Gluten sensitivity or non-celiac gluten sensitivity (NCGS) is a condition where intestinal and extraintestinal symptoms are triggered by gluten ingestion in the absence of celiac disease or wheat allergy. The overall prevalence of NCGS in the general population is still unknown, mainly because many people self-diagnose and begin a gluten-free diet without medical consultation.
Gluten can be found in foods that contain wheat (all varieties and derivatives), rye, barley, triticale, malt, and brewer’s yeast. In addition to food and beverages, gluten can be found in some lipsticks or lip balms, vitamins, herbal and nutritional supplements, drugs and over-the-counter medications, and wheat-based play dough.
Gluten Sensitivity Symptoms
Non-celiac gluten sensitivity is characterized by symptoms that usually occur soon after gluten ingestion, disappear with gluten withdrawal, and relapse following a reintroduction of gluten to the system—all within several hours or a few days.
Most Common Symptoms of Gluten Sensitivity
- Abdominal pain
- Bowel habit abnormalities (diarrhea or constipation)
- Foggy brain
- Joint and muscle pain
- Leg or arm numbness
- Eczema or skin rash
- Unexplained weight loss
- Avoiding Exposure to Gluten
The best way to treat or manage a sensitivity to gluten is to follow a gluten-free diet. The level of avoidance is based on each individual’s ability to tolerate gluten. Some people may be able to manage symptoms simply with a reduction of gluten, while others need to eliminate it altogether. The following list of foods are some of the more popular items that contain gluten:
- Bread, pasta, cakes, cookies, and muffins
- Breakfast cereals
- Cracker meal
- Farina, semolina and spelt
- Hydrolyzed vegetable protein
- Sprouted wheat
- Wheat (bran, durum, germ, gluten, malt, sprouts, starch), wheat bran hydrolysate, wheat germ oil, wheat protein isolate
- Batter-fried foods
- Snack foods such as potato chips, rice cakes, and crackers
- Salad dressings, soups, ketchup, soy sauce, and marinara sauce
- Processed meats and imitation crab meat
- Ice cream and candy
- Vegetable gum
Diagnosing Gluten Sensitivity
At this time, there are no specific medical tests that can be performed to confirm gluten sensitivity. However, in order to confirm a person may have a sensitivity to gluten, doctors must first rule out wheat allergy and celiac disease. Once other medical conditions have been ruled out, the next step is to do an elimination diet to find out if the symptoms decrease and health improves with the elimination or reduction of gluten from the diet.
Gluten sensitivity is often used interchangeably with wheat allergy, but they are not the same thing. It’s important to note that gluten sensitivity does not necessarily indicate a wheat allergy, as a person with a wheat allergy can still tolerate gluten from non-wheat sources. Similarly, wheat allergy is commonly confused with celiac disease, which causes an abnormal immune response to gluten, one of the proteins found in wheat. With such overlap among these conditions, it can be very difficult to diagnose gluten sensitivity. An overlap between irritable bowel syndrome (IBS) and gluten sensitivity has also been suspected, requiring even more stringent diagnostic criteria.
People who believe they have non-celiac gluten sensitivity are likely to benefit from lowering their dietary intake of FODMAPs, a type of carbohydrate or sugar alcohols that can be found in foods naturally or as an additive. They may be poorly absorbed by the small intestine, leading to some of these symptoms. FODMAPs are found in a variety of food including lactose, excess fructose, fructans and fructo-oligosaccharides, galacto-oligosaccharides, and sugar polyols. Wheat and rye derived products often contain the highest FODMAP content.
Regulations Related to Gluten Sensitivity
The U.S. Food and Drug Administration (FDA) has defined the term “gluten-free” for voluntary use in the labeling of foods. In order for foods to be labeled “gluten-free” it must be inherently gluten-free or must not contain an ingredient that is:
- A gluten-containing grain;
- Derived from a gluten-containing grain that has not been processed to remove gluten; or
- Derived from a gluten-containing grain that has been processed to remove gluten.
This labeling rule applies to all FDA-regulated packaged foods, including dietary supplements. The rule excludes those foods with labeling regulated by the U.S. Department of Agriculture and the Alcohol and Tobacco Tax and Trade Bureau.
If a person sensitive to gluten eats a product labeled gluten-free and becomes ill or otherwise experiences adverse health effects, they can report this to the FDA’s Center for Food Safety and Applied Nutrition’s Adverse Event Reporting System or contact an FDA Consumer Complaint Coordinator for the state where the food was purchased.