On August 2, 2013, the U.S. Food and Drug Administration (FDA) issued a standard definition for the use of the terms “gluten-free”, “free of gluten”, “no gluten” and “without gluten” in voluntary food labeling. Gluten is a type of protein found naturally in wheat, barley, rye and hybrids using these grains. From now on, the above terms may only be used if the gluten content is less than 20 parts per million. Food manufacturers who do not already meet this standard have up to one year from this ruling to have their labels comply.
This change is most relevant to Americans with celiac disease, an autoimmune disorder also sometimes known as celiac sprue or gluten-sensitive enteropathy or GSE, who must strictly avoid gluten to avoid damage to the small intestine and other potentially serious medical complications. However, this information may also be useful to some subsets of people with irritable bowel syndrome.
Firstly, some symptoms of celiac disease are similar to some symptoms of irritable bowel syndrome and some individuals who may actually have celiac disease may currently be misdiagnosed with IBS. In 2009, the IBS Task Force of the American College of Gastroenterology recommended, as part of best practices for medical care for IBS, that patients whose symptoms are consistent with IBS with diarrhea (IBS-D) or mixed/alternating IBS (IBS-M or IBS-A) be tested for celiac disease. (See page S3.) However, this may or may not have occurred, especially in people diagnosed with IBS prior to that recommendation. According to a July 29, 2013 post by About.com IBS Guide Barbara Bradley Bolen, PhD, a journal article in Scandinavia reported on a study in that region of Europe showing that many study participants with celiac disease were initially wrongly diagnosed with IBS, leading to a delay in proper treatment.
Secondly, some individuals, including some with IBS, who test negative for celiac disease do anecdotally report that their symptoms have improved when they have gone gluten-free. Various research studies in very recent years have acknowledged the probable existence of non-celiac wheat sensitivity in some people, but scientific evidence is still conflicting or inconclusive as to the prevalence and nature of the problem, whether the intolerance is to gluten or other components of wheat, or appropriate management of the condition.
Thirdly, the low FODMAP diet, originally developed in Australia, has received increasing interest and research internationally as a successful option for some people to manage IBS. A component of the low FODMAP strategy is to reduce or eliminate wheat because it contains fructans, a carbohydrate that may be problematic and trigger IBS symptoms for some people. As Patsy Catsos, a registered, licensed dietitian in private practice in Portland, Maine who specializes in the low FODMAP approach states on her blog linked earlier in this paragraph, gluten and fructans are not the same thing. However, for most people avoiding wheat for low FODMAP purposes, gluten-free labeling can also make selecting appropriate foods a bit easier.
It should be noted that while dietary modifications are helpful in reducing symptoms for many people with IBS, “safe” and “trigger” foods vary from individual to individual. Some people with IBS find that they are not significantly helped by diet at all. Diet does not cause IBS and there is no single “IBS diet” that helps everyone. For more on “Diet for IBS,”please see the linked video from the University of North Carolina Center for Functional GI and Motility Disorders Expert Update on Treatments for Functional GI Disorders conference in June 2012. The presenter is Erin Slater, RD, LDN, clinical dietitian and also a person with IBS, who also shared her experiences in a PBS television program mentioned on the IBS Impact blog on December 10, 2012.
IBS Impact does not advocate any particular diet or treatment option. We do strive to provide information and resources that are reputable, accurate and balanced to the extent of the current scientific knowledge of experienced professionals in the field of IBS and functional gastrointestinal disorders, and to encourage others with IBS and their families to make fully informed decisions that are right for their own situations. It is hoped that the new FDA ruling proves helpful to those in the IBS community who believe they benefit from avoiding gluten or wheat.