08/29/2025
IBS and the gluten-free diet
A study investigated IBS and the gluten-free diet with about 30 study participants who believed they were sensitive to gluten and followed a gluten-free diet were evenly divided to get cereal bars that contained whole wheat, gluten or neither. They did not know which group they were in.
In all groups, including the ones with bars that did not contain gluten or wheat, 93 percent of participants reported having symptoms.
This kind of reaction is called the nocebo effect, where patients develop symptoms because they anticipate negative effects will be triggered. It’s the opposite of the placebo effect, where patients feel better because they think they will.
Still, some IBS patients legitimately benefit from diets that exclude gluten or wheat, the study says.
These IBS patients should be identified, the authors wrote.
In those who don’t benefit, wheat and gluten need to be destigmatized, they noted, and psychological counseling to reintroduce these ingredients in the diet may be helpful.
There is a reluctance to give up the gluten-free diet.
“Most patients continued a gluten-free diet despite learning that neither gluten nor wheat was triggering their symptoms,” the study says, noting this suggests patients were entrenched in their belief systems.
These beliefs about harm were strong and persistent for the long term. Following the gluten-free diet may be one of the few ways patients feel they can take control of their IBS, the study suggests.
Those who did abandon the gluten-free diet usually did so because of financial constraints or difficulty following the diet.
After being given the cereal bars, study participants reported symptoms as well as whether they had eaten the bars, which all had the same appearance, taste and smell. Though most claimed that they ate all the bars, little or no gluten found in stools tests even among those who received gluten-containing bars suggested that many had avoided consuming them.
Still, gluten getting into the gluten-free diet was an issue for most study participants. Despite expert dietitian advice on maintaining the diet at the start of the study, gluten was found in stool tests of nearly 70 percent of study participants before they ate the cereal bars containing gluten or after eating the bars that did not contain gluten. Study authors attributed this to the cross-contamination and the difficulty of maintaining a gluten-free diet.
The study is not a definitive trial for all IBS patients, the authors wrote, noting several limitations. They call for larger studies to confirm their results.
Reference:
Effect of gluten and wheat on symptoms and behaviours in adults with irritable bowel syndrome: a single-centre, randomised, double-blind, sham-controlled crossover trial
Caroline Larissa Seiler, PhD, et al.
The Lancet Gastroenterology and Hepatology
Volume 10, Issue 9P794-805September 2025