Gluten Sensitivity Without Celiac: Is It the Gluten or the Wheat?
Bloating & DigestionArticleMany people feel better off wheat without having celiac disease. In blinded trials, where people didn't know what they were eating, gluten often caused no more symptoms than a placebo. In a 2018 trial of 59 people, fructans, a carbohydrate in wheat, caused the most bloating. Across 10 trials, only 16% showed symptoms specific to gluten. Here is what that means and the order to test things in.
Plenty of people without celiac disease feel better off bread and pasta. The question researchers asked is which part of the wheat is responsible.
The trials, in order
All of these were blinded: people didn’t know whether their food contained gluten.
| Trial | Who | What they found |
|---|---|---|
| 2011 | 34 people with IBS, no celiac, doing well gluten-free1 | Symptoms not controlled in 68% on gluten vs 40% on placebo; gluten intolerance “may exist”1 |
| 2013 | 37 people who believed they were gluten-sensitive2 | Symptoms improved on a low-FODMAP diet, then worsened about equally with gluten or a whey-protein placebo; gluten-specific effects in only 8%2 |
| 2018, Oslo | 59 people on a self-started gluten-free diet3 | Hidden fructans caused the highest symptom and bloating scores; gluten scored no differently from placebo3 |
What are fructans?
Fructans are a carbohydrate found in wheat, and they’re one of the FODMAPs, the fermentable carbohydrates that can trigger gut symptoms.3 Cutting gluten also cuts wheat, so a gluten-free diet removes fructans too, which may explain why people feel better.
The bigger picture
A 2017 review of 10 blinded trials with 1,312 adults found that only 16% of people with suspected gluten sensitivity had symptoms specific to gluten.4 And 40% of those also reacted to the placebo.4
That’s the nocebo effect: expecting a food to cause trouble can bring on genuine symptoms by itself. The trials also varied a lot, and some placebos contained fermentable carbohydrates of their own.4 In the Oslo trial, 22 of the 59 people felt worst during the placebo week.3
So a small share of people may react to gluten itself, but for many, the trigger looks more like fructans or expectation.
The order to test things in
- Celiac test first, while you’re still eating gluten. See could I have celiac disease? and going gluten-free before testing.
- If celiac is ruled out, a structured low-FODMAP diet with reintroduction, ideally with a dietitian, can separate fructans from other triggers.
- Test a suspect food more than once, on a calm week, before you cut it for good.
Try: “My celiac test was negative, but I feel bloated after bread. Could it be fructans rather than gluten, and could a dietitian help me test that?”
Bloated by Dinner covers this in Chapter 9, “The Food Detective,” in a section called “The Gluten Whodunit.” Its Belly Clock logs symptoms against each meal, so a food can be tested and retested before it’s crossed off. See the book.
This article is for general educational purposes only and is not medical advice. It isn't a substitute for diagnosis or treatment from a qualified healthcare professional who knows your health history. Get tested for celiac disease before cutting out gluten, because the test needs gluten in your diet to be accurate. See a clinician for weight loss, anemia, bleeding from the bottom, ongoing diarrhea, or symptoms that wake you at night. Girl Playbook does not endorse any specific product, test, or provider.
Girl Playbook sells this book. It provides education and worksheets, not individualized medical care.
Sources
The research behind this article, in the order it’s cited. How we source our articles.
- American Journal of Gastroenterology (abstract via PubMed), 2011Gluten causes gastrointestinal symptoms in subjects without celiac disease: a double-blind randomized placebo-controlled trial (opens in a new tab)ab
- Gastroenterology, 2013 trial (abstract via PubMed), 2013No effects of gluten in patients with self-reported non-celiac gluten sensitivity after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates (opens in a new tab)ab
- Gastroenterology, 2018 trial (abstract via PubMed), 2018Fructan, rather than gluten, induces symptoms in patients with self-reported non-celiac gluten sensitivity (opens in a new tab)abcd
- Clinical Gastroenterology and Hepatology (abstract via PubMed), 2017Suspected Nonceliac Gluten Sensitivity Confirmed in Few Patients After Gluten Challenge in Double-Blind, Placebo-Controlled Trials (opens in a new tab)abc
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