Unifying Hypothesis And Conclusions
As discussed above, both IBS and NCGS are common in the general population and therefore both can coexist with each other independently without necessarily sharing a common pathophysiological basis. While the treatment of NCGS is exclusion of gluten from the diet, some of the patients with IBS do improve with the gluten-free diet. Furthermore, minimal inflammation in the gut has been demonstrated in both IBS and NCGS. It is thus conceivable that ingestion of wheat containing ATIs, in the presence of intestinal inflammation enhances an innate immune response that plays a role in the generation of symptoms in patients with IBS, which then resolve when the patient takes up a gluten-free/wheat free diet. Furthermore, the microbiome may also play a role in the pathogenesis of NCGS.
How Are Celiac Disease And Ibs Treated
If your doctor suspects that your digestive issues might be related to celiac disease, there are two blood tests that can help support that diagnosis. Genetic testing for human leukocyte antigens can rule out a diagnosis of celiac disease while blood tests looking for elevated levels of certain antibody proteins can support the diagnosis. If you test positive for either of these, your doctor may order an endoscopy to check the lining of the small intestine for damage that could indicate celiac disease.
Irritable bowel syndrome is typically diagnosed by first ruling out other conditions. After doing so, your doctor may take a closer look at your symptoms to see if they line up with the diagnostic criteria for IBS. The severity and frequency of certain symptoms like abdominal pain or changes in stool can be used to support a diagnosis. By taking a closer look at your symptoms, your doctor will also be able to identify which of three types of IBS you have constipation-predominant, diarrhea-predominant, or mixed.
If youve been diagnosed with either celiac disease or IBS, making changes to your diet should help resolve symptoms. If you find that your symptoms do not improve after a few weeks, talk to your doctor about the possibility of a secondary condition. People with celiac disease are four times more likely to also have IBS than the general population, so talk with your doctor to find out if it could be a possibility for you.
Maybe It Isnt Glutens Fault
While there is no doubt that gluten is to blame for the debilitating symptoms of celiac disease, we might have been too quick to assume that this protein, found in wheat and some other grains, is also responsible for the symptoms associated with non-celiac gluten sensitivity , often colloquially called gluten intolerance.
Celiac disease affects just 1% of the population, and an estimated further 6% could have NCGS, yet as we mentioned in the Inside Tract®, issue 189, as many as 22% of Canadians are trying to cut gluten out of their diets. While many individuals believe that gluten is responsible for a vast array of symptoms and ailments, the chance of gluten being the cause is quite low. In addition, our understanding of how NCGS works is still in its infancy. There is much controversy surrounding this disorder, since there are no known physical markers, and studies conducted on the subject continue to show mixed results. Some new research shows that it is even possible that NCGS isnt really a sensitivity to gluten, but may be to another component of the plant.
So whats the real story behind wheat, gluten, and non-celiac gluten sensitivity?
Don’t Miss: Can Lettuce Give You Diarrhea
What Is Gluten Sensitivity
Gluten sensitivity means your body reacts negatively to ingesting gluten. The symptoms can vary from person to person but may include:2,3
Gluten sensitivity is often confused with celiac disease. Celiac disease can cause these same symptoms , but celiac disease is an inherited autoimmune disorder in which gluten triggers the body to attack the lining of the small intestine.2,3
Until recently, it was thought that people with gluten sensitivity didnt experience intestinal damage as in people with celiac disease. A recent study dispelled that notion, demonstrating that people with gluten sensitivity had increased markers for systemic immune activation, which suggests their intestinal lining is compromised.4
Approved Medication For Ibs Patients
Not all medication can worsen IBS. There are drugs available for diarrhea, constipation, and general pain relief. These drugs include:
A new drug called Blautix is currently undergoing clinical trials and has been cleared for further investigation by the U.S. FDA. Preliminary research showed that the drug resulted in an 82% improvement in affected individuals.
You May Like: Is Diarrhea Part Of The Flu
Does Ced Exist In Patients With Ibs
The spectrum of manifestations of CeD is wide and ranges between classic CeD having typical signs and/or symptoms of malabsorption and non-classic CeD having non-GI symptoms such as short stature, anemia, infertility, or osteopenia/osteoporosis . Furthermore, some patients with CeD remain asymptomatic or have only mild GI symptoms. While in some patients the phenotype of the disease is fully expressed, in many others the disease is expressed only in the milder form . Many such patients with CeD having mild gastrointestinal symptoms may fulfill the criteria for the diagnosis of IBS and they may be diagnosed and treated as IBS in the general clinical practice .
Overall 4% of patients meeting criteria for IBS are confirmed to have CeD based on a meta-analysis including 14 studies . Specifically, odds of having CeD in patients meeting diagnostic criteria for IBS is 4.34 in comparison to controls . Additionally almost one third of patients with CeD who already are on treatment with a gluten-free diet continue to have IBS-type symptoms. Furthermore, evidence now suggests that testing for CeD in patients with diarrhea-predominant IBS is cost-effective if the prevalence of CeD in the general population is above 1% . Based on the evidences of overlap in the symptomatology of IBS and CeD, the American College of Gastroenterology Task Force has recommended routine serologic screening for CeD in patients with diarrhea-predominant IBS or IBS with a mixed bowel pattern .
How Can Food Trigger Ibs
Patients with irritable bowel syndrome have a difficult time processing food compared to unaffected individuals. Food sensitivities from IBS arent caused by an allergy or intolerance. Instead certain foods can lead to an increase in the water uptake in the large intestine, creating a micro-environment where bacteria can thrive.
Dietary changes are administered to IBS patients to help soothe cell abnormalities in the gastrointestinal region, while ensuring that the gut is favorable for beneficial bacteria growth.
Don’t Miss: Why Does My Puppy Have Diarrhea At Night
Other Tips For Managing Ibs Symptoms
- Eat multiple small meals throughout the day instead of three large meals.
- Dont eat too quickly.
- Limit processed foods, which can contain unsuspecting ingredients that trigger IBS flare-ups.
- Eat soluble fiber instead of insoluble fiber to ease constipation without bloating or diarrhea .
- Try ginger, peppermint or chamomile, which may improve various digestion issues.
- Dont smoke. Smoking can worsen symptoms.
- Reduce stress and anxiety, which have been shown to trigger IBS flare-ups.
What Bread Is Best For Irritable Bowel Syndrome
People with IBS can seem to have increased fiber intake by replacing sugary treats with bread that provides less fibre than full-FODMAP rye.It is typical for IBS patients not to eat as much fiber as their healthy counterparts.As far as fiber, Finland most obviously counts on rye bread for dietary fiber, but they may also eat more if they are rich in fructans.
Don’t Miss: Is Excessive Gas A Symptom Of Ibs
Most Doctors Fail To Do Vitamin Blood Tests
Often, at the time of diagnosis people have been ill for a very long time. Due to this delay in diagnosis, many patients have a lengthy period of malabsorption of vitamins and minerals. The intestines have not been working properly under the constant barrage of gluten ingestion.
Many practitioners fail to test for common nutrient deficiencies associated with celiac disease or gluten sensitivity.
The vitamins and minerals most commonly deficient are below, along with some common symptoms seen with these deficiencies. This list is by no means comprehensive or exclusive.
Iron- Fatigue, cold intolerance , poor appetite, pale skin, headaches, dizziness, shortness of breath
Vitamin D- These symptoms can be nonspecific and vague: bone pain, weakness, depression, fatigue, poor concentration, and joint pain.
Folate- Fatigue, headache, anemia, palpitations, depression, difficulty concentrating, memory problems, sore tongue, gastrointestinal symptoms such as diarrhea, nausea, vomiting
Vitamin B12- Anemia, weakness, fatigue, pale skin, sore tongue, balance problems, tingling in fingers or toes, mood changes, depression
Magnesium- Fatigue, constipation, insomnia, muscle spasms or twitches, anxiety, hyperactivity, headaches
Weight Change And Body Mass Index
The median body mass index of the women was not significantly different from that of the men . Two-thirds of the patients reported weight loss in the 6 mo before diagnosis. One-half of these patients had a BMI < 20, and of the 23% who had a BMI 25, 11% were obese . The same proportions of males and females gained or lost weight after the institution of a gluten-free diet . Ninety-one patients gained weight between the time of diagnosis and 6 mo after starting a gluten-free diet, and the weight gain ranged from 0.5 to 46 kg . In the same period, 25 patients lost an average of 12.5 kg . This weight loss was most pronounced in the patients who were obese at diagnosis. However, 12 patients who had normal or low weight at diagnosis actually lost weight despite a gluten-free diet. This was largely due to excessive food restriction rather than persistent disease.
Recommended Reading: How Much Bloating Is Normal
Other Ways To Help Ibs
A low FODMAP diet can help calm a touchy digestive system. Ultimately, a combination of IBS treatments may provide you with the most relief. Take a step-by-step approach when trying out new treatments, and monitor your symptoms. Over time, you can develop an effective, personalized treatment plan for IBS.
Here are some other treatment options you may wish to try.
You May Like: Are Bud Light Seltzers Gluten Free
How Does Stress Affect Ibs
The impact of stress on IBS has long been a topic of clinical curiosity. A paper published in the World Journal of Gastroenterology showed that there is a direct link between what the researchers called an irritable bowel and an irritable brain.
The researchers affirmed that IBS is a stress-sensitive disorder. Stress can stimulate the hypothalamic pituitary adrenal axis, which can directly affect gut functions. Psychological stress can gastrointestinal interactions with the nervous system, intestinal bacteria growth, and mucus production. Stress can stimulate the hypothalamic pituitary adrenal axis, which can directly affect gut performance.
Psychological distress among IBS patients and vice-versa is common. There is a strong correlation between psychological disorders such as depression and anxiety with the severity of IBS symptoms. With these fundings, its clear that stress management should be a priority of any IBS patient.
Recommended Reading: Do Probiotics Help With Acne
Ibs Resolves Following A Gluten Free Diet
What is Irritable Bowel Syndrome ? This term has been thrown around by GI doctors for many years as a catch all diagnosis for those with bowel dysfunction of unknown origin. Typically, IBS patients dont respond to increased fiber and respond poorly to medication. In my experience most patients I see have been stamped with psychological problems and are told to see a psychiatrist and to manage their stress.
If you fall into this category of doctor negligence, keep reading. There is hope yet
A new study published in the journal Gastroenterology confirms a direct benefit of patients suffering with IBS after following a gluten free diet.
In laymans terms the study can be summarized as follows:
Here is the technical summary of the study conclusion:
Gastroenterology. 2013 Jan 25. pii: S0016-508500135-2. A Controlled Trial of Gluten-Free Diet in Patients with Irritable Bowel Syndrome-Diarrhea: Effects on Bowel Frequency and Intestinal Function. Vazquez-Roque MI, Camilleri M, Smyrk T, Murray JA, Marietta E, ONeill J, Carlson P, Lamsam J, Janzow D, Eckert D, Burton D, Zinsmeister AR.
Does Exercise Help With Irritable Bowel Syndrome
Working out might be the last thing you want to do as an IBS patient, but science shows this can actually be beneficial. A group of patients were asked to do 20 to 30 minutes of exercise three to five times a week.
After three months, the active group reported better results than the inactive group. Symptoms worsened in 23% of cases in the inactive group, while only 8% of individuals felt worse after 3 months of exercise .
Exercise is also a good way to reduce stress. To maximize your workout sessions, we recommend doing the following:
- Dont eat fatty foods before exercising
- Try to schedule your exercises closer to when your intestines are most quiet
- Dont drink caffeinated drinks such as coffee and energy drinks before working out
- If you have hyperactive bowels, eat first thing in the morning
- Drink lots of water before working out
Recommended Reading: Can Tight Pants Cause Heartburn
Other Foods To Avoid With Ibs
If you follow a gluten-free diet and still experience IBS symptoms, it could be due to other dietary components. Every persons body is different, and what may trigger one person may not necessarily impact another. Work closely with your doctor and try cutting out the following one by one to see how you feel.
- Cereal and bread made with refined grains
- Carbonated drinks and alcohol
- Processed foods
- High-protein foods
Learn more about the health and medical experts who who provide you with the cutting-edge resources, tools, news, and more on Gluten-Free Living.
You May Like: Gluten Free Pizza Dough Publix
Too Many Bacteria In The Small Intestine Causes Problems
SIBO is an overgrowth of bacteria in the small intestine that wreaks havoc on the digestive tract and a persons well-being.
If SIBO goes unchecked, it can cause malabsorption of nutrients in addition to symptoms such as gas, bloating, diarrhea, and discomfort. Symptoms often worsen after the ingestion of carbohydrates and can be progressive throughout the day.
Diagnosis is made by a hydrogen breath test, although some practitioners will treat based on history alone. SIBO can also commonly be the underlying cause of histamine intolerance.
Treatment varies from patient to patient but may include diet changes, probiotics, supplements, and antibiotics.
Also Check: How To Get Over Diarrhea
Top Foods To Eat To Help Avoid Nutritional Deficiencies Common In People With Celiac
To help restore vitamin and mineral levels, doctors will often recommend foods rich in these nutrients as well as supplements . Here are some great gluten-free sources of these common shortfall nutrients in people with celiac:
Iron Beef , spinach, white beans, dark chocolate, lentils, tofu, chickpeas, and cashews
Vitamin D Fortified dairy , fortified nondairy milk , fortified orange juice, sardines, salmon, and eggs
Calcium Dairy, nondairy milk, salmon, sardines, kale, bok choy, tofu , fortified orange juice, oranges, and dried figs
B vitamins Sunflower seeds, beans, lentils, spinach, mushrooms, chicken, broccoli, asparagus, and lentils
Zinc Beef, Alaska king crab, lobster, pork, dark meat chicken, and cashews
Do Not Avoid Gluten Pre
As part of your irritable bowel syndrome diagnosis, you will need a coeliac disease blood test. If you are excluding gluten then your test will be incorrect.
It is important to get an accurate test done and coeliac management is not quite as simple as going wheat free. The incorrect management of this condition can lead to bowel cancer.
Don’t Miss: Does Alka Seltzer Help With Bloating
Best Supplements For People With Celiac Disease
If you have recognized nutrient deficiencies, your doctor may advise that you take one or more the following supplements. Keep in mind that once you restore these nutrient levels and your intestines heal, youll likely no longer need to take that specific vitamin or mineral. Many nutrients have store houses in the body once you replete the stores, you can go off the supplement, says Beringer.
Your doctor should also monitor you periodically to ensure that your body is properly nourished, adds Mukherjee. Dont supplement unless recommended by your doctor or registered dietitian. Your doctor may advise:
Fermentable Carbohydrates And Gluten
Researchers in Sweden recently published a large study evaluating specific food types and their effect on IBS. The results appear in the American Journal of Clinical Nutrition.
They compared and contrasted two dietary restrictions frequently recommended to people living with IBS removing gluten or fermentable carbohydrates from their diet.
Fermentable carbohydrates are oligo-, di-, monosaccharides, and polyols . They are in many foods, including some vegetables and most legumes.
Many people believe FODMAPS cause IBS symptoms because they are rapidly fermented by gut bacteria and, therefore, may cause abdominal distention, bloating, and pain.
Gluten is a protein present in wheat, rye, barley, and triticale, a cross between wheat and rye. Manufacturers also add gluten to some processed foods to improve their texture.
First author, Elise Nordin, a Ph.D. candidate at the division of Food and Nutrition Science at Chalmers University of Technology in Sweden, explained to MNT:
Why restrict FODMAPS?
FODMAPS are poorly absorbed and fermentable carbohydrates. A too high intake will cause symptoms also in healthy people. Previously, research has shown that people with IBS may be more sensitive compared with healthy people. Thereby the belief has been that by excluding FODMAPS, they will gain symptom relief.
Don’t Miss: When Do You Get Heartburn During Pregnancy