People who do not have celiac disease and believe they have "non-celiac gluten sensitivity" may be weaning themselves off gluten unnecessarily, researchers from the University of Pavia, Pavia, Italy, reported in Annals of Internal Medicine. The authors added that the majority of people who avoid gluten have "nonceliac gluten sensitivity" - those with celiac disease are a minority among gluten avoiders.

Individuals with celiac disease have a condition in which the lining of the small intestine becomes damaged; undermining their ability to absorb nutrients from food properly. This occurs because of a reaction to gluten, which is found in many cereals, such as rye, barley, wheat, and perhaps oats.

Celiac disease diagnosis occurs after specific bowel and blood tests are carried out.

A number of people who do not have celiac disease can still react to gluten if they eat it and experience gastrointestinal discomfort and fatigue. Experts refer to this condition as "non-celiac gluten sensitivity".

The number of people with non-celiac gluten sensitivity is considerably higher than those with celiac disease.

Gluten sensitivity can trigger the following symptoms if gluten is ingested:
    Intestinal symptoms

  • bloating
  • flatulence
  • abdominal discomfort
  • diarrhea
  • Other symptoms

  • headache
  • ataxia (wobbliness, incoordination, unsteadiness)
  • oral ulceration (recurrent)
  • lethargy
  • attention-deficit disorder
The authors say that some people who think they are food sensitive and do not have celiac disease may be abstaining from gluten unnecessarily. They suggest that non-celiac gluten sensitivity may be a perceived sensitivity, and one caused by the nocebo effect of gluten ingestion or wheat. Nocebo effect is a negative placebo effect, as may occur when somebody takes a medication and experiences unpleasant side-effects which are unrelated to the pharmacological action of the drug. The nocebo effect is linked to the individual's prior expectations of a side effect.

The researchers give examples of patients who strictly abstained from gluten, and believed their gluten-free diets helped reduce their symptoms. However, very few of them had ever undergone a proper diagnosis procedure.

They believe doctors should think about performing open or single-blind gluten challenge tests on those with non-celiac gluten sensitivity - at least until a valid biomarker for non-celiac gluten sensitivity is found.

Written by Christian Nordqvist