Digestive woes, stomach aches, tummy troubles, gut issues, so many different names for those problems in your digestive tract! No wonder it’s hard to tell the difference between things like celiac disease, gluten intolerance, irritable bowel syndrome, and other health issues. In fact, some studies show that diagnosed and presumed IBS actually turns out in some cases to be celiac disease in disguise causing digestive issues.

But there are significant differences between these disorders and how they inevitably affect your wellbeing. The first thing to note is that it’s important to be properly diagnosed by a professional physician for these conditions: a gastroenterologist specializes in diagnosing and treating digestive disorders. Don’t worry though, you’re not the only one dealing with the pain, cramping and bloating that comes along with irritable bowel syndrome. 

Let’s take a look at these three health problems individually to see what sets them apart. 

What is irritable bowel syndrome?

IBS is a common digestive disorder affecting the gastrointestinal (GI) tract. IBS affects 10-15% of the population globally, about 25-45 million people just in the US, but only 5% of those are formally diagnosed. This disorder occurs primarily in women. Thankfully, IBS is not a disease as it does not involve inflammation, anatomical or chemical abnormalities, it is not degenerative, and does not have to be a life-long experience. 

What are the symptoms of IBS? 

A key symptom of IBS is abdominal pain - often described as “sharp,” “stabbing,” “cramping,” or like a “migraine in the abdomen.” According to the ROME IV criteria (a standard in gastrointestinal disorders), to meet the diagnosis of IBS you need to have:

• Pain related to defecation, on average at least 1 day a week in the past three months
• Associated with a change in frequency of stool, resulting in either more or less frequent bowel movements (including feeling the urgent need to run to the bathroom to poop) and
• A change in the form (appearance) of the stool, resulting in either diarrhea or constipation or alternating diarrhea and constipation.
  

There are three main types of IBS:

• IBS-D (diarrhea prominent)
• IBS-C (constipation prominent)
• IBS-Mixed Bowel Habits (a combination of alternating diarrhea and constipation)
• And if not classified yet, IBS-U (undefined)

Keep in mind that most people with IBS will shift from one category to another with time. 

Your doctor is going to want to know if the frequency and appearance of your waste has changed over time. As you might have noticed, poop can take many forms - from hard, separated lumps that look like nuts, to sausage-like or snake-like, to fluffy, mushy, or watery poop. A change in the appearance of your poop is a key sign for IBS. 

It’s okay to look in the toilet - in fact it’s encouraged! We all have occasionally looser or harder stools; but if you have IBS, these changes occur on a chronic basis.

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What is celiac disease?

Celiac disease is a serious, life-long autoimmune disease with a strong genetic basis. Because it is genetic, it often runs in families. Its trigger is gluten - a protein found in wheat, rye, barley. When gluten is ingested, the body attacks the lining of your gut, causing issues throughout the body. The only current - and typically very effective - treatment is a strict gluten free diet. 

If someone with celiac disease does not follow a gluten-free diet, there are severe consequences, including bone loss, anemia, malnutrition, fertility problems, and even, in rare cases, lymphoma. 

Celiac is an autoimmune disease; it is not the same as a food allergy, and it is not a food intolerance or sensitivity.  

What is Non-Celiac Gluten Sensitivity

First of all, let’s be clear here: we are now talking about an intolerance to foods derived from wheat that is not celiac disease nor a wheat allergy. This intolerance has many names:

• Gluten intolerance
• Gluten sensitivity
• Wheat sensitivity
• Non-celiac gluten sensitivity
• Non-celiac wheat sensitivity
• Or, non-celiac gluten intolerance
  

This is typically a generic label for someone who knows they have an issue with wheat (hence commonly blaming gluten), but either haven’t investigated further into testing for celiac disease, or have been tested for celiac disease but with negative results. 

This intolerance (now in current medical terms better defined as Non-Celiac Wheat Sensitivity - NCWS - as there are other components in wheat that can cause it besides gluten) unfortunately has no biomarkers to identify it, and thus is difficult to diagnose. You cannot tell if you have NCWS from an endoscopy, colonoscopy, blood test, stool sample, saliva sample or hair sample. 

A physician is important in the diagnostic process however, because it is extremely important that celiac disease and wheat allergy are excluded! Then, with the help of a dietitian you may design a diet plan that suits you. Many symptoms of a gluten intolerance overlap with IBS. Regular food diary entries should be kept to correlate any symptoms of IBS with any trigger foods, including FODMAPs. 

IBS vs Celiac Disease Vs Gluten Intolerance: What’s the difference?

How does IBS differ from celiac disease?

IBS is a disorder, while celiac disease is an autoimmune disease with severe consequences if undiagnosed, or if a strict gluten-free diet is not followed. IBS only has gastrointestinal symptoms, while celiac disease can have body-wide symptoms, and affect everything from growth to fertility. Patients with celiac who continue to have GI symptoms even on a gluten-free diet, may additionally have IBS - although it’s not too common (around 20-30%).

How does IBS differ from non-celiac wheat sensitivity?

This is still a muddy area, as there are studies showing that indeed a portion of patients labeled as IBS may benefit from a diet excluding wheat and gluten. In other words, some IBS patients (but only some!) may instead be better defined as patients suffering from NCWS. In general, NCWS is a direct consequence of eating wheat, while IBS can be the consequence of a gastroenteritis, or be caused by an imbalance of gut bacteria or fermentation in the gut, or can even result from stress. 

What’s the overlap between IBS, celiac disease, and non-celiac wheat sensitivity?

All three of these issues may affect the digestive tract and may lead to very similar symptoms. You may experience abdominal pain and bloating especially after eating; constipation, diarrhea, or a mixture of both. Sometimes people with IBS may also suffer from weight loss, not due to malabsorption of nutrients like in celiac disease, but because they become afraid to eat due to the experiencing of pain after eating. But please remember that all three are very different issues with different solutions!

The bottom line

If you think wheat and/or gluten are adversely affecting you: take a diary of what you eat and what symptoms you experience (don’t be shy about writing down stool characteristics! This is what gastroenterologists do for a living after all!) and then seek a medical appointment. Your doctor will decide if and what tests are needed, before concluding for IBS, celiac disease, or NCWS. Do not initiate a gluten-free diet or low-FODMAP diet on your own!

IBS vs Celiac Disease Vs NCWS comparison table

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Frequently asked questions:

What causes IBS?

There are many things that can cause IBS from food intolerances (wheat, FODMAPs), previous GI infections (like the “stomach” flu), gut microbial imbalance (dysbiosis) or hormone/stress changes. IBS is a gut-brain interaction disorder. It basically means that the brain sends signals that might be overinterpreted by the nervous system and the bowel - the bowel is over feeling or over sensitive to signals from the brain; and vice versa, the brain is oversensitive to normal signals from the bowel. 

Sometimes specific food or bacteria in your gut can make your gut think there is something serious going on, and it sounds the alarm and triggers symptoms. I know that might make it seem like IBS is all in your head, or that you’re making it up - but you’re not! Labeling this disorder this way helps physicians (and patients) understand how to treat it. This can help to explain why stress might make IBS worse, and why gut-directed psychotherapy, healthy coping mechanisms such as breathing techniques and social support (even Facebook groups) might handle IBS better. 

What if I still have digestive issues after I go gluten free? Can I have IBS and celiac disease? 

Yes, you can have IBS and celiac disease at the same time. If you are on a strict gluten-free diet, and your serology (blood) and histology (biopsies) are normal, it’s time to investigate further! Track your symptoms with a food diary, so you can see what foods give you issues over time and, when removed, which foods help stop you from feeling bloated. You can also track your emotional health to see if stress contributes to any symptoms. Work with a dietitian on an elimination diet to help find out if there are additional food triggers that might be causing IBS symptoms or overall issues with particular foods or groups of foods. 

Is gluten the cause of IBS?

‍Not necessarily. Wheat, rye, and barley are a common FODMAP (a group of fermentable sugars found in popular foods). Other FODMAP foods include cheese, honey, garlic, onions, avocados, or strawberries and apples. A FODMAP can cause IBS symptoms for some people. A low-FODMAP diet is a very strict diet that removes high-FODMAP foods in a timely, strategic method, and then strategically re-introduces them into the diet. Some might have success in reintroducing certain foods, and some might need to remove these items permanently. So, can gluten cause gas, bloating, and abdominal pain? It might, if you have a problem with these FODMAPs. 

How do you treat IBS? 

There is not a standard treatment method for IBS, and greatly depends on your symptoms and triggers. 

First, you should seek medical advice especially if there are serious issues like any blood present in your stool, weight loss, a family history of Inflammatory Bowel Disease (IBD), or celiac disease. Blood tests and family history can help your doctor rule out these issues. Then, your gastroenterologist with the important help of a GI dietitian can work with you on any of the following: 

• Gut-directed cognitive behavioral therapy 
• Probiotics
• Low-FODMAP diet.
• A breath test to test for SIBO (small intestine bacterial overgrowth). 
• Over the counter stool softeners
• Specific drugs recently developed and approved for IBS (ex. Lubiprostone, Linaclotide, Rifaximin, Eluxadoline)

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Is IBS the same as celiac disease?

No, but you can have both gut issues. Unlike celiac disease, there is no change in health risk (like a risk of lymphoma) or change in tissue with IBS. This doesn’t mean that IBS isn’t horrible to deal with, or that it doesn’t come with its share of physical and emotional symptoms that can be frustrating, embarrassing, or physically painful. However, IBS doesn’t come with the same long-term risks as other autoimmune diseases like celiac, or like other GI autoimmune diseases like Crohn’s disease or colitis. 

Is IBS a wheat allergy?

No, but again, you can have both food issues. It’s important to work with your allergist regularly to make sure that you are managing your IgE food allergy levels. 

Conclusion

While IBS, celiac disease, and NCWS are three distinct gut issues, they can easily overlap in symptoms. You can also have any of these three issues together at the same time. This makes symptoms harder to tell which disorder or disease is causing issues. A registered dietitian and gastroenterologist can help diagnose you properly, and put together a plan to help with symptoms and disease management. Eliminating gluten from your diet without needing this may actually be more harmful than beneficial.