The hunt for gluten-free food on menus and store shelves might be an unnecessary aggravation for most people who are avoiding gluten for their health. The likely culprit for a majority of gluten reactions may be irritable bowel syndrome (IBS).

True gluten sensitivities are rare, if they exist at all, according to a comprehensive review published in The Lancet on nonceliac gluten sensitivity that has collected decades of research.

Diagnosis Dilemma

Blinded studies included in the review revealed a pattern: Those with suspected nonceliac gluten sensitivity reacted the same way to gluten, wheat, or a placebo.

“That told us something else—not gluten—was driving symptoms,” co-author Jessica Biesiekierski, an associate professor at the University of Melbourne, told The Epoch Times in an email.

The review highlights a problem with diagnosing nonceliac gluten sensitivity. Unlike celiac disease—an autoimmune disorder in which gluten, a protein found in wheat, rye, and barley, damages the small intestine—nonceliac gluten sensitivity has no biomarker. It’s a diagnosis of elimination made after a person is found to react to gluten, and celiac and wheat allergies have been ruled out.

In many cases, nonceliac gluten sensitivity is self-reported, including in research studies. The authors noted that less than 3 percent of self-reported cases are validated by objective testing, and when testing is conducted, no more than 30 percent constitute nonceliac gluten sensitivity.

Also problematic is the overlap between nonceliac gluten sensitivity and IBS. Up to 80 percent of those with suspected nonceliac gluten sensitivity meet the diagnostic criteria for IBS, according to the review.

Patients who reacted even when gluten wasn’t given to them, plus the prevalence of other food intolerances, suggest altered nervous system sensitivity, as well as psychological factors, may be at play.

Evidence suggests a gut-brain connection, putting nonceliac gluten sensitivity in a category with disorders of gut-brain interaction, which includes functional motility disturbances.

Those with suspected gluten sensitivity also improve—not just their gut symptoms but also overlapping IBS issues such as chronic pain and fatigue, brain fog, and depression—on a low-FODMAP diet designed for IBS. FODMAP is an acronym for a group of carbs known to cause digestive issues. The low-FODMAP diet is a temporary elimination diet used to help people with IBS identify their specific food triggers.

“Whether [nonceliac gluten sensitivity] represents a discrete condition or a subset of patients with IBS and specific dietary triggers remains unclear,” the authors wrote.

More studies and better diagnostic criteria are needed, according to the review, particularly in light of the tendency to self-diagnose nonceliac gluten sensitivity.

Despite that celiac disease affects just 2 percent of the population, gluten-free sales are projected to jump from $7 billion to $11 billion by 2033, fueled by the widespread belief that avoiding gluten promotes weight loss and gut health.

Gluten-Free Problems

Gluten-free products are not only more expensive, but also often lower in fiber, folate, and minerals such as zinc and iron, Biesiekierski said, and can lead to nutritional deficiencies. Narrowing the diet can upset gut bacteria, which can exacerbate IBS symptoms and lead to eating-related anxiety, she added.

“Millions of people have cut out gluten unnecessarily,” she said. “Understanding what’s really behind symptoms helps people eat more freely and get the right treatment instead of avoiding foods they don’t need to.”

Changes in the gut microbiota and altered central nervous system processing are among the hallmarks of gut-brain disorders. Dysregulation can cause neurons to fire pain signals to the brain during digestion, which we begin to associate with particular foods.

“The concepts presented in this review article reflect my observations in practice,” Wendy Busse, a registered dietitian, told The Epoch Times. Her approach to food sensitivities shifted when she realized that food restriction often trapped her clients in a cycle of developing additional sensitivities. That’s because when we are using diets to monitor for gastrointestinal symptoms, we are more likely to become hypervigilant—a stress level that can put us at risk for more reactions to any food we reintroduce.

“Food sensitivities are complex, and treatment should address the whole person—including how the body reacts to food, their relationship with food, and the social factors that influence both,” she said. Social factors may include avoiding eating out or with certain people, for example, if it raises stress.

What to Do

The first step if you suspect a gluten sensitivity is to get testing for celiac disease and wheat allergy. “These tests are accurate and help rule out serious immune or allergic causes,” Biesiekierski said.

Once you know gluten isn’t the culprit, focus on eating an overall healthy diet. If that doesn’t bring relief, she said, seeing a dietitian for oversight with a short-term low-FODMAP diet can be helpful.

When people cut out gluten, they’re removing a type of carbohydrate called a fructan, which is also in other foods such as onions and garlic. Focusing solely on gluten when the cause of the digestive issues may be certain specific carbs can prevent the gut lining from healing. As a short-term elimination diet, the low-FODMAP approach often allows patients to reintroduce once-problematic foods without issues.

Dealing with underlying stressors can also help. Biesiekierski’s team is currently working on an international clinical trial comparing a low-FODMAP diet with exposure therapy—eating trigger foods—that aims to retrain the gut-brain connection. She urged anyone with IBS symptoms to participate.

Psychological factors such as fear, food avoidance, and a more anxious nervous system do shape physical symptoms, Biesiekierski noted, and shouldn’t be minimized.

“These findings highlight how strongly the brain and gut interact—expectations can shape how we physically feel.”