A landmark study has revealed that gluten sensitivity, which affects approximately 10 per cent of the global population, is not actually about gluten but part of the way the gut and brain interact.
The findings are expected to set a new benchmark for how gluten sensitivity is defined, diagnosed and treated.
The research review, published today in The Lancet, examined current published evidence for non-coeliac gluten sensitivity (NCGS) to better understand this highly prevalent condition.
People with NCGS experience symptoms after consuming gluten but do not have coeliac disease, an autoimmune disease triggered by gluten. Common symptoms include bloating, gut pain and fatigue.
Lead researcher, University of Melbourne Associate Professor Jessica Biesiekierski, said the findings overturn long-held assumptions about gluten sensitivity.
"Contrary to popular belief, most people with NCGS aren't reacting to gluten," Associate Professor Biesiekierski 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."
In the largest combined analysis, only a few tightly controlled trials found any real gluten reaction. Overall, people's responses were no different from when they were given a placebo.
"Across recent studies, people with IBS who believe they're gluten-sensitive react similarly to gluten, wheat, and placebo. This suggests that how people anticipate and interpret gut sensations can strongly influence their symptoms," Associate Professor Biesiekierski said.
"Taken together, this redefines NCGS as part of the gut–brain interaction spectrum, closer to conditions like irritable bowel syndrome, rather than a distinct gluten disorder."
The research team – from Australia, The Netherlands, Italy and the United Kingdom – say the findings have major implications for people self-managing gut symptoms, for clinicians prescribing restrictive diets, and for policymakers shaping 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. Improving our scientific and clinical understanding of a condition affecting up to 15 per cent of the global population is incredibly important," Associate Professor Biesiekierski said.
Associate Professor Jason Tye-Din, Director of the Snow Centre for Immune Health and a gastroenterologist at the Royal Melbourne Hospital, said the updated scientific knowledge could help clinicians provide more accurate diagnoses and tailored treatment for patients who present 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," Professor Tye-Din said.
"This review supports a more personalised, evidence-based approach to gut health and avoids unnecessary dietary restriction."
Associate Professor Biesiekierski added that effective care for people with NCGS should combine dietary modifications with psychological support, while ensuring nutritional adequacy.
"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 labelling."
