Gluten sensitivity affects over one in ten people globally, and most people who think they have the condition could actually be wrong, a landmark new study suggests.
The review research, published in The Lancet, better distinguishes coeliac disease, an autoimmune disease triggered by gluten, from the more common non-coeliac gluten sensitivity (NCGS).
These findings could overturn long-held assumptions many people may have about their gluten sensitivity and could set a new benchmark for how the condition is defined, diagnosed and treated, say researchers from the University of Melbourne.
“Millions of people around the world avoid gluten believing it harms their gut, often after experiencing real symptoms that range from mild discomfort to severe distress,” said Jessica Biesiekierski, an author of the study.
“Improving our scientific and clinical understanding of a condition affecting up to 15 per cent of the global population is incredibly important,” Dr Biesiekierski said.
Gluten-free products are pictured in an hypermarket store (AFP via Getty Images)
In the study, scientists examined current evidence of NCGS, whose symptoms include bloating, gut pain and fatigue.
“Contrary to popular belief, most people with NCGS aren’t reacting to gluten,” Dr Biesiekierski said.
Instead, scientists say the sensitivity arises mainly due to the way the gut and brain interact.
“Our findings show that symptoms are more often triggered by fermentable carbohydrates, commonly known as Fodmaps, by other wheat components or by people’s expectations and prior experiences with food,” Dr Biesiekierski said.
Only a few of the cases reported in clinical trials reviewed in the study showed signs of any real gluten reaction, researchers say.
Most people’s responses appeared no different from when they were given a placebo, the review found.
“Across recent studies, people with irritable bowel syndrome (IBS) who believe they’re gluten-sensitive react similarly to gluten, wheat, and placebo,” Dr Biesiekierski said.
“This suggests that how people anticipate and interpret gut sensations can strongly influence their symptoms,” she explained.
The findings, according to researchers, suggest NCGS could be part of the gut–brain interaction spectrum, closer to conditions like IBS, rather than a distinct disorder triggered by gluten.
This new way of looking at NCGS could have implications for people self-managing their gut symptoms, as well as for clinicians prescribing restrictive diets, and policymakers shaping public health messaging.
“Distinguishing NCGS from related gut conditions is essential for clinicians to offer accurate diagnosis and individualised care, as well as treating underlying drivers,” said Jason Tye-Din, gastroenterologist at the Royal Melbourne Hospital.
“This review supports a more personalised, evidence-based approach to gut health and avoids unnecessary dietary restriction,” said Dr Tye-Din, who was not involved in the research.