The Relationship between Gluten and Irritable Bowel Syndrome

Can Gluten cause Irritable Bowel Syndrome?

It seems only natural that food would have an impact on the cause and symptoms of irritable bowel syndrome (IBS). Historically however, that has not been the case. Healthcare providers frequently avoided addressing the impact of diet with IBS patients for a variety for reasons,  such as lack of training, data, and conclusive research that food has an impact. According to the article, What Role Does Wheat Play in the Symptoms of Irritable Bowel Syndrome?, recent research shows there is a potential for food, in particular gluten, to trigger symptoms for a significant number of IBS patients. The findings included within that article are highlighted here.

First, what is IBS?
According the the article “IBS is a chronic gastrointestinal disorder that affects 7-20% of the adult population in the United States… IBS as recurrent abdominal pain or discomfort for at least 3 days per month in the past 3 months that is associated with 2 or more of the following: improvement with defecation, onset associated with a change in the frequency of stool, or onset associated with a change in the form (appearance) of stool.”

Understanding the Role of Food in regulating IBS
In 2009, The American College of Gastroenterology IBS Task Force said, “Patients often believe that certain foods exacerbate their IBS symptoms.” However, there is not enough evidence to state that food allergy testing and exclusion diets are effective in treating IBS. The lack of conclusive research collides with many patients, who are “increasingly seeking more holistic solutions for their IBS symptoms.”  Many individuals consult with friends and family or seek advice on the internet. With the sporadic information they gather, they go on reduction diets of fatty foods, carbs, gluten, milk, dairy, etc, with the hopes that it will cause relief in IBS symptoms. This disorganized approach can lead to a lack of relief and frustrations for both patients and healthcare providers.  Moreover, “highly restrictive diets for extended periods of time without appropriate supervision or monitoring can lead to the development of malnutrition.” How is one to know if the restriction of certain foods will lead to relief from IBS symptoms? It appears that some food types do exacerbate symptoms of IBS, but it is different from individual to individual. Gluten has shown to cause discomfort for some with IBS.

The impact of Gluten on a subgroup of IBS patients
Evidence from recent studies support the existence of a “subgroup of IBS patients with undiagnosed nonceliac gluten sensitivity (NCGS), a term that is used to describe individuals who experience gastrointestinal and extraintestinal symptoms as a result of immunologic, morphologic, or symptomatic abnormalities that are precipitated by the ingestion of gluten.”

A recent study included 34 patients with IBS who had experienced symptomatic relief with a gluten-free diet. Those in the study who received a gluten-free diet: “reported significantly greater improvements in pain, bloating, satisfaction with stool consistency, and tiredness, than patients who ingested a diet containing gluten… Based on these results, the researchers concluded that NCGS may well be a distinct clinical entity and that gluten ingestion is associated with the development of gastrointestinal symptoms in a subset of patients with IBS.”

This study and others show that there are some IBS patients in which gluten may cause IBS and its exclusion may be an effective treatment. There are however, multiple variables that could be the explanation for the relief some IBS patients feel from excluding gluten. More research is required to understand the role of food in regulation IBS. It is likely that NCGS, “represents only the tip of the iceberg as it pertains to the role of food in IBS.”

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