Table of ContentsView AllTable of ContentsCommon CausesGeneticsLifestyle Risk FactorsFrequently Asked QuestionsNext in Gluten Sensitivity GuideIs There a Gluten Intolerance Test?
Table of ContentsView All
View All
Table of Contents
Common Causes
Genetics
Lifestyle Risk Factors
Frequently Asked Questions
Next in Gluten Sensitivity Guide
Gluten sensitivity may affect about 6% to 7% of the population, according to Allessio Fasano, MD of the University of Maryland and the Salerno Experts' Panel that helped define non-celiac gluten sensitivity.
Verywell / Alex Dos Diaz
Is Gluten Bad for You?
As of yet, there is no explanation for why non-celiac gluten sensitivity occurs and how it might be related to celiac disease. It is possible that gluten sensitivity and celiac disease represent different aspects of the same condition, but they may be completely different.
Some researchers theorize that the problem in those told they have gluten sensitivity may not be gluten at all. Instead, it may be some other compound found in wheat (and possibly in barley and rye, which are closely related to the grain).
Researchers have identified other compounds in wheat, specifically, that they say could be responsible: fructans and amylase trypsin inhibitors.
What’s more, the results of one study suggest that gluten sensitivity symptoms occur because microbes and food proteins are crossing the intestinal barrier into the bloodstream, causing widespreadinflammation.
Here’s what the research shows on all of the three grain components and how they might be related to non-celiac gluten sensitivity.
Gluten
Gluten is the grain component that tends to get focused on the most. It is a protein that grain plants use to store nutrients for the next generation of plants. Found in the seeds of grain plants, it’s the part of the plant we think of, and use, as food.
The initial research on non-celiac gluten sensitivity fingered gluten as the problem in the newly described condition. That study said gluten made some people’s intestines leaky and inflamed without causing celiac disease. The researchers concluded these people were reacting to gluten in the foods they ate.
However, since that initial study, there have been several more studies that used pure wheat gluten to try and induce symptoms in people who believed they were gluten-sensitive. These studies have had mixed results.
One study published in the journalGastroenterology, for example, removed all gluten grain-based foods from 37 subjects' diets and then fed them with pure wheat gluten. (The subjects didn’t know when they were eating gluten and when they were eating aplacebo.) The people in the study didn’t experience digestive symptoms while eating the pure gluten, but some of them did getdepression.
Another study used the same technique to “challenge” people who said they were gluten-sensitive with gluten and found that some of them did react to pure gluten. In that study, 101 people said their digestive symptoms improved when following a gluten-free diet, and 14% of them got worse when they unknowingly ingested gluten as part of the study.
Some people who say they’re sensitive to gluten grains do seem to be reacting to gluten, but many others don’t react when fed pure gluten unknowingly. More research on this is needed.
FODMAPs
The aforementionedGastroenterologystudy noted that the problem with wheat is its fructans—complex carbohydrates that ferment in your large intestine, potentially causing gas, bloating, cramping, pain, diarrhea, and constipation.
When the study found that its participants did not see their intestinal symptoms worsen with pure gluten, the researchers implicated FODMAPS (fermentable oligo-, di-, mono-saccharides and polyols). These are found in wheat, as well as foods such as garlic and onions.
FODMAPs seem to cause digestive symptoms in many people with irritable bowel syndrome, and a low-FODMAP diet is proven to reduce symptoms in nearly three-quarters of those with IBS. But it’s far from clear whether the problem in gluten sensitivity is really the FODMAPs, and whether the solution is a low-FODMAP diet, rather than a gluten-free diet. Again, more research is needed.
Avoiding High-FODMAP Foot Types
Amylase Trypsin Inhibitors
Modern wheat has been bred to have lots more of these proteins. The problem is, amylase trypsin inhibitors in wheat (and possibly other gluten grains) seem to cause inflammation in some people, both in their intestines and elsewhere in their bodies.
Amylase trypsin inhibitors may contribute to or even cause what people call non-celiac gluten sensitivity. However, right now, they’re the least studied of these three possible causes.
While there are genetic combinations that raise the risk of celiac disease, these don’t seem to have much influence on developing non-celiac gluten sensitivity. There needs to be more research in this area.
Gluten Sensitivity and Genetics
Currently, the diagnosis of non-celiac gluten sensitivity rests on symptoms improving when you are on a strict gluten-free diet (after excluding celiac disease and other causes) and returning if you consume gluten.
It is challenging to maintain a gluten-free diet, especially avoiding cross-contamination. It takes commitment and constant vigilance. Consulting with a dietitian can help you learn what you can eat, what you must avoid, and how to prevent being exposed to gluten.
An Overview of the Gluten-Free Diet
A Word From Verywell
It’s nowhere near clear right now what might cause non-celiac gluten sensitivity. It could wind up being how your body reacts to gluten, FODMAPs, amylase trypsin inhibitors, some combination of the three, or something else entirely. If gluten isn’t to blame, but something else in gluten grains is, then people who have the condition might need to follow a diet free ofallcomponents of wheat, barley, and rye—not just gluten.
Frequently Asked QuestionsSymptomsof non-celiac gluten sensitivity are often similar to celiac disease. They include:Bloating and gasAbdominal painDiarrheaBalance problemsFatigueBrain fogIt can vary from person to person. If you have gluten sensitivity, you might start having symptoms soon after or not until the next day. In a study of 486 patients, the time between eating gluten and noticing symptoms ranged from a few hours to one day. More than half of patients noticed symptoms within six hours.
Symptomsof non-celiac gluten sensitivity are often similar to celiac disease. They include:Bloating and gasAbdominal painDiarrheaBalance problemsFatigueBrain fog
Symptomsof non-celiac gluten sensitivity are often similar to celiac disease. They include:
It can vary from person to person. If you have gluten sensitivity, you might start having symptoms soon after or not until the next day. In a study of 486 patients, the time between eating gluten and noticing symptoms ranged from a few hours to one day. More than half of patients noticed symptoms within six hours.
Is There a Gluten Intolerance Test?
9 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Barbaro MR, Cremon C, Stanghellini V, Barbara G.Recent advances in understanding non-celiac gluten sensitivity.F1000Res. 2018;7(F1000 Faculty Rev):1631. doi:10.12688/f1000research.15849.1Celiac Disease Foundation.Dr. Alessio Fasano Speaks Out About Celebrity Gluten-Bashing, Celiac Disease Research.Junker Y, Zeissig S, Kim SJ, et al.Wheat Amylase Trypsin Inhibitors Drive Intestinal Inflammation via Activation of Toll-Like Receptor 4.The Journal of Experimental Medicine. 2012;209(13):2395-408. doi:10.1084/jem.20102660Uhde M, Ajamian M, Caio G, et al.Intestinal cell damage and systemic immune activation in individuals reporting sensitivity to wheat in the absence of coeliac disease.Gut. 2016;65:1930–1937. doi:10.1136/gutjnl-2016-311964Sapone A, Lammers KM, Casolaro V, et al.Divergence of Gut Permeability and Mucosal Immune Gene Expression in Two Gluten-Associated Conditions: Celiac Disease and Gluten Sensitivity.BMC Medicine. 2011;9:23. doi:10.1186/1741-7015-9-23Biesiekierski JR, Peters SL, Newnham ED, Rosella O, Muir JG, Gibson PR.No Effects of Gluten in Patients With Self-Reported Non-Celiac Gluten Sensitivity After Dietary Reduction of Fermentable, Poorly Absorbed, Short-Chain Carbohydrates.Gastroenterology. 2013;145(2):320-8.e1-3. doi:10.1053/j.gastro.2013.04.051Elli L, Tomba C, Branchi F, et al.Evidence for the Presence of Non-Celiac Gluten Sensitivity in Patients with Functional Gastrointestinal Symptoms: Results from a Multicenter Randomized Double-Blind Placebo-Controlled Gluten Challenge.Nutrients. 2016;8(2):84. doi:10.3390/nu8020084Harvard Hwalth Publishing.Non-celiac gluten sensitivity.Volta U, Bardella M, Calabrò A, Troncone R, Corazza G.An Italian prospective multicenter survey on patients suspected of having non-celiac gluten sensitivity.BMC Med. 2014;12(1). doi:10.1186/1741-7015-12-85Additional ReadingBiesiekierski J, et al.Gluten Causes Gastrointestinal Symptoms in Subjects Without Celiac Disease: A Double-Blind Randomized Placebo-Controlled Trial. American Journal of Gastroenterology. Published online Jan. 11, 2011. doi:10.1038/ajg.2010.487Biesiekierski J et al.Non-Coeliac Gluten Sensitivity: Piecing the Puzzle Together.United European Gastroenterology Journal. 2015 Apr;3(2):160-5. doi:10.1177/2050640615578388Fasano A. et. al.Spectrum of Gluten-Related Disorders: Consensus on New Nomenclature and Classification. BMC Medicine. BMC Medicine 2012, 10:13 doi:10.1186/1741-7015-10-13. Published: 7 February 2012. doi:10.1186/1741-7015-10-13Schuppan D et al.Wheat Amylase Trypsin Inhibitors as Nutritional Activators of Innate Immunity.Digestive Diseases (Basel, Switzerland). 2015;33(2):260-3. doi:10.1159/000371476
9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Barbaro MR, Cremon C, Stanghellini V, Barbara G.Recent advances in understanding non-celiac gluten sensitivity.F1000Res. 2018;7(F1000 Faculty Rev):1631. doi:10.12688/f1000research.15849.1Celiac Disease Foundation.Dr. Alessio Fasano Speaks Out About Celebrity Gluten-Bashing, Celiac Disease Research.Junker Y, Zeissig S, Kim SJ, et al.Wheat Amylase Trypsin Inhibitors Drive Intestinal Inflammation via Activation of Toll-Like Receptor 4.The Journal of Experimental Medicine. 2012;209(13):2395-408. doi:10.1084/jem.20102660Uhde M, Ajamian M, Caio G, et al.Intestinal cell damage and systemic immune activation in individuals reporting sensitivity to wheat in the absence of coeliac disease.Gut. 2016;65:1930–1937. doi:10.1136/gutjnl-2016-311964Sapone A, Lammers KM, Casolaro V, et al.Divergence of Gut Permeability and Mucosal Immune Gene Expression in Two Gluten-Associated Conditions: Celiac Disease and Gluten Sensitivity.BMC Medicine. 2011;9:23. doi:10.1186/1741-7015-9-23Biesiekierski JR, Peters SL, Newnham ED, Rosella O, Muir JG, Gibson PR.No Effects of Gluten in Patients With Self-Reported Non-Celiac Gluten Sensitivity After Dietary Reduction of Fermentable, Poorly Absorbed, Short-Chain Carbohydrates.Gastroenterology. 2013;145(2):320-8.e1-3. doi:10.1053/j.gastro.2013.04.051Elli L, Tomba C, Branchi F, et al.Evidence for the Presence of Non-Celiac Gluten Sensitivity in Patients with Functional Gastrointestinal Symptoms: Results from a Multicenter Randomized Double-Blind Placebo-Controlled Gluten Challenge.Nutrients. 2016;8(2):84. doi:10.3390/nu8020084Harvard Hwalth Publishing.Non-celiac gluten sensitivity.Volta U, Bardella M, Calabrò A, Troncone R, Corazza G.An Italian prospective multicenter survey on patients suspected of having non-celiac gluten sensitivity.BMC Med. 2014;12(1). doi:10.1186/1741-7015-12-85Additional ReadingBiesiekierski J, et al.Gluten Causes Gastrointestinal Symptoms in Subjects Without Celiac Disease: A Double-Blind Randomized Placebo-Controlled Trial. American Journal of Gastroenterology. Published online Jan. 11, 2011. doi:10.1038/ajg.2010.487Biesiekierski J et al.Non-Coeliac Gluten Sensitivity: Piecing the Puzzle Together.United European Gastroenterology Journal. 2015 Apr;3(2):160-5. doi:10.1177/2050640615578388Fasano A. et. al.Spectrum of Gluten-Related Disorders: Consensus on New Nomenclature and Classification. BMC Medicine. BMC Medicine 2012, 10:13 doi:10.1186/1741-7015-10-13. Published: 7 February 2012. doi:10.1186/1741-7015-10-13Schuppan D et al.Wheat Amylase Trypsin Inhibitors as Nutritional Activators of Innate Immunity.Digestive Diseases (Basel, Switzerland). 2015;33(2):260-3. doi:10.1159/000371476
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Barbaro MR, Cremon C, Stanghellini V, Barbara G.Recent advances in understanding non-celiac gluten sensitivity.F1000Res. 2018;7(F1000 Faculty Rev):1631. doi:10.12688/f1000research.15849.1Celiac Disease Foundation.Dr. Alessio Fasano Speaks Out About Celebrity Gluten-Bashing, Celiac Disease Research.Junker Y, Zeissig S, Kim SJ, et al.Wheat Amylase Trypsin Inhibitors Drive Intestinal Inflammation via Activation of Toll-Like Receptor 4.The Journal of Experimental Medicine. 2012;209(13):2395-408. doi:10.1084/jem.20102660Uhde M, Ajamian M, Caio G, et al.Intestinal cell damage and systemic immune activation in individuals reporting sensitivity to wheat in the absence of coeliac disease.Gut. 2016;65:1930–1937. doi:10.1136/gutjnl-2016-311964Sapone A, Lammers KM, Casolaro V, et al.Divergence of Gut Permeability and Mucosal Immune Gene Expression in Two Gluten-Associated Conditions: Celiac Disease and Gluten Sensitivity.BMC Medicine. 2011;9:23. doi:10.1186/1741-7015-9-23Biesiekierski JR, Peters SL, Newnham ED, Rosella O, Muir JG, Gibson PR.No Effects of Gluten in Patients With Self-Reported Non-Celiac Gluten Sensitivity After Dietary Reduction of Fermentable, Poorly Absorbed, Short-Chain Carbohydrates.Gastroenterology. 2013;145(2):320-8.e1-3. doi:10.1053/j.gastro.2013.04.051Elli L, Tomba C, Branchi F, et al.Evidence for the Presence of Non-Celiac Gluten Sensitivity in Patients with Functional Gastrointestinal Symptoms: Results from a Multicenter Randomized Double-Blind Placebo-Controlled Gluten Challenge.Nutrients. 2016;8(2):84. doi:10.3390/nu8020084Harvard Hwalth Publishing.Non-celiac gluten sensitivity.Volta U, Bardella M, Calabrò A, Troncone R, Corazza G.An Italian prospective multicenter survey on patients suspected of having non-celiac gluten sensitivity.BMC Med. 2014;12(1). doi:10.1186/1741-7015-12-85
Barbaro MR, Cremon C, Stanghellini V, Barbara G.Recent advances in understanding non-celiac gluten sensitivity.F1000Res. 2018;7(F1000 Faculty Rev):1631. doi:10.12688/f1000research.15849.1
Celiac Disease Foundation.Dr. Alessio Fasano Speaks Out About Celebrity Gluten-Bashing, Celiac Disease Research.
Junker Y, Zeissig S, Kim SJ, et al.Wheat Amylase Trypsin Inhibitors Drive Intestinal Inflammation via Activation of Toll-Like Receptor 4.The Journal of Experimental Medicine. 2012;209(13):2395-408. doi:10.1084/jem.20102660
Uhde M, Ajamian M, Caio G, et al.Intestinal cell damage and systemic immune activation in individuals reporting sensitivity to wheat in the absence of coeliac disease.Gut. 2016;65:1930–1937. doi:10.1136/gutjnl-2016-311964
Sapone A, Lammers KM, Casolaro V, et al.Divergence of Gut Permeability and Mucosal Immune Gene Expression in Two Gluten-Associated Conditions: Celiac Disease and Gluten Sensitivity.BMC Medicine. 2011;9:23. doi:10.1186/1741-7015-9-23
Biesiekierski JR, Peters SL, Newnham ED, Rosella O, Muir JG, Gibson PR.No Effects of Gluten in Patients With Self-Reported Non-Celiac Gluten Sensitivity After Dietary Reduction of Fermentable, Poorly Absorbed, Short-Chain Carbohydrates.Gastroenterology. 2013;145(2):320-8.e1-3. doi:10.1053/j.gastro.2013.04.051
Elli L, Tomba C, Branchi F, et al.Evidence for the Presence of Non-Celiac Gluten Sensitivity in Patients with Functional Gastrointestinal Symptoms: Results from a Multicenter Randomized Double-Blind Placebo-Controlled Gluten Challenge.Nutrients. 2016;8(2):84. doi:10.3390/nu8020084
Harvard Hwalth Publishing.Non-celiac gluten sensitivity.
Volta U, Bardella M, Calabrò A, Troncone R, Corazza G.An Italian prospective multicenter survey on patients suspected of having non-celiac gluten sensitivity.BMC Med. 2014;12(1). doi:10.1186/1741-7015-12-85
Biesiekierski J, et al.Gluten Causes Gastrointestinal Symptoms in Subjects Without Celiac Disease: A Double-Blind Randomized Placebo-Controlled Trial. American Journal of Gastroenterology. Published online Jan. 11, 2011. doi:10.1038/ajg.2010.487Biesiekierski J et al.Non-Coeliac Gluten Sensitivity: Piecing the Puzzle Together.United European Gastroenterology Journal. 2015 Apr;3(2):160-5. doi:10.1177/2050640615578388Fasano A. et. al.Spectrum of Gluten-Related Disorders: Consensus on New Nomenclature and Classification. BMC Medicine. BMC Medicine 2012, 10:13 doi:10.1186/1741-7015-10-13. Published: 7 February 2012. doi:10.1186/1741-7015-10-13Schuppan D et al.Wheat Amylase Trypsin Inhibitors as Nutritional Activators of Innate Immunity.Digestive Diseases (Basel, Switzerland). 2015;33(2):260-3. doi:10.1159/000371476
Biesiekierski J, et al.Gluten Causes Gastrointestinal Symptoms in Subjects Without Celiac Disease: A Double-Blind Randomized Placebo-Controlled Trial. American Journal of Gastroenterology. Published online Jan. 11, 2011. doi:10.1038/ajg.2010.487
Biesiekierski J et al.Non-Coeliac Gluten Sensitivity: Piecing the Puzzle Together.United European Gastroenterology Journal. 2015 Apr;3(2):160-5. doi:10.1177/2050640615578388
Fasano A. et. al.Spectrum of Gluten-Related Disorders: Consensus on New Nomenclature and Classification. BMC Medicine. BMC Medicine 2012, 10:13 doi:10.1186/1741-7015-10-13. Published: 7 February 2012. doi:10.1186/1741-7015-10-13
Schuppan D et al.Wheat Amylase Trypsin Inhibitors as Nutritional Activators of Innate Immunity.Digestive Diseases (Basel, Switzerland). 2015;33(2):260-3. doi:10.1159/000371476
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