The symptoms of non-celiac gluten sensitivity (NCGS, or simply gluten sensitivity) are divided into two broad categories: gastrointestional (GI) symptoms such as abdominal pain, bloating, and diarrhea, and extra-intestinal manifestations that include neurological symptoms such as “brain fog” and systemic ones (overall malaise, fatigue, and more).
These symptoms are often strikingly similar to those of celiac disease (CD) and wheat allergy and so diagnosis of NCGS is contingent not only on these shared potential symptoms of the disorder but also on ruling out CD and wheat allergy.
Symptoms associated with NCGS develop within a few hours to a day of ingesting gluten, disappear as soon as gluten is removed from the diet, and do not reappear as long as gluten is avoided.
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Gastrointestinal Symptoms
Digestive issues are the most common symptoms reported by people with non-celiac gluten sensitivity. These tend to mimic those of irritable bowel syndrome, or IBS. (In fact, IBS has been found in some research to be an associated disorder.)
The most common GI manifestations of gluten sensitivity are represented well by a 2014 study of patients with NCGS in 38 medical centers in Italy.
| Incidence of GI Symptoms of Gluten Sensitivity | |
|---|---|
| Symptom | Prevalence |
| Abdominal pain | 83% |
| Diarrhea | 54% |
| Epigastric pain (pain just below the ribcage) | 52% |
| Nausea | 44% |
| Aerophagia (excessive air swallowing) | 36% |
| Gastroesophageal reflux | 32% |
| Aphthous stomatitis (mouth ulcers) | 31% |
| Alternating bowel habits | 27% |
| Constipation | 24% |
Extra-intestinal Symptoms
Symptoms that do not affect GI function are more common in gluten sensitivity than in celiac disease. These often are divided into neurological or behavioral symptoms and systemic symptoms.
Behavioral/neurological symptoms
Among the most common of these are:
- Chronic headache: A study in the journal Headache found that about 56% of those with gluten sensitivity had chronic headaches.
- Brain fog, characterized by difficulty concentrating, short-term memory lapses, confusion, and disorientation
- Anxiety, which may be due to anticipation of abdominal pain
- Depression, possibly a result of a chronic health problem, although there is some evidence gluten may directly affect brain function. In addition, there also has been research showing increased depression among people with gluten sensitivity after undergoing a gluten challenge.
- Neuropathy. Numbness or the sensation of “pins and needles” in the arms and legs is often experienced by people with gluten sensitivity. For example, in the Italian medical center study, 32% of subjects experienced these symptoms.
Systemic symptoms
In the Italian study, 68% of patients reported feeling feeling generally unwell. Fatigue also was prevalent, affecting 64% of patients.
Joint and muscle pain described as similar to the discomfort characteristic of fibromyalgia also is often associated with non-celiac gluten sensitivity. There is some speculation it’s due to gluten-induced inflammation.
Some people with NCGS develop skin changes. In a study out of the University of Maryland’s Center of Celiac Research, 40% of patients with gluten sensitivity developed a rash and/or eczema.
The spectrum of non-GI symptoms that have been linked to gluten sensitivity extend beyond these most notable ones, including several quantified in the Italian study.
| Extra-intestinal Symptoms of Gluten Sensitivity | |
|---|---|
| Symptom | Incidence |
| Overall feeling of being unwell | 68% |
| Fatigue | 64% |
| Headache | 54% |
| Anxiety (believed to be caused by anticipation of abdominal pain) | 39% |
| Ataxia, or “brain fog” | 38% |
| Numbness/pins and needles in extremities | 32% |
| Joint and/or muscle pain (similar to that associated with fibromyalgia) | 31% |
| Skin rash | 29% |
| Weight loss | 25% |
| Anemia | 23% |
| Depression | 18% |
| Dermatitis | 10% |
| Rhinitis | 5% |
| Asthma | 3% |
Frequently Asked Questions
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What does a gluten headache feel like?
Some studies have shown that those with gluten sensitivity may be more likely to get migraine headaches. A 2020 study found that those with gluten sensitivity had fewer migraines after making dietary adjustments for three months. Migraine symptoms include a throbbing sensation on one side of your head and sensitivity to light and sound.
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What are the signs of gluten intolerance in children?
A 2019 study found that the most common symptoms in children from 0 to 18 years old were abdominal pain, bloating, rash, diarrhea, loose stool, and emotional and behavioral issues. Talk to your healthcare provider if you suspect your child has non-celiac gluten sensitivity to rule out other conditions like celiac disease or wheat allergy.
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Sapone A, Bai JC, Ciacci C, et al. Spectrum of gluten-related disorders: consensus on new nomenclature and classification. BMC Med. 2012;10:13. doi: 10.1186/1741-7015-10-13
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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
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Sapone A, Bai JC, Ciacci C, et al. Spectrum of gluten-related disorders: consensus on new nomenclature and classification. BMC Med. 2012;10:13. doi:10.1186/1741-7015-10-13
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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
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Dimitrova AK, Ungaro RC, Lebwohl B, et al. Prevalence of migraine in patients with celiac disease and inflammatory bowel disease. Headache. 2013;53(2):344-55. doi:10.1111/j.1526-4610.2012.02260.x
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Ford R. The gluten syndrome: a neurological disease. Medical Hypotheses. 2009 Sep;73(3):438-40. doi:10.1016/j.mehy.2009.03.037
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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
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Arthritis Foundation. The Connection Between Gluten and Arthritis.
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Griauzdaitė K, Maselis K, Žvirblienė A, et al. Associations between migraine, celiac disease, non-celiac gluten sensitivity and activity of diamine oxidase. Med Hypotheses. 2020;142:109738. doi:10.1016/j.mehy.2020.109738
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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
Additional Reading
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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
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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
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Harvard Health Publishing. Non-celiac gluten sensitivity. Dec 2014.
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