IBS vs. Gluten Intolerance. What is the difference?   

By Melody Khorrami, PharmD, RPh, INHC      

Confused about the difference between IBS and gluten intolerance? This blog post explores the similarities and differences between these two conditions, including their symptoms, causes, and treatment options. While their gastrointestinal symptoms can overlap, it's essential to identify the root cause to determine the right treatment plan. Bio-individuality plays a role, meaning that there's no one-size-fits-all approach to addressing these conditions.

Irritable bowel syndrome (IBS) is a chronic functional disorder associated with the gastrointestinal tract. It is associated with abdominal pain, discomfort, gas, and bloating, and can change a person’s bowel habits. It is a common condition amongst the general population with various causes ranging from early life stress, changes in the gut microbiome leading to dysbiosis, severe infections or overgrowth of bacteria, and nervous system dysregulation. Triggers such as food sensitivities, and stress can also worsen the condition. Food allergies such as dairy, beans, and wheat can trigger symptoms and stress can worsen the symptoms of IBS.  

Risk factors for IBS include age, gender, and mental health status. It occurs more frequently among people under the age of 50 years old. It is more predominant in females, and those with anxiety, depression, or other mental health conditions, as well as having a family history of the condition.

Treatment for IBS includes the following: avoiding certain foods that are triggering the condition and your symptoms, eating high-fiber foods, increasing fluids, regular exercise, and sleeping. Some foods that you may consider eliminating include foods containing gluten, and FODMAPS.  FODMAPS contain carbohydrates like fructose, lactose, and fructans. They are found in certain vegetables, dairy products, and grains.

Over-the-counter medications that might be considered include, fiber supplements, and laxatives. Prescribed medications might include anticholinergic medications and antidiarrheals, tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), or pain medications. Some medications target specific areas of the colon and small intestines that can be considered. 

Gluten is a protein that is mainly found in wheat, barley, and rye. Gluten intolerance, also known as non-celiac gluten sensitivity (NCGS) is a condition where the patient experiences gastrointestinal and non-gastrointestinal symptoms after ingesting the protein gluten. These patients do not have any evidence of celiac disease or wheat allergy. The condition includes symptoms like IBS, diarrhea, abdominal pain, discomfort, bloating, and flatulence. Other symptoms which are not like IBS include headache, attention-deficit hyperactivity disorder, depression, skin conditions that cause itchiness, oral ulcers, and fatigue.

Gluten sensitivity or intolerance is typically diagnosed by ruling out wheat allergies and celiac disease. Gluten intolerance has been linked to an abnormal immune system response to gluten. Some research points to certain genetic factors that may be related to gluten intolerance and imbalances in the gut microbiome, which may make a person more sensitive to gluten. There are no specific tests or biomarkers currently to diagnose the condition. Gluten intolerance is not considered an autoimmune disorder, and while the immune system may be involved in it, it does not cause the intestinal damage and inflammation that celiac disease causes. It is also important to differentiate between celiac disease and gluten sensitivity or intolerance. Celiac disease is an autoimmune disorder that can damage the small intestines when gluten is consumed. Gluten intolerance, however, does not cause the same intestinal damage. The symptoms of both can be similar. 

The causes and the risk factors for gluten sensitivity and intolerance are not clear, but there is a link between consuming gluten and certain symptoms. Going gluten-free can help alleviate some of these. If your healthcare provider thinks you might have a gluten intolerance they may recommend a “rule out” diagnosis, which is looking to make sure there aren’t any other root causes of your condition such as celiac disease or wheat allergy. There is no way to prevent gluten intolerance, which can sometimes appear later in life. 

It is also important to note that health conditions like irritable bowel syndrome might also increase the risk of gluten intolerance, and people with gluten intolerance may have additional inflammation in the gut, which could increase intestinal permeability. This increase in intestinal permeability may create an environment where toxins and other harmful substances might leak into the bloodstream and contribute to the symptoms of IBS. People who have IBS can also have alterations in their gut microbiota which might make them more prone to developing gluten intolerance. People with gluten intolerance are also more likely to have food sensitivities which could also contribute to IBS symptoms. Stress also contributes to IBS symptoms and gluten intolerance. While not everyone with gluten intolerance will have IBS, and vice versa, it is important to work with a licensed healthcare provider to address symptoms and other issues related to these health conditions.

Please note: This article is for informational purposes only, please talk to your healthcare provider if you have any questions related to your health regimen or if you plan to make any changes to your health plan.