Clarifying The Role of Gluten In Digestive Disorders

Most people who suffer from daily bloating wonder about the role of gluten in their diets. One of the most common questions I’m asked in my clinical practice is: do I need to go gluten free, and for how long? First, there are a few things to consider.

Gluten can contribute to bloating

Gluten causes inflammation, reduces motility, and impairs healing in the small intestine. It does so by activating the immune system and triggering the release of immune chemicals, one of which is histamine. Patients with irritable bowel syndrome (IBS) and small intestinal bacterial overgrowth (SIBO) are already very sensitive to histamine, so ingesting gluten creates an additional histamine load in their small intestine.

Gluten sensitivity or bacterial overgrowth?

Bacterial overgrowth can also trigger immune activation and histamine release. Although headaches, rashes, and brain fog can happen in non-celiac gluten sensitivity (NCGS), excessive histamine causes similar symptoms. Histamine can also cause fluid buildup, loose stools, and can worsen asthma, eczema, and allergies. If you tried being gluten-free for 4-6 weeks and still have bloating, SIBO testing can help narrow down the diagnosis.

Not all wheat is the same

For example, organic durum wheat contains less gluten and causes less bloating than commercial wheat used in most breads. An easy way to try gluten reduction is to eat pasta and breads made from durum. It is also important to consider that wheat components other than gluten can also trigger the immune system and cause inflammation.

My clinical considerations

A gluten-free diet for 4-6 weeks can help rule in gluten sensitivity. But it feels very restrictive long term, and patients should carefully weigh the pros and cons of strict gluten avoidance.
Gluten increases histamine release by activating our intestinal immune cells, but the same is observed in SIBO. This can be very confusing.
Strict gluten avoidance is more important in autoimmune diseases like Crohn’s, celiac disease and Hashimoto’s in which the immune system is already in overdrive.
Gluten reduction may be more feasible. It can modestly improve bloating symptoms in IBS and SIBO, possibly by reducing histamine burden. However, these patients may experience greater relief by reducing the intake of fermentable sugars and starches, and by treating the underlying dysbiosis instead.

Ruling out bacterial overgrowth by measuring intestinal gases is an important step in figuring out where the bloat is coming from. There are no reliable lab tests for gluten sensitivity at this time.

Looking For More Digestive Support?

If you’re ready to learn more about how Naturopathic Medicine can support non-celiac gluten sensitivity, IBS, SIBO, and other gut disturbances, you can check out our resource pages here.