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One in ten people consider themselves gluten-sensitive without a diagnosis

Non-coeliac gluten/wheat sensitivity is often self-diagnosed, leading millions of people without coeliac disease to follow gluten-free diets. Discover the key facts.

Around 10% of the world's population claims to suffer from gluten or wheat sensitivity without a clinical diagnosis

Around the world, more and more people are following a gluten-free diet without having been diagnosed with coeliac disease. Many of them experience gastrointestinal and extraintestinal symptoms after consuming gluten-containing foods and find relief by eliminating them from their diet. This change is often based on a self-diagnosis of non-coeliac gluten or wheat sensitivity (NCGWS). Its pathophysiology is not yet clearly defined: there are no specific biomarkers, and differentiating it from functional disorders such as irritable bowel syndrome remains a challenge.

The diagnosis is therefore based on ruling out coeliac disease and wheat allergy, together with a subjective improvement in symptoms on a gluten-free diet. In this context, it is increasingly important to understand NCGWS from a scientific point of view. A recent meta-analysis comprehensively analysed the prevalence of self-reported NCGWS, its clinical characteristics and associated factors. Its aim was to shed light on this complex clinical picture, question the usual therapeutic approach and explore possible links with stress, mental health and the gut-brain axis.

The complexity of non-coeliac gluten sensitivity

Unlike coeliac disease, an autoimmune disease with measurable markers, non-coeliac gluten/wheat sensitivity has no defined cause and no specific diagnostic tests. Its diagnosis is only established by exclusion in people who report symptoms after consuming gluten.

The meta-analysis "Global prevalence of self-reported non-coeliac gluten and wheat sensitivity" reveals that nearly 10% of the world's population claims to suffer from NCGWS, and analyses its causes, prevalence and challenges for clinical practice.

Study methodology

The study by Shiha et al. reviewed 25 studies published between 2014 and 2024, with data from approximately 50,000 people in 16 countries in the Americas, Europe, the Eastern Mediterranean, Southeast Asia and the Western Pacific.

The research analysed:

self-reported gluten or wheat sensitivity
symptoms present
sociodemographic factors
associations with psychological disorders
relationship with functional digestive diseases

The studies included were population surveys with heterogeneous methodologies.

Main results

10% of respondents reported NCGWS.
Of these, 40% followed a gluten-free diet.
High-income countries showed a higher prevalence than middle- or low-income countries.
Twice as many cases were reported in women than in men.
There were significant associations with anxiety, depression, and irritable bowel syndrome.

Most common symptoms:

Gastrointestinal:

Bloating
General discomfort
Nausea
Abdominal pain
Diarrhoea
Constipation

Extraintestinal:

Fatigue
Headaches
Skin rashes
Joint pain

Conclusion

The data show that self-diagnosed gluten/wheat sensitivity is common, but it does not correspond to a homogeneous clinical picture or a clear pathophysiology. Its strong association with females, psychological disorders and irritable bowel syndrome, as well as its marked geographical variability, suggests that factors such as the gut-brain axis may play a key role.

Gluten may not be the primary culprit in all cases; other components such as FODMAPs could explain the symptoms in certain patients.

The authors propose a revision of the concept of NCGWS towards an approach focused on gut-brain axis disorders and standardised diagnostic criteria. For clinical practice, it is recommended that a gluten-free diet not be adopted without an accurate diagnosis and always under professional supervision.