Many people without celiac disease or wheat allergy report gluten and wheat sensitivity, according to a meta-analysis. The study found that 10% of individuals without celiac disease or wheat allergy self-reported symptoms from eating gluten or wheat. This sensitivity was significantly more common in women and was associated with anxiety, depression, and irritable bowel syndrome. The findings suggest that psychological factors and the gut-brain axis play a central role in the pathophysiology of non-celiac gluten/wheat sensitivity (NCGWS) rather than the immune system, as in celiac disease. The wide range of extraintestinal symptoms, resembling those of disorders of gut-brain interaction (DGBI), further supports this notion. The study also found that around 40% of individuals with self-reported NCGWS follow a gluten-free diet. However, many patients' symptoms attributed to gluten could actually be triggered by fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs), particularly fructans, which are commonly found in wheat-based foods like bread. The study's limitations include substantial heterogeneity in most of the analyses, which might reflect a combination of residual confounding factors, variability in diagnostic criteria, true differences in prevalence across populations and countries, and potential publication bias. Self-reported symptoms can also be subject to recall or misclassification bias.
