You eat a sandwich, pizza, pita or pasta — and about an hour later start to feel tired, develop a headache or notice bloating. You go to the doctor, take a blood test for celiac disease and the results come back negative. So why does your body keep signaling that something is wrong? The answer may be a condition increasingly recognized in recent years: non-celiac gluten sensitivity (NCGS).
People with NCGS experience symptoms similar to those of celiac disease, which improve once gluten is removed from their diet. However, they test negative for both celiac disease and a wheat allergy. Symptoms can include bloating, abdominal pain, diarrhea, constipation, fatigue and headaches. Cutting gluten out of the diet usually resolves them.
In the past, experts believed people with NCGS only had symptoms without intestinal damage. But some studies suggest a mild inflammatory response may occur in the gut, though the exact cause remains unknown. What is clear is that it is not an autoimmune disease like celiac, nor is it an allergy. Doctors currently classify it as a “sensitivity,” meaning the body reacts negatively to gluten even when standard tests show no evidence of disease.
What’s the difference between celiac disease, wheat allergy and non-celiac gluten sensitivity?
Celiac disease is a chronic autoimmune condition in which the immune system attacks the small intestine, causing lasting damage. People with celiac must avoid gluten completely and for life.
Wheat allergy, by contrast, is an immediate immune reaction to wheat proteins. Allergies — including wheat allergy — can be identified through IgE blood tests or skin-prick testing.
Non-celiac gluten sensitivity shares many symptoms with both celiac disease and wheat allergy, and in some cases may trigger mild inflammation in the gut. Diagnosis is more complex and usually involves ruling out celiac disease and wheat allergy, then observing improvement on a gluten-free diet.
Common symptoms of non-celiac gluten sensitivity
NCGS can cause a wide range of physical and emotional symptoms after eating gluten, including:
- Digestive issues: bloating, abdominal pain, diarrhea or constipation
- Non-digestive symptoms: fatigue, headaches or migraines, “brain fog,” joint pain, skin problems such as rashes or itching, and even low mood or depression
How is non-celiac gluten sensitivity diagnosed and treated?
Diagnosis typically involves ruling out celiac disease and wheat allergy. If all tests are negative but symptoms clearly improve with a gluten-free diet, NCGS is considered the likely cause.
The main way to manage the condition is through a gluten-free diet. Gluten is a protein found in wheat, spelt, barley, rye and foods made from them. That means avoiding bread, pizza, pasta, cakes, cookies and other baked goods — as well as many processed foods containing “hidden gluten,” such as soy sauce, beer, pre-made sauces, flavorings and malt-based ingredients. Reading ingredient labels is essential.
Doctors stress that dietary changes should be made with professional guidance to ensure the diet remains balanced and includes all necessary nutrients.
Though no blood test for NCGS currently exists, the condition is considered relatively common. If you repeatedly experience symptoms after eating gluten, experts recommend seeking medical advice and, with professional support, testing whether reducing or eliminating gluten can improve your short-term well-being and long-term quality of life.