA-D2/8 positive individuals. This genotype shows a marked increase in autoimmune disease susceptibility AND a decreased susceptibility to gut pathogens. In essence, these people show a more vigorous immune response, which is likely one of the adaptations to living in close proximity to both a large number of humans and animals in a post Foraging life-way. This represents an evolutionary trade-off between enhanced immunity on the one hand, and autoimmune potential on the other. HLA-D2 Positive individuals are very common amongst celiac (95% of celiacs carry this trait if my memory is correct). However, not all HLA-D2 positive individuals develop celiac. But they do seem to be generally more gluten sensitive and show greater reactivity in all of the findings.

The gluten containing diet showed greater intestinal permeability. Several interesting things: This effect was greater, but no limited to the HLA-D2/8 Positive patients. The effects appear to be via an ENTIRELY different mechanism than that which underlies celiac disease. We to not see CD4T-cell activity, nor do we see increased interferon-gamma in this group studied, in stark contrast to classic celiac disease. We do see elements of both the innate and adaptive immune system being activated, but in novel ways relative to CD.

Thoughts

The study authors concede more work needs to be done to see what, if any, effects a GCD vs a GFD might have on gut biome. I like that these folks are thinking in this direction, as the big picture to all this goes beyond just what happens in the interface between immunogenic proteins from grains and our gut. The most important takeaways are clearly that a GFD improves IBD symptoms, decreases stool frequency, and decreases intestinal permeability. When we consider the highly inflammatory processes associated with intestinal permeability (ranging from autoimmune disease, to obesity, to cardiovascular disease, to various cancers), this is a huge “win.” Would we see even better results with an integrated paleo approach, adequate sunshine, probiotics, etc, etc? I would guess “yes”, and as always, what we are suggesting in all this is a safe, easy intervention that could have profound health benefits. If you suffer from GI problems, why not give it a shot?

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  1. Liz
    May 17, 2013 at 6:59 am

    This post seems to use the terms “Irritable Bowel Disease”, “IBD”, and “IBS” interchangeably. This is NOT correct. IBS stands for “Irritable Bowel Syndrome”. “IBD” refers to Inflammatory Bowel Disease (Crohn’s Disease and Ulcerative Colitis), a completely different medical issue from IBS. Please do not contribute to the massive popular misconception that IBD and IBS are the same thing!

    • Robb Wolf
      May 17, 2013 at 5:19 pm

      Liz-
      I’ll do my best to tighten that up. I see this largely as a spectrum of severity. IBS presents with inadequate inflammation to ID a specific disease state (also alternating bouts of constipation and diarrhea) and is Dx’d largely via symptoms vs clear ulcerative pathology.

  2. Lance
    May 17, 2013 at 7:09 am

    Robb

    I have had IBS most of my life, so I’ve come to know the types of foods that trigger an “episode” (for me at least). I’ve been trying to nudge myself toward a paleo lifestyle, but haven’t flipped the switch yet. This info here is definitely more encouragement and I’m thankful that you took the time to write about it.

  3. lisa
    May 17, 2013 at 7:42 am

    Thank you for this great and easy to understand post.

    My 14 yr old son had stomach and bowel problems for years and going paleo 2 years ago relieved many of his symptoms. Going low FODMAP and low fibre this winter has given him a “99% symptom free” life (and has enabled him to gained weight for the first time in 2 years).

    You used the term IBD and IBS. What is the relationship between the terms? Is IBS (irritable bowel syndrome) an overreaching umbrella statement?

    I am curious about the terms and the differences because our pediatric gastroenterologist keeps correcting me – saying my son has IBD, meaning, and only meaning inflammatory (not irritable) bowel disease (not syndrome). I was calling it IBS. This doc also commented that my boy would be a lot worse off by now, had he not gone paleo.

    thanks again,
    Lisa

  4. mm
    May 17, 2013 at 9:44 am

    Robb,

    I have IBD, and it is very important to note the difference between IBD and IBS. IBD is the umbrella term for two autoimmune diseases- Crohns and ulcerative colitis. IBS is something different. Please do use more care and not equate the two. While the symptoms can be similar, (and I do not doubt that a GFD can be beneficial in both), the main distinction is that IBD involves ulceration of the intestines (and therefore bleeding) where IBS does not. IBD is much more severe, medically speaking, and they are in fact two separate conditions with unfortunately similar names. Thank you.

    • Sandra Brigham
      May 18, 2013 at 10:36 am

      No ulceration necessary in all IBD states. Crohn’s can present with inflammation of the intestinal wall and stricture with no bleeding, cramps or diarrhea. In this case, impaction and pain, nausea and vomitting are seen, caused by the stricture which in and of itself is an obstruction. Most Crohn’s patients present with belly pain and diarrhea at 10-12 yrs of age and diagnosed with IBS or no diagnosis. Then they are diagnosed with Crohn’s in mid to late teens. How many 10 yr olds are being scoped for mild symptoms? It’s usually not until there is severity or intensity or blood that they are scoped. IBS is on the continuum…most probably the beginning of IBD.

  5. Lindsay
    May 17, 2013 at 9:45 am

    What a great study design and execution. Encouraging that the NIH fund this kinds of thing. But, discouraging that this kind of study doesn’t get traction in the media while crappy TMAO studies do.

  6. Under vårt tak
    May 17, 2013 at 10:00 am

    Interesting article. I have been diagnosed with IBS and lived for many years with pain, nausea, and a poorly functioning body. After I, three years ago, switched to a Paleo diet all the problems disappeared and I am now completely symptom free! Would like to say that gluenfri diet is essential for health in general, whether it’s IBS or just general well-being!

    Thank you for this article. It is good to know that science is going in the right direction.

    Magnus Andersson

  7. Fi
    May 17, 2013 at 10:01 am

    I’m the same – went paleo and my IBS symptoms dropped dramatically.

  8. MARLENE
    May 17, 2013 at 10:02 am

    Most likely being a Celiac my whole life and not being diagnosed until after I almost died (in my 50’s)…going gluten free helped immensely, but going grain free helped even more. It has taken 5 years to heal adrenals, realize that my IBS symptoms were actually manageable with the right diet and also being able to stay in remission from an incurable autoimmune disease that attacks the muscle tissue….(which I was also diagnosed with just before finding out I had CD.) With the help of a Nutritionist I have been able to heal Barrett’s Esophagus, Stomach Ulcers, Acid Reflux, non stop bloating/diarrhea…etc., etc., etc.

    Thank you so very much for your continued quest for research in this direction!!!!

  9. Kim
    May 17, 2013 at 11:07 am

    Hi Robb –

    Thanks for posting this. One caveat: I would change the headline from Irritable Bowel disease to Irritable Bowel Syndrome. I understand lowercase “disease” is to differentiate from Irritable Bowel Disease (Crohn’s and UC) but the title can still be misleading.

    Love your site!

  10. Blisco
    May 17, 2013 at 6:37 pm

    Hey, it looks like the people concerned here are only women, so like a man I can eat what I want:-) If I don’t come back to tell you that I’m sick it means that everything it’s OK.

  11. Richard
    May 18, 2013 at 1:21 am

    I have had diarreah almost everyday for the past two years. A GF Paleo diet initially curbed the issue but it’s back with a vengeance and I pass water from my ass EVERY day! Recently had a colonoscopy, gastroscopy both with biopsies and everything was negative with only a small hiatus hernia being found. I’ve had many blood tests and stool samples which were all negative also. This week I was given the diagnosis of…….wait for it…….IBS! I’m Paleo six days a week with only one meal at the weekend being slightly off track (no gluten though) and I just can’t shrug the squits! I have a feeling that stress may have something to do with this but the epsom salt baths, meditation and monthly sports masssages aren’t helping either? I’m going crazy over here!!!

    • Eugenia
      May 18, 2013 at 7:32 am

      If it worked for you initially but not then, I’d fear parasites. In that case, the dreaded antibiotics would be needed. If that’s not it, I’d go fodmaps for a while and maybe add some home made goat kefir.

    • Cathy
      May 18, 2013 at 9:10 am

      Epsom salt baths?? That in itself could cause or exacerbate your symptoms. We absorb a lot of magnesium from the epsom salt, and that can cause the runs!

    • Richard
      May 20, 2013 at 12:09 am

      Yes I know about the magnesium causing the runs but I’ve had the issue for a long time and I’ve only just started using the baths to help me relax! I’ve tinkered with my diet to exclude FODMAPS and nightshades but I just can’t stop the stomach cramps, wind and diarreah?! I feel I’ve created a stress cycle that doesn’t help things and I’m naturally an anxious person. I would try the kefir but any dairy cause almost instant acne across my upper back and neck??

      It’s a long process that’s causing me to be even more anxious than I already am and really don’t know what I can do?!

      • Rebecca
        June 1, 2013 at 1:50 am

        Try Traditional Chinese Medicine. IBS is one condition that TCM is considered particularly successful at treating.

    • C Varner
      January 17, 2014 at 2:33 pm

      Stress absolutely has something to do with it. I was diagnosed in my 30’s, with IBS, during a time when I was dealing with an incredible amount of stress. (An abusive boss, appearing as a witness in an academic hearing, etc.)While changing the diet to gluten-free (I didn’t know about paleo back then) helped, the situation didn’t change until I changed my life circumstances (quit said horrible job and got counselling). After the lifestyle changes, I was symptom-free for almost 10 years, and could even eat pretty much anything. Later, stress comes up regarding my son and my significant other, and boom, my IBS rears its’ ugly head. I changed the lifestyle first, this time, and then went gluten-free. I’ve had complications with having pneumonia 4 times this year (also, I think attributable to stress)that is slowing my recovery, but I’m not near as bad as I was the first time IBS reared it’s ugly head. Lose the stress–it will help…and it may be the hardest thing you ever do in your life, but when you come out healthier for it, you will see it is worth it.

  12. Kathleen
    May 18, 2013 at 6:05 am

    Sorry to hear about your Mom, Robb. Hope she is on the mend and that life calms down for you.

  13. Kathleen
    May 18, 2013 at 6:07 am

    Oops..hit send too soon. Interesting piece. I recommend a paleo diet for almost everyone I work with (health coach) and it has worked for so many people. One of my best friends has diagnosed Celiac — and getting her away from some of the packaged ‘gluten-free’ foods has truly provided enormous benefits. She is feeling better, suffering less migraines and her performance in the box exploded. Any and everyone she knows that has IBS — she preaches Paleo.

  14. Max Sebring
    May 18, 2013 at 11:04 am

    Hi Robb,

    Sorry to hear about your mom. I hope she’s fine right now. Anyway, your article is wealthy of information. I just converted to paleo diet and I hope I could survive this lifestyle.

  15. Susan Graham
    May 18, 2013 at 1:49 pm

    Robb, as you know from my first email to you a year and a half ago, I healed every illness I had including IBS by following your book. In just 3 short months of following your plan, 25 years of IBS, depression, allergies,annual bouts of bronchitis & pneumonia disappeared. I was 275lbs. and now weigh in at 165lbs and went from a size 24 pant to a size 10. I have not been sick in all this time nor have I had depression for the first time in over 20 years. I have not had IBS at all anymore! I feel younger, healthier and stronger than ever! Thank you for writing the Paleo Solution and I hope I can help others. Unfortunately, I am not having luck with that because everyone I talk to is skeptical because I do not have a degree. My medical records and new body don’t seem to be enough for these folks. LOL Also, I just had an FIA test done of my white blood cells to see if I am deficient in anything. I am only deficient in B12, but that is my fault because I did not take the digestive enzymes like you recommended so that I can better absorb my nutrients from my food. Keep up the good work!!!

  16. Julie
    May 18, 2013 at 2:58 pm

    Dropping both gluten and lactose has been amazing for my IBS. I wish I would have tried this 20 years ago when I was constantly in pain.

  17. Linda
    May 18, 2013 at 6:02 pm

    Robb, do have any scientific data showing GF helps Lupus patients. My daughter has Lupus and in a great deal of pain but says she can’t do GF but has had a gluten allergy test but tested ok, so now not much hope of getting her to go GF without scientific data. My husband and I have been Paleo for almost 2 years and love it, but no chance getting her to be GF much less grain free. She is almost vegetarian now.

  18. Katie
    May 19, 2013 at 9:46 am

    Hey Rob,

    Really sorry to hear about you mother. But your article is excellent and well described

  19. Martine
    May 20, 2013 at 6:00 am

    I suffer from plain ole constipation and went on Paleo 8 months ago and have only deviated on average once every two weeks for pizza night. I feel much better but it didn’t alleviate my problem. I’ve eliminated so many foods (fodmaps, night shades, etc.) that now I’m afraid I’ll starve to death. I’m happy that so many people have had such success on Paleo but it isn’t the panacea people think it is. I’ve added fermented vegetables and kombucha. I am going to stay on track with Paleo but I’m wondering if there is something I am missing. Thanks for your books and website!

    • Cindy K.
      May 22, 2013 at 8:56 am

      Hi Martine,

      Until recently, I had the same problem and I’ve been Primal for a year. I found probiotics and Psyllium husks in pill form have really healped. Previously, I was diagnosed with Adrenal Fatigue and am pretty sure my insides just didn’t work anymore. Turns out I was severly deficient in magnesium. My Dr. put me on Natural Calm… might be worth a try.

  20. Anke
    May 20, 2013 at 2:32 pm

    I was suffering from IBS and my husband and I tried the Paleo diet. We do not call it a diet anymore, we call it a lifestyle!!
    Have been doing paleo for 1 1/2 years now and WE LOVE IT!!!
    Would not want to go back for nothing.
    No IBS anymore, no migranes anymore… and we feel so much better and healthier.
    Thank you, Robb Wolf, we can never thank you enough.

  21. Theresa
    May 22, 2013 at 2:21 pm

    Robb

    THANK YOU! I started the Paleo Diet in January after reading Loren Cordain’s book and then yours. I have had Crohns Disease (IBD) since I was 16. Partial bowel re-section at 24 and had been in remission (very luckily) for 34 years, but still had all those pesky “autoimmune” complications. Recently the Crohns has become active, and I have been on a Remicade regimen for 3 years now, with great success. However, I am becoming increasingly wary of the continued use of meds and was looking for a more healthy solution, and viola! I found Paleo.
    AFter 5 months most of my symptoms have abated, I feel and look great (people tell me I look 10 years younger!) and have just adopted this as my way of living. I think everyone around me is getting sick and tired of hearing about this diet and it’s success, but if I can convert just one person and encourage those open to the idea to live a healthier lifestyle then boo to those who won’t listen!
    I have converted 3 people already, one with diabetes, one with chanelopothy and one with high cholesterol, and can’t wait to see how things turn out for them after their 30 day challenge.
    BTW, I am very active, spin 3 times a week, pilates and barre method classes 3 times a week, and I feel so much stronger during my classes than ever before.
    Keep it coming Robb

    • Rachel
      August 16, 2013 at 6:50 pm

      Hi Theresa,

      I just have a quick question for you. Were you able to go off of the Remicade? And if so, how did you do it. I’ve also had Crohn’s since I was 16, and am now 27. I took Remicade for 6 years, then switched to Humira, and I’ve been on that for about 5 years now.

      I do have some minor symptoms now, and haven’t yet tried the Paleo diet. I’m hoping that I’ll be able to adopt some form of it, despite the fact that I seem to be addicted to sugar, and that it will help me to ultimately get off of the Humira. The longer I take this medication, the more I worry about the risk of lymphoma. Please let me know what your experience has been.

      Thanks!
      Rachel

  22. Julia
    May 24, 2013 at 6:44 pm

    Hi Robb,

    I am following up to Linda’s comment/question (re lupus), to which I don’t see a reply. Any information on a paleo diet helping with lupus?

    I have a client with lupus and IBS. We tried a paleo diet for about a month, but her IBS symptoms worsened. She then reverted to her typical grain based diet and since then her IBS symptoms have been worse than ever.

    Julia

    • Robb Wolf
      May 25, 2013 at 7:17 am

      Julia- fodmaps, histamine, tyramine, dysbiosis…there are a lot of potential avenues here. This is why we are working to get a physician network trained in all this.

  23. Linnie
    June 30, 2013 at 2:42 pm

    I recently discovered the FODMAPS diet, after 30 years of IBS (latterly the constipated and severe bloating variety, past years been the diarrhoea and bloating type) and quite honestly FODMAPS has changed my life. Utterly. I cannot praise it highly enough. I have my life back!

  24. Leslie
    July 27, 2013 at 12:11 am

    I was diagnosed with IBS and two years later PCOS. The gastro-doc told me to eat a diet high in fiber, the Endo-doc told me to eat a diet low in carbs. I threw out all the papers they gave me and figured I was just going to live a miserable life. I have been Paleo for two weeks and I am happy to report I think this is going to help BOTH issues. Here hoping.

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