FPIN's Help Desk Answers
Gluten-Free Diet for Irritable Bowel Syndrome
Am Fam Physician. 2017 Jul 1;96(1):52.
Does a gluten-free diet improve gastrointestinal symptoms in patients with irritable bowel syndrome (IBS)?
The evidence is conflicting on whether gluten-free diets improve symptoms of IBS. Gluten-free diets may improve symptoms such as abdominal pain, stool consistency, and tiredness, and they can be recommended to patients with IBS. (Strength of Recommendation: B, based on inconsistent, small, randomized controlled trials [RCTs].)
A 2011 RCT included 34 patients 29 to 59 years of age who had IBS and no celiac disease and whose symptoms were controlled on a gluten-free diet.1 They were randomized to remain on a gluten-free placebo diet or to switch to a gluten-containing diet. Patients recorded overall symptoms, abdominal pain, bloating, satisfaction with stool consistency, tiredness, wind, and nausea using a 0- to 100-mm visual analog scale at baseline and weekly for six weeks. Patients on the gluten-containing diet had statistically significant increases in mean scores at week 1, including overall symptoms (+28 vs. +9.2 for placebo; P = .047), abdominal pain (+28 vs. +5; P = .016), bloating (+26 vs. +5.8; P = .031), satisfaction with stool consistency (+24 vs. +2.5; P = .024), and tiredness (+25 vs. −5; P = .001). At six weeks, scores for abdominal pain (+40 vs. +18.3; P = .02), stool consistency (+30 vs. +16; P = .03), and tiredness (+34 vs. +8; P = .01) increased significantly from baseline in the gluten group. Significantly more patients on the gluten diet answered “no” to the question “Over the last week, were your symptoms adequately controlled?” (68% vs. 40%; P = .001).
A 2013 double-blind crossover RCT examined 37 patients 24 to 61 years of age with nonceliac gluten sensitivity and IBS whose self-reported symptoms improved with a gluten-free diet.2 Patients were started on a two-week diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs), which has been proven
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1. Biesiekierski JR, et al. Gluten causes gastrointestinal symptoms in subjects without celiac disease. Am J Gastroenterol. 2011;106(3):508–514.
2. Biesiekierski JR, et al. No effects of gluten in patients with self-reported non-celiac gluten sensitivity after dietary reduction of fermentable, poorly absorbed short-chain carbohydrates. Gastroenterol. 2013;145(2):320–328.
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