A friend of mine started a gluten-free diet for her IBS, and she was saying that she feels much better, even though she did not have celiac disease when she was tested. How this can be right?

Dr. Mikolaitis: Diet has been proposed to play a role in functional gastrointestinal disorders for many years. Interestingly, when a group of IBS patients were asked if they related their symptoms to foods, many of them rated wheat as their number one culprit. Wheat-containing foods were followed by milk products, eggs, caffeine-containing foods, fructose-containing beverages, sulfur-containing vegetables, and alcohol as foods that trigger IBS. Some scientists have also looked at naturally occurring chemicals in foods such as salicylates and amines as the origins of IBS symptoms. Foods have been thought to contribute to IBS symptoms due to their unknown effects, and this could be related to food intolerance or food allergy, bacterial overgrowth or other alterations in colonic flora, or alterations in intestinal motility. However, to date, few scientific studies have examined the role of foods in IBS, while many persons who suffer with IBS continue to report that dietary modification has been helpful in controlling their disease. Gluten is found in wheat, rye, barley, and possibly oats. Gluten is the protein portion of cereal storage grains. A gluten-free diet is a very challenging diet to assimilate in today’s westernized society, and people with celiac disease find it very difficult to adopt the medically necessary a gluten-free diet due to the impact on their psycho-social quality of life. Gluten free is NOT synonymous with wheat free, because gluten encompasses more grains than wheat. While wheat has been strongly suggested as a possible trigger food for IBS, rye, oats, and barley have not been typically named. Due to the restrictive, expensive, and lifestyle-altering nature of following a gluten-free diet, it is not recommended that it be undertaken unless there is compelling evidence that an individual has celiac disease or a gluten sensitivity. Wheat products such as pastas, breads, and cereals are typically enriched with niacin, riboflavin, thiamine, and iron, so the elimination of this single grain poses some risk to the nutritional value of one’s diet. The literature does suggest that wheat is a potential trigger for IBS in some individuals. If you decide to eliminate this nutritious grain to see if it is your trigger, you should supplement your diet with a preservative-free, additive-free, color-free vitamin with mineral supplement appropriate for your age and gender. If you find that elimination of wheat does not reduce your symptoms and improve your quality of life, then consider adding whole-wheat products back into your diet and eliminating refined processed wheat food, sometimes referred to as “white flour products,” as this may be much healthier way of dietary adjustment.

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