Scientists say gluten isn’t the problem after all

Published on October 22 in The Lancet, the comprehensive review analyzed existing studies on non-celiac gluten sensitivity (NCGS). Researchers aimed to clarify why people experience symptoms after eating foods that contain gluten even though they do not have celiac disease. Symptoms such as bloating, abdominal pain, and fatigue are common among those who report gluten sensitivity.

Most Symptoms Aren't Caused by Gluten

Associate Professor Jessica Biesiekierski from the University of Melbourne, who led the study, explained that the results challenge long-held assumptions about the condition.

"Contrary to popular belief, most people with NCGS aren't reacting to gluten," she said. "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."

When researchers compared reactions in carefully controlled studies, they found that only a small number of people showed genuine gluten responses. Overall, reactions were no different from those caused by a placebo.

A New Definition for Gluten Sensitivity

According to Biesiekierski, recent evidence shows that people with irritable bowel syndrome (IBS) who think they are gluten-sensitive often react in similar ways to gluten, wheat, and placebo. "This suggests that how people anticipate and interpret gut sensations can strongly influence their symptoms," she said.

Taken together, the findings indicate that NCGS is part of a broader gut-brain interaction spectrum, more closely related to conditions like IBS than to a gluten disorder.

Implications for Public Health and Treatment

The research team, which included scientists from Australia, The Netherlands, Italy, and the United Kingdom, said the results have important consequences for how gut-related symptoms are managed. They may influence not only medical diagnosis and dietary advice but also future public health messaging.

"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," Biesiekierski said. "Improving our scientific and clinical understanding of a condition affecting up to 15 percent of the global population is incredibly important."

Toward More Accurate Diagnosis and Personalized Care

Associate Professor Jason Tye-Din, Director of the Snow Centre for Immune Health and a gastroenterologist at the Royal Melbourne Hospital, said the updated understanding will help clinicians better identify and treat people with NCGS.

"Distinguishing NCGS from related gut conditions is essential for clinicians to offer accurate diagnosis and individualised care, as well as treating underlying drivers," he said. "This review supports a more personalized, evidence-based approach to gut health and avoids unnecessary dietary restriction."

Rethinking Gluten Messaging

Biesiekierski added that successful management of NCGS should combine dietary changes with psychological support while maintaining proper nutrition.

"We would like to see public health messaging shift away from the narrative that gluten is inherently harmful, as this research shows that this often isn't the case," she said. "These findings additionally call for better diagnostic tools, more rigorous clinical pathways and research funding in this field, as well as improved public education and food labeling."