Gluten sensitivity: symptoms, diagnosis and dietary treatment
What it found
Non-celiac gluten sensitivity causes gut and other symptoms after eating gluten-containing foods, but the condition is hard to diagnose and its true prevalence is unknown.
The evidence comes from surveys, patient studies and lab work.
What they found
Studies in people
How common
Survey studies based on self-report suggest that between 0.49% and 14.9% of people may have non-celiac gluten sensitivity. These surveys did not use objective tests to confirm the diagnosis.
Symptoms
The most common gut symptoms are bloating, abdominal pain, diarrhea, nausea and reflux. Other symptoms can include headache, tiredness, joint pain and depression, and they can appear hours or days after eating the trigger.
Possible triggers
Gluten, amylase and trypsin inhibitors, and FODMAPs are all suspected triggers, alone or in combination. In one study, 59 patients with self-reported non-celiac gluten sensitivity had a higher overall symptom score after a fructan challenge than after gluten or placebo.
Diet treatment
A gluten-free diet is the main treatment, but it can lead to higher intake of saturated fat and sugar and lower intake of fiber and some vitamins and minerals. A low-FODMAP diet can also reduce symptoms but may lower antioxidant and micronutrient intake.
Other findings
What it is
Non-celiac gluten sensitivity is defined as gut and other symptoms triggered by eating gluten-containing foods in people who do not have celiac disease or wheat allergy. Celiac disease and wheat allergy must be ruled out first.
Diagnosis
There are no reliable biomarkers, so diagnosis relies on ruling out celiac disease and wheat allergy and then doing a placebo-controlled gluten challenge. The Salerno criteria use a double-blind challenge with one week of gluten and one week of placebo.
What the authors conclude
“The treatment of NCGS involves the dietary restriction of the suspected triggers of the disease, but there is controversial data about the effectiveness of different dietary interventions such as the gluten-free diet and low-FODMAP diet.”
Also in their conclusions
- They say that the real prevalence of non-celiac gluten sensitivity remains unknown because there are no sensitive and reproducible biomarkers and no adequate diagnostic approach for clinical practice.
- They advise that researchers should work to clarify the specific role of dietary triggers and their interaction with the immune system.
- They recommend that dietary counseling by a health professional should always be encouraged because a gluten-free or low-FODMAP diet can lead to nutritional imbalance.
How it was done
The authors wanted to give an up-to-date overview of non-celiac gluten sensitivity, from how common it is to how it is treated, because research on this condition is increasing quickly.
They reviewed published studies on non-celiac gluten sensitivity, covering its definition, how common it is, symptoms, causes, diagnosis and dietary treatment.
What it can’t tell you
- Most prevalence estimates come from surveys where people report their own symptoms, so they may not reflect the true number of cases.
- The studies used different methods and definitions, making it hard to compare results or draw firm conclusions.
- The exact causes and the role of specific triggers like gluten, ATIs and FODMAPs are still not known.
Who paid
- Conflicts
- The authors declare no conflict of interest.
- Authors work at
- University of Sinaloa, Mexico; University of Sonora, Mexico
The paper
- Title
- Non-Celiac Gluten Sensitivity: An Update
- Type
- ReviewThe authors read earlier studies and describe what they found. It isn’t a new study.
- Evidence
- Studies in people
- Summarised from
- Full text
- Cite
- Cárdenas-Torres FI, Cabrera-Chávez F, Figueroa-Salcido OG, Ontiveros N (2021). Non-Celiac Gluten Sensitivity: An Update. Medicina (Kaunas, Lithuania). doi:10.3390/medicina57060526Free full textPubMed 34073654DOI
Summary written 26 Sep 2026. Check it against the paper before it changes what you eat. How we summarise papers · Report an error