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Both celiac disease and NCGS are treated by not eating gluten, a protein found in certain grains, including wheat, rye and barley. Someone with celiac disease must avoid gluten completely for their entire life, while someone with NCGS may only need to reduce their gluten and carbohydrate intake. “NCGS does not have the same negative consequence on intestinal tissues or immune function like celiac disease does,” says Doerfler.

Gluten-Free: What You Need to Know

You can’t seem to go to a grocery store or restaurant without encountering the phrase “gluten-free.” The global gluten-free product market was estimated to be worth . Despite the large market for gluten-free products, Doerfler points out, “removing gluten from your diet if you don’t have celiac or a gluten intolerance will not improve your digestive or metabolic health.”

In fact, many grains that contain gluten also have essential vitamins and iron, which may be lacking in gluten-free alternatives.

“Gluten-free products are not required to be fortified with these same nutrients,” says Doerfler. “People with celiac disease therefore must work to incorporate adequate vitamin D, vitamin B12, calcium, magnesium, zinc, iron and fiber into their diets either with other foods like nuts and seeds, or supplements.”

Going gluten-free can also alter your gut microbiome, since many gluten-free foods contain more ultra-processed grains like tapioca starch, potato starch and rice flour. A diverse microbiome supports digestion, balances inflammatory gut bacteria and promotes a strong immune system. Gluten-free products can also be higher in refined carbohydrates and sugars.

For these reasons, “gluten-free diets should be medically prescribed by your healthcare team,” says Doerfler.

Celiac Disease vs. Non-celiac Gluten Sensitivity

Celiac Disease

• It affects about 1% of the United States population.
• About 38% of the population carries genes for celiac disease, but only a small percentage will develop it.
• It is a genetic autoimmune disease in which wheat triggers antibodies to attack the small intestine.
• It’s diagnosed with a blood test or biopsy during an endoscopy to detect antibodies produced in the autoimmune response.
• One crumb of gluten (20 parts gluten per million) can activate an immune response in someone with celiac disease.
• Treatment is a complete and lifelong avoidance of gluten.

GI symptoms:

• Bloating
• Difficulty with bowel movements
• Diarrhea
• Abdominal pain 

Non-GI symptoms:

• Anemia
• Fatigue
• Headaches
• Cavities
• Joint pain
• Low vitamin D and vitamin B12
• Psychiatric disorders

Symptoms can last hours or days. Autoimmune markers will remain elevated in blood for weeks.

Non-celiac Gluten Sensitivity

• It affects about 6% of the U.S. population.
• The cause is not fully understood. It’s not an autoimmune disorder or allergy.
• It’s diagnosed by ruling out celiac disease and wheat allergies with a blood test.
• No genetic component has been identified.
• It is more common in people who have irritable bowel syndrome (IBS) or other GI conditions.
• Treatment is a reduction of gluten or carbohydrates in the diet.

Symptoms are limited to the GI tract, including:

• Bloating
• Difficulty with bowel movements
• Diarrhea
• Abdominal pain. 

Gluten tolerance varies by individual, as well as by the frequency and amount of gluten consumed. Symptom intensity and duration also depend on these factors.