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Non-Celiac Wheat Sensitivity—Does it Exist?

Andrea Hardy, RD

Many people struggle with digestive symptoms when eating foods that contain wheat but there can be many different causes! We see gluten-free written on menus at restaurants or labels on food products at the grocery store, but what does this actually mean for people who don’t have celiac disease but still struggle eating wheat?

Registered dietitian Andrea Hardy reviews the difference between celiac disease, wheat allergy, and non-celiac wheat sensitivity (NCWS) and explains how smart swaps like low-fructans, wheat-free bread can be part of a healthy approach to managing NCWS.

In this article:

As a digestive health dietitian, I can see how making the right choice for your digestive symptoms can be confusing. There are different reasons that people may have to limit (or eliminate!) wheat products from their everyday diet. One of those conditions includes non-celiac wheat sensitivity (NCWS).

To better understand NCWS, it’s important to first break down other conditions that require reducing or eliminating wheat and other gluten containing grains from the diet.

While they share similarities, each condition has distinct causes and management strategies. By better understanding those differences, you can avoid unnecessary restriction and have better control of your digestive symptoms.

What is Celiac disease?

Celiac disease is an autoimmune disorder where consuming gluten—the protein found in wheat, barley, and rye—triggers an immune response that damages the small intestine.
This damage can lead to malabsorption of nutrients, and symptoms like diarrhea, abdominal pain, and bloating, to name a few. 

Celiac disease is a lifelong condition.

The only option for management involves a strict gluten-free diet, including no wheat or other gluten containing grains—even a few crumbs are enough to trigger an immune response in those with celiac disease.

How is Celiac Disease Diagnosed?

Celiac disease is typically diagnosed via a blood test called tTg-IgA and confirmed via gastroscopy and biopsy. If you think wheat containing foods are contributing to your symptoms, it is crucial celiac disease be ruled out prior to making any dietary changes.

Why? For the test results to be accurate, you must have been consuming gluten regularly. 

And ruling out celiac disease is an important first step towards a NCWS diagnosis. 

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What is Wheat Allergy?

A wheat allergy is an IgE-mediated
immune response where the body mistakenly identifies wheat proteins—
not just gluten—as harmful. 

This reaction can cause symptoms such as:

  • Diarrhea
  • Hives
  • Rashes
  • Difficulty breathing and/or
    asthma symptoms
  • Anaphylaxis

Like other food allergies, living with a wheat allergy involves completely avoiding wheat.

But unlike celiac disease, having a wheat allergy does not necessarily require eliminating other gluten-containing grains like barley or rye, which many with a wheat allergy can tolerate.

While some individuals can tolerate wheat derivatives that would be considered gluten-free, (like maltodextrin), others cannot. 

How is Wheat Allergy Diagnosed?

Whereas celiac disease is diagnosed with a blood test, wheat allergies are typically diagnosed via skin prick tests by an allergist or immunologist.

While celiac disease is commonly ruled out on the path to a NCWS diagnosis, I often find patients have not had wheat allergy ruled out.

Symptoms of wheat allergy can often be mild—especially in comparison with other IgE-mediated allergies. In fact, some individuals find they only have a reaction when they consume wheat and then exercise, or when they bake with flour, and it triggers asthma.

It is important that you get tested for wheat allergy if you believe wheat is contributing to your symptoms, prior to assuming non-celiac
wheat sensitivity.

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Non-Celiac Wheat Sensitivity (NCWS)

As you may have guessed, NCWS diagnosis can only begin when celiac disease and wheat allergy have been ruled out first. 

Why? Because there are no specific tests we can use to diagnose NCWS.

In fact, the definition of NCWS is that the condition is characterized by the following:

  • Intestinal and extra-intestinal symptoms, 
  • Related to the ingestion of gluten-containing foods, 
  • In the absence of celiac disease and wheat allergy.1

Since the symptoms can present very much like celiac disease or wheat allergy—and those ARE diagnoses we can test for—ruling them out before cutting out wheat and/or gluten is important.

So, what are the symptoms we should be watching for?

Symptoms of Non-Celiac Wheat Sensitivity (NCWS)

Symptoms of NCWS can vary widely from person to person, both in type and severity. 

For some, wheat exposure primarily causes intestinal symptoms, while others may experience symptoms that extend beyond the gut, called ‘extra-intestinal’ symptoms.

Intestinal Symptoms of NCWSExtra-Intestinal Symptoms of NCWS
BloatingFatigue
Abdominal PainSkin rashes & itching
DiarrheaHeadaches or migraines
ConstipationBrain fog
NauseaMuscle & joint pain
RefluxPsychological (moodiness, anxiety, irritability) 

Unlike celiac disease or wheat allergy, the severity of symptoms in NCWS often depends on the amount of wheat consumed. Some people can tolerate small amounts, while others may need to significantly reduce or eliminate wheat from their diet.

How is Non-Celiac Wheat Sensitivity (NCWS) Diagnosed?

If you’ve had celiac disease and wheat allergy ruled out, but still feel wheat is contributing to your symptoms, that’s where a dietitian can come in handy.

Dietitians can take you through a series of elimination and reintroduction tests and provide crucial data to your physician to help make the diagnosis. 

Food elimination tests require objectivity and careful assessment to gather the right data, re-test when needed, and provide the right information to your physician to make the diagnosis. 

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Where Does Gluten Fit?

Research on non-celiac wheat sensitivity (NCWS) is still evolving—one of the biggest challenges is pinpointing exactly which components of wheat actually trigger symptoms. 

You might have noticed that the term 
non-celiac wheat sensitivity refers to
wheat rather than gluten.

While many people describe their condition
as a gluten sensitivity, emerging research suggests that gluten may not actually
be the main culprit.

In fact, studies comparing gluten to a placebo have found that participants often don’t experience more NCWS symptoms when consuming gluten alone.2,3

This suggests that other components in wheat may be driving the discomfort commonly associated with NCWS.

And one of the components identified is fructans.

Could Fructans Be the Culprit?

What are Fructans?

Fructans are a type of fermentable carbohydrate found in wheat that can trigger digestive symptoms in some people. Because they are non-digestible, they ferment rapidly in the colon, leading to bloating, gas, abdominal pain, and diarrhea.

Many people with self-diagnosed NCWS notice symptom improvement when they remove wheat from their diet.4 However, they often haven’t teased out whether wheat itself is the issue or if fructans are the true trigger. 

One simple way to test this is by introducing a low-fructan wheat product—such as traditionally fermented sourdough—to see if symptoms return or remain the same. It’s best to do this with dietitian supervision, as they can help to ensure there are no other factors leading to symptoms and impacting the results. 

The benefit of reintroducing a low-fructan wheat product is that it helps you understand your individual reaction to wheat. 

Once you know what that is—and whether wheat is contributing to your symptoms or not—you can find more freedom in your diet. 

Freedom could mean welcoming back foods you’ve missed once you know you don’t need to avoid them. Or knowing what you actually need to eliminate, so you can be confident as you discover alternatives that work for you. 

For those who struggling with wheat-related symptoms, focusing on fructan reduction—rather than strictly eliminating gluten and wheat—is often adequate to manage symptoms associated with consuming wheat. 

TGE Blog Wheat Allergy Image White Bread

The Grain Escape breads and baked goods are not only gluten-free, but low in fructans and a great choice for those avoiding wheat to improve their digestive discomfort associated with wheat consumption.

When it Isn’t Fructans

Beyond fructans and gluten, there are other components in wheat that have been implicated in non-celiac wheat sensitivity.

In some studies, researchers have found that there is indeed an immune response5 in some patients with NCWS.

While this immune response is different from what we see in celiac disease or a wheat allergy, it may help explain why some people experience not only digestive issues but also symptoms beyond the gut when consuming wheat.

Unfortunately, there are no publicly available tests to determine this type of immune reaction to wheat yet. For now, symptoms alone guide us in who is most appropriate to follow a diet free from wheat.

As a dietitian, I typically recommend total avoidance of wheat in patients who continue to react to low-fructan wheat products. We may occasionally retest tolerance, if symptoms come back, continued avoidance is recommended.

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Smarter Swaps:
Enjoying Your Favourite Foods Without the Symptoms

Fortunately, we live in a time when gluten-free options are widely available. Choosing gluten-free breads, sauces, and baked goods allows people with NCWS to enjoy their favourite foods with fewer symptoms. Many restaurants label gluten-free items, and unlike those with celiac disease or wheat allergies, cross-contact is usually not a major concern for NCWS.

One downside? Many gluten-free alternatives lack fibre—one of the most essential nutrients for gut health and digestion.

Men should aim for 38 grams of fibre per day, and women should aim for 25 grams, but reducing wheat intake can make it challenging to meet these goals.6,7

Even for those who tolerate sourdough in small amounts, the refined flour means another fibre trade-off.

TGE Blog Wheat Allergy Image Hot Dogs

Thankfully, there are products designed to support a low-wheat diet without sacrificing fibre.

The Grain Escape products use easy-to-digest sources of fibre to help maintain digestive health and hit fibre targets, all while minimizing symptoms.

If you’re struggling to navigate wheat and gluten in your diet, it’s crucial to rule out celiac disease and wheat allergies first. But even after that, finding the right balance can be frustrating. 

A dietitian can help you build a simple, sustainable approach to managing NCWS while maintaining a well-rounded diet.

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About Andrea Hardy

Nutrition communicator and knowledge translator, Andrea Hardy is a registered dietitian from Calgary, Canada, where she runs Ignite Nutrition, a multi-disciplinary digestive health practice. She specializes in gut health and gastrointestinal diseases and is recognized in the media as Canada’s Gut Health Expert. Passionate about translating science into easy to digest information to support a healthy gut, Andrea Hardy has spoken on the TEDx stage, as well as internationally about digestive health. Follow her on Instagram at @andreahardyrd or tune into her gut health podcast Let’s Gut Real which is all about making nutrition science easy to digest!

Invite more wheat- and grain-free, gluten-free, low-fructans content into your inbox—scroll down to sign up for The Grain Escape emails! And follow The Grain Escape on Instagram and Facebook to find content for people with sensitive tummies of all sorts in your favourite social feed!

Footnotes
  1. Barbaro, M. R., Cremon, C., Stanghellini, V., & Barbara, G., Recent advances in understanding non-celiac gluten sensitivity [version 1; peer review: 2 approved]. F1000Research 2018, 7(F1000 Faculty Rev):1631. Available from: https://f1000research.com/articles/7-1631/v1 ↩︎
  2. Iven, J., Geeraerts, A., Vanuytsel, T., Tack, J., Van Oudenhove, L., & Biesiekierski, J. R., Impact of Acute and Sub-Acute Gluten Exposure on Gastrointestinal Symptoms and Psychological Responses in Non-Coeliac Gluten Sensitivity: A Randomised Crossover Study. United European Gastroenterology Journal, 2025 Mar 26. Epub ahead of print. PMID: 40138597. Available from: https://onlinelibrary.wiley.com/doi/10.1002/ueg2.70014 ↩︎
  3. Biesiekierski, J. R., Peters, S. L., Newnham, E. D., Rosella, O., Muir, J. G., & Gibson, P. R., No effects of gluten in patients with self-reported non-celiac gluten sensitivity after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates. Gastroenterology. 2013 Aug; volume 145(2):320-8.e1-3. Epub 2013 May 4. PMID: 23648697. Available from: https://www.gastrojournal.org/article/S0016-5085(13)00702-6/fulltext ↩︎
  4. Skodje, G. I., Sarna, V. K., Minelle, I. H., Rolfsen, K. L., Muir, J. G., Gibson, P. R., Veierød, M. B., Henriksen, C., & Lundin, K. E. A., Fructan, Rather Than Gluten, Induces Symptoms in Patients with Self-Reported Non-Celiac Gluten Sensitivity. Gastroenterology. 2018 Feb; volume 154(3):529-539.e2. Epub 2017 Nov 2. PMID: 29102613. Available from: https://www.gastrojournal.org/article/S0016-5085(17)36302-3/fulltext ↩︎
  5. D’Alcamo, A., Cavataio, F., Brusca, I., Florena, A. M., Ambrosiano, G., Seidita, A., Pirrone, G., & Rini, G. B., Non-celiac wheat sensitivity diagnosed by double-blind placebo-controlled challenge: exploring a new clinical entity.The American journal of gastroenterology, 2012 Dec; volume 107(12):1898-1906. Epub 2012 Jul 24. PMID: 22825366. Available from: https://celiac.org/wp-content/uploads/2009/12/2012-08-29.pdf ↩︎
  6. Health Canada, Dietary Reference Intakes Tables: Reference Values for Macronutrients: Total Fibre. 2023 12 18. Available from: https://www.canada.ca/en/health-canada/services/food-nutrition/healthy-eating/dietary-reference-intakes/tables/reference-values-macronutrients.html#a1 ↩︎
  7. USDA, US Department of Health & Human Services, and Dietaryguidelines.gov, Dietary Guidelines for Americans, Ninth Edition. 2020 – 2025: Appendix 1: Table A1-2: Daily Nutritional Goals, Ages 2 and Older, p 133. Available from: https://www.dietaryguidelines.gov/sites/default/files/2021-03/Dietary_Guidelines_for_Americans-2020-2025.pdf ↩︎

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