IBS and Gluten Sensitivity

Will a gluten-free diet help IBS?

Some patients who have been diagnosed with irritable bowel syndrome (IBS) report a lessening of symptoms when they follow a gluten-free diet. And although good quality studies are limited, the American College of Gastroenterology concludes that a gluten-free diet holds some promise for IBS patients. However, 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.

Mature Adult Woman on Gluten Free Diet
Rafael Ben-Ari / Getty Images

What Is Gluten?

Gluten is a protein composite found in the following grains:

  • Barley
  • Rye
  • Wheat

Gluten is present in a lot of the things we eat. This would most obviously include most cereals, bread, 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.

Once a celiac disease diagnosis is made, it is essential that you follow a gluten-free diet. 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 sensitivity would not involve damage to the small intestine like in celiac disease, but there is still some possible immune system reactivity to foods containing gluten. It is thought that such reactivity can result in both gastrointestinal and extra-intestinal symptoms, such as migraine headaches or attention deficit disorder. Preliminary 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.

Is it possible that some cases of IBS are actually a "gluten sensitivity?" Researchers have theorized that there may be a certain subset of IBS patients whose symptoms might be attributable to gluten sensitivity. In medical literature, this is now being called non-celiac gluten sensitivity (NCGS) and research in the area is ongoing.

Interestingly, researchers have made an observation that wheat contains fructans—a type of carbohydrate identified as a FODMAP—which is associated with contributing to digestive symptoms. This suggests that IBS patients 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. For the test to be accurate, you need to be consuming foods that contain gluten. If the test comes back negative, have a discussion 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 at the end of the one month trial 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.

Was this page helpful?
Article Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Ford AC, Moayyedi P, Chey WD, et al. American college of gastroenterology monograph on management of irritable bowel syndrome. Am J Gastroenterol. 2018;113(Suppl 2):1-18. doi:10.1038/s41395-018-0084-x

  2. Domżał-magrowska D, Kowalski MK, Szcześniak P, Bulska M, Orszulak-michalak D, Małecka-panas E. The prevalence of celiac disease in patients with irritable bowel syndrome and its subtypes. Prz Gastroenterol. 2016;11(4):276-281. doi:10.5114/pg.2016.57941

  3. Lewis D, Haridy J, Newnham ED. Testing for coeliac disease. Aust Prescr. 2017;40(3):105-108. doi:10.18773/austprescr.2017.029

  4. Makharia A, Catassi C, Makharia GK. The overlap between irritable bowel syndrome and non-celiac gluten sensitivity: a clinical dilemma. Nutrients. 2015;7(12):10417-26. doi:10.3390/nu7125541

  5. Catassi C, Alaedini A, Bojarski C, et al. The overlapping area of non-celiac gluten sensitivity (NCGS) and wheat-sensitive irritable bowel syndrome (IBS): an update. Nutrients. 2017;9(11). doi:10.3390/nu9111268

  6. Dieterich W, Zopf Y. Gluten and FODMAPS-sense of a restriction/when is restriction necessary?. Nutrients. 2019;11(8). doi:10.3390/nu11081957

Additional Reading
  • Ford, A., et.al. "American College of Gastroenterology Monograph on the Management of Irritable Bowel Syndrome and Chronic Idiopathic Constipation" American Journal of Gastroenterology 2014 109:S2-S26.

  • 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.
Related Articles