Some patients who have been diagnosed with irritable bowel syndrome (IBS) report a lessening of symptoms when they follow a gluten-free diet. Before placing yourself on a restricted diet that may or may not be helpful, it is important to be educated as to what is known about any overlap among IBS, celiac disease and gluten sensitivity.
What Is Gluten?
Gluten is a protein composite found in the following grains:
Gluten is present in a lot of the things we eat. This would most obviously include most cereals, breads, and other baked goods, but gluten is also frequently used as a food additive for a wide variety of products.
IBS and Celiac Disease
Celiac disease is a health condition in which the consumption of gluten causes damage to the small intestine. This damage leads to malabsorption of important nutrients, which can then lead to other serious health problems. The gastrointestinal symptoms associated with celiac disease look a lot like those associated with IBS:
Research estimates regarding the risk of celiac disease in IBS patients range from no increased risk to statements that IBS patients are four to seven times more likely than the average person to suffer from celiac disease. Due to this perceived possible overlap, current medical management guidelines for IBS recommend routine testing for celiac disease for all alternating type IBS (IBS-A) and diarrhea predominant IBS (IBS-D) patients. For more information on celiac testing, see:
Once a celiac disease diagnosis is made, it is essential that a gluten-free diet be followed. Research has shown that IBS patients who are subsequently identified as having celiac disease typically see a significant reduction in their digestive symptoms following the use of a gluten-free diet. There remains the possibility, for a small number of individuals, that they may suffer from IBS in addition to celiac disease, and thus symptoms may persist even with the use of a gluten-free diet.
IBS and Gluten Sensitivity
Is it possible to test negative for celiac disease and yet still have a sensitivity to gluten? This is a relatively new focus for researchers. Such a sensitivity would not involve damage to the small intestine like in celiac disease, but a gastrointestinal reactivity to foods containing gluten. Some studies have shown some evidence that such a "gluten sensitivity" exists, but more research needs to be conducted before any firm conclusions can be drawn.
This question regarding the existence of a "gluten sensitivity" raises the possibility that this might be the cause of IBS in some individuals. Luckily, research in this area is beginning to be conducted. Researchers have theorized that there may be a certain sub-set of IBS patients whose symptoms might be attributable to a gluten sensitivity. In medical literature, this is now being called nonceliac gluten sensitivity (NCGS).
Interestingly, researchers have made an interesting observation that wheat contains fructans -- a type of carbohydrate identified as a FODMAP and involved in fructose intolerance -- both of which are associated with contributing to digestive symptoms. Like gluten intolerance, research into the role that fructose intolerance may play in IBS is ongoing. This suggests that individuals who appear to be sensitive to gluten may be reacting to the fructans found in wheat, as opposed to the gluten. It is encouraging that work in this area is being conducted and we will all eagerly await more definitive findings.
Should You Try a Gluten-Free Diet?
If you suspect that you have a gluten intolerance, the first thing you should do is to consult with your doctor and get tested for celiac disease. If the test comes back negative, discuss with your doctor about the possibility of engaging in an elimination diet for a period of approximately one month to assess the effect of such on your IBS symptoms. If celiac disease has absolutely been ruled out, your doctor may recommend that you resume eating foods with gluten to see if your symptoms reappear before coming to the conclusion that you are gluten intolerant. Until there are more accurate blood tests for identifying gluten intolerance, these steps are vitally important to avoid an unnecessary restriction of your diet.
Essential Reading from Dr. Bolen, Your IBS Guide:
Gluten-Free Diet Resources
- How to Eat Gluten-Free
- Nine Steps to Ditch the Gluten
- Gluten-Free Food List - What You CAN Eat
- Finding Gluten on Food Labels
- Nine Places Gluten Can Hide
- Gluten-Free Diet Side Effects
- Five Tips for New Gluten-Free Cooks
- Gluten In Processed Foods and Beverages
American College of Gastroenterology IBS Task Force "An Evidence-Based Position Statement on the Management of Irritable Bowel Syndrome" American Journal of Gastroenterology 2009:S1-S35.
Cash, B. et.al. "The Prevalence of Celiac Disease Among Patients With Nonconstipated Irritable Bowel Syndrome Is Similar to Controls" Gastroenterology 2011 141:1187-1193.
Ford, A., et.al. "Yield of Diagnostic Tests for Celiac Disease in Individuals With Symptoms Suggestive of Irritable Bowel Syndrome" Archives of Internal Medicine 2009 169:651-658.
Sapone, A., et.al. "Divergence of gut permeability and mucosal immune gene expression in two gluten-associated conditions: celiac disease and gluten sensitivity" BMC Medicine 2011 9:23.
Wahnschaffe, U., et.al. "Celiac disease–like abnormalities in a subgroup of patients with irritable bowel syndrome" Gastroenterology 2001 121:1329-1338.
Wahnschaffe, U., et.al. "Predictors of Clinical Response to Gluten-Free Diet in Patients Diagnosed With Diarrhea-Predominant Irritable Bowel Syndrome" Clinical Gastroenterology and Hepatology 2007 5:844-850.