Is Non-Celiac Gluten Sensitivity Real?
Leah Johansen, M.D., practices alongside Robert Rountree, M.D., at Boulder Wellcare in Boulder, Colorado. Johansen earned her medical degree from Trinity School of Medicine and completed her residency training in family and community medicine at Case Western Reserve University.
Celiac disease is a well-established, and widely accepted, form of gluten sensitivity. Health experts and the general population agree that it's real and that it affects around 1% of the U.S. population. On the other hand, there's been some heavy debate on whether or not non-celiac gluten sensitivity exists or is just a trendy ailment.
While, in the past, researchers weren't exactly sure if non-celiac gluten sensitivity was a real thing, science has finally acknowledged that it is possible to react negatively to gluten, even if you don't have celiac disease.
What is non-celiac gluten sensitivity?
Just like it sounds, non-celiac gluten sensitivity is an adverse reaction to eating gluten that doesn't fall under the clinical umbrella of celiac disease. Although non-celiac gluten sensitivity, or NCGS, is the official nomenclature, it's also referred to as gluten intolerance or just gluten sensitivity.
But does science acknowledge the existence of non-celiac gluten sensitivity? The short answer is yes. Here's the longer answer:
In one randomized, placebo-controlled, double-blind crossover study (the gold standard), researchers divided 59 participants who had not celiac disease, but suspected gluten intolerance, into two groups. For one week, they gave each group either a gluten-containing capsule or a placebo filled with rice starch. After a week, they swapped groups. When given the gluten-containing capsule, the participants experienced a significant increase in symptoms of abdominal pain, gas, headaches, tiredness, bloating, and brain fog.
In another study that was similar in design, 101 non-celiac participants followed a gluten-free diet for three weeks and then were given either a gluten supplement or a placebo for one week. After the initial week, the groups were switched. During the period of gluten ingestion, participants reported an increase in symptoms and decrease in well-being and quality of life.
A literature review on the subject sums it all up, acknowledging that non-celiac gluten sensitivity is real and that further research should focus on figuring out ways to properly diagnose it.
Because there's no real reliable way to diagnose non-celiac gluten sensitivity, researchers don't know exactly how many people are affected, but estimates are around 6% of the U.S. population.
What are some symptoms of non-celiac gluten sensitivity?
Part of what makes non-celiac gluten sensitivity so difficult to pinpoint is the wide range of symptoms it can cause. Many people have digestive clues, like bloating, gas, diarrhea and/or constipation, nausea, heartburn, and stomach pain, but symptoms go beyond that, too.
In fact, many people don't experience any digestive symptoms at all. Some other possible symptoms of non-celiac gluten sensitivity are:
- Brain fog
- Muscle and joint pain
- Weight loss
- Skin rash
- Numbness in the arms and legs
How is gluten sensitivity different from celiac?
According to a report in BMC Medicine, even though both conditions produce similar symptoms, there are a few major things that set non-celiac gluten sensitivity apart from celiac disease. In those with celiac disease, eating gluten triggers an autoimmune response that causes the release of multiple types of antibodies (anti-tissue transglutaminase, anti-endomysial IgA, and anti-reticulin IgA). Non-celiac gluten sensitivity doesn't trigger this same response.
Those with celiac disease also experience physical damage to structures in the small intestine called villi. When these structures are damaged, it makes it harder for the body to properly absorb vitamins and minerals, which can lead to deficiencies over time. In those with non-celiac gluten sensitivity, the small intestine is usually normal.
Functional medicine expert William Cole, D.C., IFMCP, further explains that there's a gluten intolerance spectrum. Non-celiac gluten sensitivity, which is the mildest form, lies on one end of the spectrum, while celiac disease sits on the other end. According to Cole, celiac disease is the most severe form of gluten intolerance and it develops when gluten has caused so much damage to your gut that your immune system has gotten involved.
How is it different from a wheat allergy?
The term "wheat allergy" gets thrown around a lot with gluten intolerance and celiac disease, but a true wheat allergy is in its own camp entirely. If you're allergic to wheat, eating the grain sets off an immune reaction that involves Immunoglobulin E (or IgE) antibodies.
These antibodies trigger the release of a chemical compound called histamine, which can cause anything from mild symptoms like sneezing and itchy eyes to a serious life-threatening reaction called anaphylaxis. Some people with a wheat allergy also experience abdominal symptoms like bloating, gas, and diarrhea.
Someone with a wheat allergy has to avoid it, but they may be able to eat other gluten-containing grains like rye and barley, assuming they don't also have an underlying gluten intolerance.
How do you test for a gluten sensitivity?
Because non-celiac gluten sensitivity doesn't involve the same immune reaction as celiac disease, it can be difficult to diagnose. Unlike with celiac disease, there isn't a specific test that gives you a definitive "yes" or "no" answer to whether or not you have it.
Instead, the best test is listening to your body, says Wendie Trubow, M.D., MBA, a functional medicine doctor. "Do you feel amazing after eating and free of chronic health complaints? Then you don't need to obsess over gluten," she says. "Are you fatigued, headachy, and suffering from weight-loss resistance? You might want to try eliminating it—which is the only way to really know if it's a problem for you." You may want to consider keeping a food journal, to help track how you feel on a daily basis.
While none are conclusive, there are a few functional lab tests that may point to signs of gluten sensitivity. Consider asking your doctor about these if you're interested.
What's the treatment?
Four targeted strains to beat bloating and help reduce abdominal fat.*
Right now, the only immediate "treatment" for gluten sensitivity is eliminating gluten from the diet. This means complete avoidance of anything made with wheat, barley, or rye—or any products with hidden sources of gluten. This gluten-free food list provides a comprehensive rundown of foods to stick with or avoid.
It may help to support your gut health, too. This involves a combination of gut-restoring foods like bone broth and sauerkraut, probiotic supplements, and giving your digestive system a rest through things like intermittent fasting.*
Be sure to speak to your medical practitioner before making any major changes to your diet.
Non-celiac gluten sensitivity is real, and it affects up to 6% of the U.S. population. While it's not as severe as celiac disease, non-celiac gluten sensitivity can cause a wide range of similar symptoms, like gas, bloating, skin rashes, and anxiety. To help treat the condition, stick to a gluten-free diet and other gut-healing diet lifestyle changes.