Dietary Triggers in Irritable Bowel Syndrome: Is There a Role for Gluten?

Abstract

A tight link exists between dietary factors and irritable bowel syndrome (IBS), one of the most common functional syndromes, characterized by abdominal pain/discomfort, bloating and alternating bowel habits. Amongst the variety of foods potentially evoking "food sensitivity", gluten and other wheat proteins including amylase trypsin inhibitors represent the culprits that recently have drawn the attention of the scientific community. Therefore, a newly emerging condition termed non-celiac gluten sensitivity (NCGS) or nonceliac wheat sensitivity (NCWS) is now well established in the clinical practice. Notably, patients with NCGS/NCWS have symptoms that mimic those present in IBS. The mechanisms by which gluten or other wheat proteins trigger symptoms are poorly understood and the lack of specific biomarkers hampers diagnosis of this condition. The present review aimed at providing an update to physicians and scientists regarding the following main topics: the experimental and clinical evidence on the role of gluten/wheat in IBS; how to diagnose patients with functional symptoms attributable to gluten/wheat sensitivity; the importance of double-blind placebo controlled cross-over trials as confirmatory assays of gluten/wheat sensitivity; and finally, dietary measures for gluten/wheat sensitive patients. The analysis of current evidence proposes that gluten/wheat sensitivity can indeed represent a subset of the broad spectrum of patients with a clinical presentation of IBS. (J Neurogastroenterol Motil 2016;22:547-557)

Prevalence and Characterization of Self-Reported Gluten Sensitivity in The Netherlands

“…As shown in Table 1, anxiety, chronic headache and gastro-intestinal reflux disease were more common in the srGS group compared with controls. These subjective health complaints are also common symptoms in patients with irritable bowel syndrome (IBS) and self-reported food intolerance in general [21,22,23]. …”

“…Foods which are reported to be associated with IBS symptoms are commonly rich in gluten, wheat and carbohydrates [23]. Therefore NCWS could be seen as part of IBS with a gluten-free diet as treatment strategy.…”

Non‐celiac gluten or wheat sensitivity: It's complicated!

“…described chronic diarrhea that improved after a gluten‐free diet (GFD) and was triggered by gluten challenge in subjects without celiac disease. Since then, studies have reported conflicting results leading to a shift in terminology, non‐celiac wheat sensitivity (NCWS), which reflects our uncertainty on the exact trigger and mechanisms involved …”

Diet in irritable bowel syndrome: What to recommend, not what to forbid to patients!

“…Gluten-rich cereals are a valuable source of nutrients in the general diet, so their exclusion could potentially lead to nutritional deficiencies[98]. …”