Celiac disease affects a small but significant share of the population and requires complete elimination of gluten. Non-celiac gluten sensitivity is recognized as a possible condition but remains controversial and has no validated diagnostic biomarker: in many cases, the trigger may be fermentable carbohydrates in wheat rather than gluten itself. For people who have neither celiac disease nor wheat allergy, meta-analyses do not show a general health benefit from removing gluten, while commercial gluten-free products can bring practical disadvantages: less fiber, more added sugar, higher cost and frequent ultra-processing.

Gluten has become one of the great enemies of contemporary food culture. Some people remove it because they “feel better,” some because they have read that it inflames the gut, others because a neighbor stopped eating it and lost five kilos. Gluten-free products now fill mainstream supermarket shelves, not just specialist stores. What began as a medical necessity for some people has also become a lifestyle choice.

It is worth looking at what the science actually says, because the gap between popular narratives and the evidence is substantial.

Start with the definition. Gluten is not a single protein. It is a protein network formed when components in wheat — mainly gliadin and glutenin — interact with water during mixing. It gives bread dough and pasta dough elasticity and structure. It is found in wheat and related grains such as spelt, as well as barley and rye. Oats do not contain gluten in the same sense, although ordinary oats can be contaminated during processing. Rice, corn, quinoa, buckwheat and millet are naturally gluten-free.

Who absolutely has to avoid gluten? People with celiac disease. Celiac disease is an autoimmune disorder: when a person with celiac disease eats gluten, the immune system reacts abnormally and damages the lining of the small intestine. Over time, the intestinal villi — tiny structures responsible for absorbing nutrients — can be injured, leading to poor absorption of iron, calcium, vitamin D, folate and other nutrients. Untreated disease can contribute to anemia, osteoporosis, neurological problems and, in rare severe cases, certain intestinal cancers.

The source article reports an estimated prevalence of around 1.65% in Italy and notes that many cases remain undiagnosed because celiac disease can present quietly or with non-classic symptoms. Diagnosis involves specific blood tests, particularly tissue transglutaminase antibodies, and in many adults an intestinal biopsy. One detail matters enormously: you need to still be eating gluten during the diagnostic process. Removing it beforehand can make tests falsely reassuring.

Then there is non-celiac gluten sensitivity, often shortened to NCGS. It is a label used for people who do not have celiac disease or wheat allergy but report symptoms — bloating, abdominal pain, fatigue, headache — that improve when gluten-containing foods are removed. The estimated prevalence varies widely because there is no validated blood or stool biomarker that objectively confirms the condition.

One of the more interesting parts of the story comes from controlled trials by researchers who helped establish the concept. An early study appeared to support non-celiac gluten sensitivity. A later, more rigorous double-blind rechallenge study reached a more complicated conclusion. When another group of fermentable carbohydrates present in wheat — FODMAPs — was also reduced, symptoms improved regardless of gluten exposure in many participants. Only a small subgroup showed a gluten-specific response. The implication was not that NCGS is imaginary, but that in many people the trigger may be something in wheat other than gluten itself.

That does not mean non-celiac gluten sensitivity does not exist. It means the condition is heterogeneous, probably overdiagnosed and still not fully understood.

Wheat allergy is different again. It is an allergic immune reaction, often mediated by IgE antibodies, to wheat proteins that are not necessarily gluten. It can cause hives, swelling, acute gastrointestinal symptoms and, rarely, anaphylaxis. It affects a small proportion of the population and is diagnosed with standard allergy assessment.

What happens when someone without any of these conditions removes gluten? The available evidence does not show a general health benefit for healthy people. There can also be disadvantages. Commercial gluten-free products are often lower in fiber and may contain more sugar or fat to compensate for the structural role gluten would normally play. They are usually more expensive and are frequently highly processed. Someone who removes gluten without a medical reason and relies heavily on these substitutes can end up lowering the overall quality of the diet rather than improving it.

Major gastroenterology and nutrition organizations do not recommend a gluten-free diet for the general population. They recommend it very strongly for people with confirmed celiac disease.

The summary is straightforward: gluten is a serious problem for people with celiac disease, potentially relevant for a subset of people with genuine non-celiac sensitivity, and clinically important for people with wheat allergy. For everyone else, removing it has no demonstrated universal benefit and can bring real nutritional and practical disadvantages.

If you suspect gluten is causing problems, the right first step is not to eliminate it on your own. It is to get properly tested while you are still eating gluten and obtain a diagnosis. Everything else risks treating anxiety instead of health.