Gluten Sensitivity

As celiac disease diagnoses increased in the early 21st century, in part due to improved serological testing, gluten-free foods appeared on store shelves to meet the needs of people with this dietary restriction. 

But with greater availability of these products and growing awareness of the gluten-free diet, gluten sensitivity has become a popular self-diagnosis, People who felt poorly after eating foods containing gluten (a protein found in wheat, barley and rye) adopted restrictive gluten-free diets.

Non-celiac gluten sensitivity is an umbrella term used to describe people with gastrointestinal (GI) or non-GI symptoms that improve when they avoid gluten and reoccur when they reintroduce it into the diet, despite not having a formal diagnosis of celiac disease.

Unlike celiac disease, an autoimmune disorder with measurable biomarkers, it’s unclear what causes non-celiac gluten sensitivity. Because there are no specific blood markers associated with the condition, it’s only diagnosed by ruling out other causes in people who report adverse symptoms after eating gluten. And often, it’s a self-diagnosis.

A previous survey of people aged 16 years or older at a single site in the UK, for example, found that self-reported gluten sensitivity increased more than 2-fold—from 13% to 33%—between 2012 and 2015, even as rates of celiac disease remained fairly constant. 

A more recent meta-analysis examined data from 25 studies published between 2014 and 2024, including nearly 50 000 people from across 16 countries in the Americas, the Eastern Mediterranean, Europe, Southeast Asia, and the Western Pacific.

• Overall, about 10% of study participants had self-reported non-celiac gluten or wheat sensitivity. Approximately 40% of these participants indicated that they adhered to a gluten-free diet.
• Prevalence varied widely in countries, ranging from less than 1% in Chile to 23% in the UK to 36% in Saudi Arabia. In the US, prevalence was 5%. The researchers said this may reflect a variety of factors, including different study designs, cultural attitudes, and availability and marketing of gluten-free products. High-income countries had a much higher prevalence of gluten or wheat sensitivity than middle- and low-income countries, Shiha noted.
• The most common GI symptom among people with a self-diagnosed gluten or wheat sensitivity was bloating, followed by abdominal discomfort and abdominal pain. Fatigue was the most frequently reported non-GI symptom. Participants also reported constipation, diarrhea, headache, nausea, rash, and joint pain.
• Self-reported non-celiac gluten or wheat sensitivity was about 2 times more common in females than in males (14% vs about 8%, respectively). It was also strongly associated with anxiety, depression, and irritable bowel syndrome (IBS).

Some people who believe they’re sensitive to gluten may actually be reacting to fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs). This is a group of carbohydrates that are poorly absorbed in the small intestine and are rapidly fermented in the colon. They increase water volume in the small intestine and gas in the colon, causing abdominal pain, bloating, excess gas, and diarrhea. Foods high in FODMAPs include wheat, onions, garlic, legumes, mushrooms, cauliflower, and dairy products.

References

Anderer S, Gluten Sensitivity is Common Around the World - Explanations are Emerging, JAMA, Dec 16, 2025, 334 (23):2058-2059

Croall ID, et al, A population survey of dietary attitudes towards gluten, Nutrients, 2019;11(6):1276.

Shiha MG, et al. Global prevalence of self-reported non-coeliac gluten and wheat sensitivty: a systematic review and meta-analysis, Gut, Gut 2026;75(3):502-510.