Gluten and IBS: Unraveling the Connection

There has been growing interest in the relationship between gluten and IBS in recent years, particularly as more people have become aware of the impact of diet on digestive health.

The growing popularity of gluten-free diets and the reported benefits experienced by some IBS patients have fueled the exploration of the gluten-IBS connection.

This article aims to shed light on this intricate relationship, providing valuable insights for those seeking relief from IBS symptoms and avoiding unnecessary restrictions.

We will delve into scientific studies examining the impact of gluten on individuals with IBS, including those with celiac disease and non-celiac gluten sensitivity.

Can I eat gluten if I have IBS?

Since IBS symptoms can overlap with other conditions, proper diagnosis is crucial to distinguish between gluten-related disorders and other potential causes of symptoms.

A gluten-free diet is unnecessary and not recommended for individuals with IBS without celiac disease or wheat allergy diagnosis. 

Although some people report improved IBS symptoms on a gluten-free diet, studies have failed to demonstrate consistent improvements in IBS symptoms with a gluten-free diet. 

It has been shown that fructans (a FODMAP which falls under the oligosaccharide category) are responsible for gluten-related symptoms in individuals with IBS (3). 

Therefore, exploring a low FODMAP diet is recommended under the guidance of a healthcare professional or registered dietitian, targeting a broader range of potential triggers beyond gluten.

What is gluten?

To understand the connection between gluten and IBS, it is essential to clearly understand what gluten is and where you find it. 

Gluten is a protein composite primarily found in wheat, barley, and rye grains (1). It provides elasticity to dough, helping it rise and giving bread its chewy texture. 

Gluten is commonly present in various foods, including:

• Bread
• Pasta
• Cereals
• Baked goods
• Some processed foods. 

It can also be a hidden ingredient in sauces, dressings, and other food products.

It is worth noting that gluten is not inherently high in FODMAPs, although you will often opt for gluten-free alternatives if you are on a low FODMAP diet. 

This is because some sources of gluten, such as wheat-based bread or pasta, also contain high FODMAP ingredients (2), which can contribute to symptoms in individuals with IBS.

Medical conditions affecting gluten

Some medical conditions mean you should avoid gluten. However, it’s essential to differentiate between them, as they may require different approaches for diagnosis and management. 

If you suspect a gluten-related condition, consult a healthcare professional for proper testing, evaluation and guidance.

Celiac disease

Celiac disease is an autoimmune condition triggered by the ingestion of gluten. 

For these individuals, consuming gluten leads to an immune response that damages the small intestine lining, resulting in gastrointestinal symptoms and potential long-term complications (4).

The primary treatment for celiac disease is adherence to a strict gluten-free diet, eliminating all sources of gluten (5).

While celiac disease and IBS are distinct conditions, there is an overlap between some symptoms, such as abdominal pain, bloating, and irregular bowel movements.

However, people with coeliac disease can also present with other generalized symptoms such as (6): 

• Weight loss
• Fatigue
• Malabsorption of nutrients
• Iron-deficiency anemia

For individuals with IBS-like symptoms, it is essential to consider celiac disease as a potential underlying cause and seek appropriate testing via your GP to rule out this condition. 

However, remember not to cut out gluten before your coeliac test, or it will be inaccurate.

Wheat allergy

A wheat allergy is an immune response to specific proteins found in wheat, such as albumin, globulin, gliadin, or gluten (7).

When someone with a wheat allergy consumes wheat or wheat-containing products, their immune system releases histamine and other chemicals, leading to allergic symptoms. 

These symptoms can vary in severity and may include (7):

• Skin reactions (such as hives, itching, or eczema)
• Respiratory symptoms (such as nasal congestion, asthma, or difficulty breathing)
• Gastrointestinal issues (such as nausea, vomiting, or abdominal pain)
• In severe cases, anaphylaxis, which is a life-threatening allergic reaction.

Wheat allergy is diagnosed through medical history, skin prick tests, blood tests (specific IgE antibody testing), and sometimes oral food challenges. 

Treatment involves strict avoidance of wheat and wheat-derived products. 

Individuals with a wheat allergy may also need to carry emergency medication, such as epinephrine auto-injectors, in case of severe reactions.

Non-celiac gluten sensitivity

Individuals with non-celiac gluten sensitivity (NCGS) experience symptoms similar to celiac disease but without celiac-specific antibodies or intestinal damage (8). 

In the case of NCGS (sometimes called gluten intolerance), individuals may experience symptoms such as abdominal pain, bloating, diarrhea, or fatigue after ingesting gluten. 

Symptoms occur soon after eating gluten, improving or disappearing within hours or a few days after gluten withdrawal and then relapsing following its reintroduction (9). 

NCGS is regarded as a sub-group of IBS as there are no convincing, reproducible results from clinical trials showing effects on inflammatory or immune markers (8).

It is thought to only affect a few people, despite many self-reporting NCGS (10). This may be related to the effects of fructans in gluten-containing foods.

Tips for successfully maintaining a gluten-free lifestyle

If you are diagnosed with celiac disease, wheat allergy or NCGS, you must follow a gluten-free diet. 

Fortunately, plenty of gluten-free alternatives are available, including gluten-free grains like rice, quinoa, and corn. 

Additionally, a wide range of gluten-free products and substitutes, such as gluten-free bread, pasta, and flour, help maintain variety and meet dietary preferences.

However, successfully maintaining a gluten-free lifestyle requires careful attention and planning, which can be challenging. Here are some tips to support a gluten-free diet:

• Education and awareness: Learn about sources of gluten and hidden ingredients to make informed choices.
• Meal planning: Plan meals and snacks to ensure a well-balanced gluten-free diet.
• Kitchen organization: Keep gluten-free and gluten-containing products separate to avoid cross-contamination.
• Explore gluten-free recipes: Discover new recipes and experiment with alternative flours and ingredients.
• Dining out: When eating out, communicate your dietary needs to restaurant staff and choose gluten-free options from the menu
• Support network: Seek support from others following a gluten-free diet through support groups or online communities.
• Regular monitoring: Keep track of your symptoms and assess how the gluten-free diet impacts your IBS management.

Gluten-free diet and health considerations 

Is a gluten-free diet healthier?

While a gluten-free diet is necessary for individuals with diagnosed gluten-related disorders, it may not necessarily be healthier for everyone. 

Gluten-free products often substitute gluten-containing ingredients with alternative flour and additives, which may have different nutritional profiles.

Thus, a gluten-free diet can be low in certain nutrients such as fiber, iron, and B vitamins. 

For individuals without gluten-related disorders, a balanced diet of whole grains, fruits, vegetables, lean proteins, and healthy fats is generally recommended for optimal health.

Does gluten cause inflammation in the body?

While gluten may trigger inflammation in individuals with celiac disease or wheat allergy, its impact on inflammation in the general population is still uncertain. 

Limited research suggests a potential role of gluten in low-grade inflammation for some individuals with non-celiac conditions. Still, the evidence is feeble, mostly in rats (10).

More studies are needed to understand the mechanisms and determine the extent of this effect.

Is gluten responsible for fatigue? 

Fatigue is often attributed to gluten intolerance or sensitivity. However, limited research directly linking gluten to fatigue exists. 

Fatigue is a complex symptom with various potential causes, including sleep patterns, stress, lifestyle factors, or underlying medical conditions. 

It is crucial to consider other potential factors contributing to fatigue before solely attributing it to gluten.

Will I lose weight on the gluten-free diet?

There is a common misconception that a gluten-free diet automatically leads to weight loss. 

While some individuals may experience weight loss after adopting a gluten-free diet.

This can be attributed to factors unrelated to gluten elimination, such as reduced processed foods or overall calorie intake. 

For example, following a gluten-free diet will exclude many high-calorie foods such as cakes, biscuits, and pastries.

Focusing on a well-balanced, nutrient-dense diet and regular physical activity is essential for sustainable, healthy weight management rather than relying on a gluten-free diet.

Our blog about losing weight and IBS goes into more detail about why losing weight with IBS can be difficult and how to go about it safely.

Summary

Gluten-free diets, although popular, are not necessarily best for your general health unless you are diagnosed with gluten-related disorders like celiac disease or a wheat allergy.

A gluten-free diet is not recommended for those with IBS without these diagnoses. 

Instead, a low FODMAP diet may be beneficial as fructans in gluten-containing foods, rather than the gluten itself, can trigger symptoms in individuals with IBS.

Collaborating with healthcare professionals and utilizing appropriate testing methods can ensure accurate diagnoses and personalized treatment plans tailored to your needs.

Article written by Annabelle Green, Registered Dietitian, reviewed by Kirsten Jackson, Consultant Dietitian BSc Hons, RD, PG Cert

Last updated on July 14th, 2023 at 09:40 pm