Digestive Health Celiac Disease Gluten Sensitivity Gluten Sensitivity Guide Gluten Sensitivity Guide Overview Symptoms Causes Testing Treatment Symptoms of Gluten Sensitivity By Jane Anderson Updated on August 30, 2023 Medically reviewed by Jay N. Yepuri, MD Print Table of Contents View All Table of Contents Gluten Sensitivity vs. Celiac Disease Symptoms Gluten Sensitivity in Kids Diagnosis Treatment Next in Gluten Sensitivity Guide Causes and Risk Factors of Gluten Sensitivity The symptoms of gluten sensitivity, otherwise known as non-celiac gluten sensitivity (NCGS), are often indistinguishable from celiac disease (CD). Both are triggered by exposure to gluten (a protein found in wheat and other grains like rye and barley), and both can cause gastrointestinal (GI) symptoms like stomach pain and bloating. However, with gluten sensitivity, symptoms tend to develop faster and people are far more likely to develop extraintestinal (non-GI) symptoms like fatigue, headaches, and "brain fog." This article looks at the symptoms, causes, diagnosis, and treatment of non-celiac gluten sensitivity and explains how it differs from celiac disease. Illustration by Nez Riaz for Verywell Health Gluten Sensitivity vs. Celiac Disease Non-celiac gluten sensitivity, as per its name, is an abnormal sensitivity to gluten that is not associated with celiac disease. With CD, symptoms are caused by an autoimmune reaction to gluten. This means that the body will respond to gluten by releasing immune proteins, called autoantibodies, that inappropriately target and attack the lining of the small intestine causing inflammation. With NCGS, gluten appears to cause direct damage to intestinal tissues in the absence of a known autoimmune response. NCGS is poorly understood, but studies have shown that gluten can be cytotoxic (toxic to cells) in some people. Other studies suggest that gluten might trigger an innate immune response similar to what would happen with a local infection, causing inflammation as gluten passes through the gut. How They Differ NCGS differs from CD in a few key ways. Because gluten directly affects the lining of the intestines in people with NCGS, it generally causes symptoms within minutes to hours. By contrast, the autoimmune response triggered by CD can develop gradually rather than abruptly, sometimes causing symptoms days or weeks later. Another way that NCGS differs is that it is more likely to cause extraintestinal symptoms. Because inflammation is triggered when gluten comes into contact with intestinal tissues, it is more generalized and can "spill over" beyond the intestines, reaching muscles, joints, and the brain. By contrast, the autoimmune response with CD is more targeted. The autoantibodies released by the immune system are essentially "programmed" to attack tiny, finger-like projections in the intestinal lining called villi. Because of this, symptoms are predominantly gastrointestinal. Symptoms of Gluten Sensitivity NCGS can cause both gastrointestinal and extraintestinal symptoms, although some people may only experience GI symptoms while others may only experience non-GI symptoms. Gastrointestinal Digestive problems are common with non-celiac gluten sensitivity. These symptoms tend to develop soon after eating gluten and can mimic those of irritable bowel syndrome (IBS). Studies suggest the most common GI symptoms of NCGS (by the percentage of people affected) include the following: Gastrointestinal Symptom Percentage Affected Abdominal pain 83% Diarrhea 54% Epigastric (upper abdominal) pain 52% Nausea 44% Bloating and gas 36% Gastroesophageal reflux (acid reflux) 32% Aphthous stomatitis (mouth ulcers) 31% Alternating diarrhea and constipation 27% Constipation 24% Extraintestinal Symptoms Symptoms outside of the GI tract are more common with gluten sensitivity than with CD. These are categorized as being neurological (related to the nervous system) or systemic (related to the body as a whole). These are the most common extraintestinal symptoms of NCGS (by the percentage of people affected): Extraintestinal Symptom Percentage Affected Malaise (a general feeling of being unwell) 68% Fatigue 64% Headache 54% Anxiety 39% Ataxia ("brain fog") 38% Peripheral neuropathy (tingling or burning sensations in the hands or feet) 32% Joint and/or muscle pain 31% Skin rash 29% Weight loss 25% Anemia 23% Depression 18% Dermatitis (skin irritation leading to itchiness, dry skin, or a rash) 10% Rhinitis (nasal congestion, runny nose, sneezing, and itching) 5% Asthma 3% Gluten Sensitivity in Children It is difficult to know how many children are affected by NCGS because the symptoms are hard to differentiate from functional gastrointestinal disorders (FGDs) like IBS. Some studies suggest that the rate of IBS among children in the United States hovers between 1.2% and 2.9%. Children thought to have gluten sensitivity may, in fact, have a wheat, rye, or barley allergy. Cereal grain allergy is common in children and is usually outgrown with age. In children diagnosed with NCGS, GI symptoms predominate, while extraintestinal symptoms are rare. A 2019 study in the Journal of Pediatrics reported that the most common symptoms in children were abdominal pain, bloating, rash, and diarrhea or loose stools. Diagnosis of Gluten Sensitivity Due to the lack of understanding about the disease and how it causes illness, there are no lab tests or imaging studies that can diagnose NCGS. The diagnosis is primarily based on the testing and exclusion of all other possible causes. Chief among these are: Celiac disease: Diagnosed with blood tests that can detect celiac autoantibodies and a biopsy of the small intestines to check for villous atrophy (the erosion of villi) Wheat allergy: Diagnosed with an allergy blood test, a skin prick test (applying a tiny amount of wheat protein under the skin), or a patch test (applying wheat protein against the skin) Other tests may be ordered to rule out other suspected causes. If CD and wheat allergy are excluded, your healthcare provider may recommend eating a gluten-free diet for six weeks, followed by the reintroduction of gluten for one week. A 30% improvement in symptoms with the diet and a 30% increase in symptoms with the reintroduction of gluten is considered by some to be diagnostic of NCGS. The healthcare provider will take into account other clues that NCGS is involved, including the rapid onset of symptoms after eating gluten and extraintestinal symptoms. How Gluten Sensitivity Is Treated The elimination of gluten from the diet is the primary treatment of NCGS. Experimentation may be needed to determine how much, if any, gluten you can eat before symptoms develop. The grains not allowed on a gluten-free diet include: WheatWheat varietals like durum, graham, bulgur, farro, farina, semolina kamut, and speltBarleyRyeTriticale (a hybrid of rye and wheat)Malt The grains allowed on a gluten-free diet include: QuinoaBrown riceWild riceSorghumTapiocaMilletAmaranthOats Where to Find Gluten-Free Food Summary Gluten sensitivity, otherwise known as non-celiac gluten sensitivity (NCGS), is a functional gastrointestinal disorder that has many of the same symptoms as celiac disease (CD). However, symptoms of NCGS develop within minutes to hours of eating gluten, while symptoms of CD can occur days or even weeks after. While NCGS and CD can both cause gastrointestinal symptoms like stomach pain, bloating, nausea, and diarrhea, NCGS is more likely to cause extraintestinal symptoms like headaches, fatigue, joint and muscle pain, and "brain fog." If positively diagnosed, NCGS is treated with a gluten-free diet. 15 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Biesiekierski JR, Iven J. Non-coeliac gluten sensitivity: piecing the puzzle together. United European Gastroenterol J. 2015 Apr; 3(2): 160–165. doi:10.1177/2050640615578388 Beyond Celiac. Non-celiac gluten sensitivity. National Institutes of Health, Genetic and Rare Diseases Information Center. Celiac disease. Elli L, Branchi F, Tomba C, et al. Diagnosis of gluten related disorders: celiac disease, wheat allergy and non-celiac gluten sensitivity. World J Gastroenterol. 2015 Jun 21;21(23):7110–7119. doi:10.3748/wjg.v21.i23.7110 Losurdo G, Principi M, Iannone A, et al. Extra-intestinal manifestations of non-celiac gluten sensitivity: an expanding paradigm. World J Gastroenterol. 2018 Apr 14;24(14):1521–1530. doi:10.3748/wjg.v24.i14.1521 American Academy of Allergy, Asthma & Immunology. Celiac disease, non-celiac gluten sensitivity, and food allergy: how are they different? Rinninella E, Cintoni M, Mele MC, Gasbarrini A. Irritable bowel syndrome (IBS) and non-celiac gluten sensitivity (NCGS): where is the culprit hiding? Nutritional tips for gastroenterologists. Nutrients. 2019 Oct;11(10):2499. doi:10.3390/nu11102499 Volta U, Bardella MT, Calabrò A, Troncone R, Corazza GR. An Italian prospective multicenter survey on patients suspected of having non-celiac gluten sensitivity. BMC Med. 2014;12:85. doi:10.1186/1741-7015-12-85 Llanos-C A, Fasano A. Gluten and functional abdominal pain disorders in children. Nutrients. 2018 Oct;10(10):1491. doi:10.3390/nu10101491 Ruemmele FM. Non-celiac gluten sensitivity: a challenging diagnosis in children with abdominal pain. Ann Nutr Metab. 2018;73 Suppl 4:39-46. doi:10.1159/000493929 Camhi S, Sangal K, Kenyon V, Lima R, Fasano A, Leonard M. Pediatric nonceliac gluten sensitivity: A gluten-related disorder treatment center experience. Journal of Pediatric Gastroenterology & Nutrition. 2019;69(2):200-205. doi:10.1097/mpg.0000000000002335 Catassi C. Elli L, Bonza B, et al. Diagnosis of non-celiac gluten sensitivity (NCGS): the Salerno experts' criteria. Nutrients. 2015:7:4966-4977. doi:10.3390/nu7064966 National Institute of Diabetes and Digestive and Kidney Diseases. Diagnosis of celiac disease. Cianferoni A. Wheat allergy: diagnosis and management. J Asthma Allergy. 2016;9:13–25. doi:10.2147/JAA.S81550 Celiac Disease Foundation. Sources of gluten. Additional Reading Al-Toma A, Volta U, Auricchio R, et al. European society for the study of coeliac disease (ESsCD) guideline for coeliac disease and other gluten-related disorders. United European Gastroenterol J. 2019 Jun;7(5):583-613; doi:10.1177/2050640619844125 Busby E, Bold J, Fellows L, et al. Mood disorders and gluten: It’s not all in your mind! A systematic review with meta-analysis. Nutrients. 2018 Nov; 10(11): 1708. doi:10.3390/nu10111708 Harvard Health Publishing. Non-celiac gluten sensitivity. Dec 2014. By Jane Anderson Jane Anderson is a medical journalist and an expert in celiac disease, gluten sensitivity, and the gluten-free diet. See Our Editorial Process Meet Our Medical Expert Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit By clicking “Accept All Cookies”, you agree to the storing of cookies on your device to enhance site navigation, analyze site usage, and assist in our marketing efforts. Cookies Settings Accept All Cookies