Overview
- Synthesizing more than 58 studies, the review reports that symptoms attributed to gluten are more often driven by FODMAPs, other wheat components, or expectation effects than by gluten itself.
- Across tightly controlled, blinded trials, participants who believed they were gluten‑sensitive typically reacted similarly to gluten, wheat, and placebo, with only a small minority showing gluten‑specific responses.
- Authors estimate that while roughly 10–15% of adults self‑report sensitivity, only about 16–30% demonstrate a reproducible reaction to gluten under double‑blind conditions.
- Clinicians are advised to rule out coeliac disease and wheat allergy, optimize overall diet, trial a low‑FODMAP plan if needed, then consider a four to six‑week dietitian‑supervised gluten‑free trial followed by structured reintroduction.
- The review urges combining dietary strategies with psychological support, warns that unnecessary gluten‑free diets can be costlier and less nutritious, and calls for better diagnostics and updated public messaging.