IBS or celiac disease? How to know the cause of your stomach pain.

Gastrointestinal (GI) issues are a fact of life. All sorts of things can cause stomach pain, from stress at school or work to constipation from too many low fiber grab-and-go meals. 

When belly pain is the main complaint, it can be tough to know what’s going on. That’s because GI issues are a common symptom of many illnesses. But sometimes they’re a sign of a chronic condition, such as irritable bowel syndrome (IBS) or celiac disease.

These two conditions share similar symptoms too. So how do you know which one is causing digestive distress? Here are some ways to help tell them apart.

Roughly 10 to 15% of Americans have IBS, and it affects more women than men.¹ While it can be painful, IBS doesn’t actually damage the GI tract.

Symptoms can include the following²:

• Abdominal pain, often when you have a bowel movement
• Bloating
• Constipation*
• Diarrhea*
• Feeling like you had an incomplete bowel movement
• Whitish mucus in your stool

*Symptoms can switch back and forth between constipation and diarrhea.

You may also have non-GI symptoms, notes Abigail Hueber, R.D., a Boston-based functional dietitian who specializes in digestive health and owns Above Health Nutrition. Those non-GI symptoms could include skin conditions such rosacea or eczema, fatigue or low energy, sleep disturbances, hormonal imbalances (such as premenstrual syndrome) and mood imbalances (including worsening anxiety or depression).

Celiac disease is an autoimmune condition, and about 2 million Americans have it.³ If you have celiac disease, you shouldn’t eat gluten. Gluten is a protein found in wheat, barley, rye and triticale (a cross between wheat and rye), as well as in products made with those grains, including bread, pasta and cookies. 

If people with celiac disease eat something containing gluten, it causes an inflammatory response by the immune system that can damage the small intestine. “It causes a devastating level of inflammation,” Hueber says. Over time, if not properly supported, people with celiac disease have a higher risk of developing malnutrition, heart disease and other autoimmune disorders such as type 1 diabetes and multiple sclerosis³.

You can have digestive symptoms with celiac, including:

• Abdominal pain
• Bloating
• Chronic diarrhea
• Constipation 
• Gas 
• Lactose intolerance
• Loose, greasy, bulky and foul-smelling stools
• Nausea or vomiting 

Celiac disease can also affect the rest of your body. You may have many other non-GI symptoms too, including⁴:

• Cognitive impairment
• Depression and/or anxiety
• Fatigue
• Headaches or migraines 
• Iron-deficiency anemia 
• Joint pain 
• Reduced bone density
• Skin rashes 
• Weight loss

But surprisingly enough, you might not have any symptoms at all – this is known as asymptomatic celiac disease³. Or you might not have diarrhea or weight loss but instead have nonspecific symptoms like abdominal pain and bloating. Or you might have only non-GI symptoms. “That’s one of the reasons why people can go undiagnosed for years,” says Hueber.

There are two ways to find out if you have celiac disease.

• A blood test could determine if you have higher levels of certain antibodies in the blood that your body produces if you eat anything containing gluten. That’s why it’s so important to eat normally before the blood test. If you start a gluten-free diet right before the test, you’ll throw off the results⁵.
• An intestinal biopsy. During this procedure, a physician takes a sampling of your small intestines and reviews for damage and inflammation to make a diagnosis.⁶ 

There’s no blood test or any other test that can diagnose IBS. Instead, your provider will give you a physical exam and review your symptoms. For example, you might get diagnosed with IBS if your pain gets better or worse after a bowel movement. Or if you’ve had abdominal pain at least 1 day a week for the past 3 months. Your provider may also test you for other GI diseases (such as celiac) to rule them out.

The only treatment for celiac disease is to avoid foods, beverages and products that contain gluten. Luckily, that’s gotten easier, as there are now large gluten-free sections in most supermarkets.

Treating IBS is a little trickier. But it’s important to figure out what may be causing the IBS, notes Hueber. That way, you can treat the problem and feel better again. Some triggers of IBS include mental health conditions, such as stress, anxiety or depression. Other causes include bacterial infections in your GI tract, and even changes in the type of bacteria that grow in your small intestine.

Hueber also recommends making changes to your diet and eating habits, including: 

• Slowing down when you eat and chewing your food well
• Not eating on the go 
• Spacing out meals 
• Adding foods that contain prebiotics, such as chia seeds and flaxseeds, which help the growth of healthy bacteria in your gut

You can also consider trying the FODMAP diet⁷ to reduce IBS symptoms. FODMAPs are a type of sugar that may be causing your GI issues. They’re found in foods such as dairy products, beans and lentils, wheat, and certain fruits and vegetables. The idea is to replace high-FODMAP foods with low-FODMAP ones while you’re working to uncover the root cause of your IBS symptoms.

The challenge is that this is a very restrictive diet. Get input from your doctor or a nutritionist before trying it on your own. Although it can help people with IBS, it’s a short-term plan to help you find out which foods trigger your symptoms. 

GI issues can affect the quality of your life. There’s no reason to suffer in silence. Schedule a visit with your doctor. Even if you don’t have celiac disease or IBS, you’ll get the care you need to start enjoying meals again.