Both irritable bowel syndrome (IBS) and gluten intolerance are gastrointestinal conditions that cause similar symptoms, such as abdominal gas, bloating, pain, diarrhea, and constipation. The differential diagnosis is not always straightforward since no biological markers identify these conditions. Read more to learn the differences and similarities between gluten intolerance and IBS.
Gluten intolerance explained
Gluten intolerance or non-celiac gluten sensitivity describes a gastrointestinal problem resulting from the body's inability to digest gluten, a protein in grains such as wheat, barley, and rye. There are several diseases caused by gluten, including gluten intolerance, celiac disease, wheat allergy, and dermatitis herpetiformis.
In celiac disease, immune cells attack the body's cells and disrupt the intestinal lining, which then causes health problems. However, although similar symptoms are seen in gluten intolerance, disruption in intestinal cells doesn't appear.
What is irritable bowel syndrome (IBS)?
Irritable bowel syndrome (IBS) is an inflammatory bowel disease that is characterized by changes in bowel habits, abdominal discomfort, and pain. Symptoms of IBS include but are not limited to bloating, diarrhea, constipation, and mucus in stool.
Causes of IBS remain uncertain; there could be many underlying factors, such as disturbed brain-gut interaction, stressful life, mental health problems, small intestinal bacterial overgrowth, and genes.
The diagnosis was made by determining patterns in bowel movements and symptoms because no biological markers were available. Sometimes, blood tests may be required to eliminate the possibility of other gastrointestinal diseases.
What are the similarities between gluten intolerance and IBS?
Although these two conditions can present alone, IBS patients can also have gluten intolerance, among other food intolerances. There are no biological markers to define either gluten intolerance or IBS; therefore, similarities between the two conditions can be confusing both for patients and healthcare providers.
People with gluten intolerance or celiac disease can also experience IBS symptoms even with adherence to a gluten-free diet. Symptoms of IBS can be triggered not only by gluten but other food components, such as FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols found in many foods, including vegetables (such as onion, green peas, and mushrooms), fruits (such as apples, pears, peaches), dairy, legumes, sugars, and sweeteners.
A gluten-free diet should resolve the symptoms of people with gluten intolerance. In IBS, many other foods can worsen the symptoms; however, the gluten-free diet has been associated with improved gut microbiota, bowel movements, and decreased inflammatory markers in people with IBS.
Although some IBS patients may benefit from a gluten-free diet, others may not experience a significant difference. A meta-analysis investigated the effects of gluten restriction on IBS patients. The analysis of nine controlled clinical studies showed that a gluten-free diet didn't cause significant improvements in bloating, abdominal pain, or quality of life.
Keep in mind that similarities may arise due to the presence of gluten intolerance or celiac disease in IBS patients, or IBS-like symptoms can be caused by gluten intolerance or celiac disease. Serological tests can be required to rule out celiac disease in patients with IBS or IBS-like symptoms.
Gluten-free or IBS-friendly?
IBS and gluten intolerance have no cure; nutritional intervention, food supplements, digestive enzymes, and medication are part of the treatment.
People diagnosed with gluten intolerance are prescribed a gluten-free diet. A gluten-free diet excludes gluten-containing foods, including but not limited to wheat, wheat products, barley, rye, cereals, granola, candy, and packaged products. Most patients experience reduced symptoms upon a gluten-free diet.
On the other hand, there is no IBS diet proven to work for every IBS patient because individuals with IBS may have different intolerances toward specific foods or food groups. Therefore, careful evaluation is needed to prevent unnecessary elimination of certain foods on an individualistic scale.
Several dietary approaches are designed for IBS, including but not limited to an anti-inflammatory diet (IBD-AID), autoimmune protocol diet (AIP), Crohn's disease exclusion diet (CDED), CD-TREAT diet, Low-FODMAP diet, specific carbohydrate diet (SCD), and the list goes on. Therefore, it's necessary to consult your doctor and dietitian to find the best diet to decrease symptoms while preventing unnecessary elimination of foods from your diet.
The last words
Both IBS and gluten intolerance patients experience gastrointestinal symptoms, such as abdominal cramps, discomfort, pain, diarrhea, and constipation. Both conditions are diagnosed based on symptoms because of the lack of biological markers. Therefore, a healthcare provider must carefully evaluate a differential diagnosis.
Dietary interventions, such as a gluten-free diet, can improve symptoms of gluten intolerance in some IBS patients. Both groups of patients may need to limit other food components besides gluten, which can need careful evaluation by a healthcare provider and dietitian.
What is gluten intolerance?
Gluten intolerance or non-celiac gluten sensitivity refers to a condition associated with gastrointestinal symptoms caused by eating gluten-containing foods despite having negative tests for celiac disease. Therefore, patients with gluten intolerance can't digest gluten-containing foods well, but they don't also have celiac disease.
What are the common symptoms of IBS?
Common symptoms of irritable bowel syndrome (IBS) are abdominal pain, cramps, bloating, diarrhea, and constipation. Also, other gastrointestinal symptoms can present, including but not limited to mucus in stool, flatulence, bowel incontinence, and lack of energy.
Does low-FODMAP mean no gluten?
No, low-FODMAP does not necessarily mean no gluten. The low-FODMAP diet primarily focuses on reducing specific types of carbohydrates, but it does not eliminate gluten. Gluten is found in wheat, barley, and rye, and its presence depends on the specific foods included in the low-FODMAP plan.
Gluten intolerance or non-celiac gluten sensitivity is characterized by gastrointestinal symptoms resulting from a gluten-containing diet.
Irritable bowel syndrome is an inflammatory bowel disease characterized by changes in bowel habits, abdominal discomfort, and pain. The cause of IBS remains uncertain and can be related to many factors, including genes, microbial changes, and stress.
Screening for celiac disease may be needed for IBS patients, especially in diarrhea-predominant and mixed bowel habits cases.
Dietary interventions are a central part of the treatment of both gluten intolerance and IBS. While patients with gluten intolerance need to follow a gluten-free diet to ease symptoms, IBS patients may or may not benefit from a gluten-free diet.
Various diets are available for IBS patients. IBS patients can experience different food intolerances. Dietary interventions should be individualized to eliminate unnecessary limitations of food or food groups.
- National Library of Medicine. Gluten-associated medical problems.
- National Institute of Diabetes and Digestive and Kidney Diseases. Symptoms & causes of irritable bowel syndrome.
- Johns Hopkins Medicine. FODMAP diet: what you need to know.
- Frontiers in Genetics. Gluten-free diet reduces the risk of irritable bowel syndrome: a mendelian randomization analysis.
- Frontiers in Nutrition. Gluten restriction in irritable bowel syndrome, yes or no?: a GRADE-assessed systematic review and meta-analysis.
- Celiac Disease Foundation. Sources of gluten.
- Crohn's & Colitis Foundation. Special IBD diets.
- National Health Service. Symptoms: irritable bowel syndrome (IBS).
- Beyond Celiac. What are FODMAPs and what’s the connection to celiac disease and gluten sensitivity?