Six years after a small-intestine biopsy confirmed my celiac diagnosis, my daughter Kolbie received her Type 1 Diabetes diagnosis. Celiac followed for her shortly after. Two diagnoses, two people, two very different presentations, and one question I still get from readers every single week: how do I test whether gluten is my problem?
The first gluten symptom test was a famine. During a wartime food shortage, a Dutch pediatrician observed what no lab test had yet measured.
Willem-Karel Dicke and the Hunger Winter
During the winter of 1944 and 1945, the western Netherlands was cut off from food shipments under German occupation. Bread disappeared from cities and villages. A Dutch pediatrician named Willem-Karel Dicke had spent years treating children with a wasting illness marked by chronic diarrhea and failure to thrive. Celiac disease was a recognized diagnosis at the time, but its cause and treatment were contested.
When the famine tightened, something unmissable happened. The sick children improved while bread was scarce. When limited flour supplies returned to certain hospitals and orphanages first, the children who ate bread worsened again. Dicke watched the pattern repeat, and after the war he formalized it. His 1950 doctoral thesis made the wheat-free diet the standard approach.
The original gluten symptom test ran on observation, not antibodies. Remove the food. Watch. Return the food. Watch again. It was unblinded, uncontrolled, and forced by circumstance. It also worked, because the children he treated were ill enough that the before and after could not be ignored.
What a Famine-Era Observation and an Elimination Diet Share
The method Dicke stumbled into has the same shape as today's elimination-reintroduction protocol. You remove one food category for a defined window. You record what changes in concrete, boring detail. Then you reintroduce it and record again. If the change appears on removal and returns on reintroduction, you have a signal worth pursuing. If it does not, you have a different kind of signal.
The gap between 1944 and 2026 is noise. Dicke's patients were children whose illness was severe enough to be unmistakable. If gluten is your suspect, the symptoms that keep you wondering may sit in softer territory:
- fatigue
- bloating
- brain fog
- loose stools
- headaches
- mood dips
- joint pain
Those symptoms overlap with sleep, stress, hormones, other food components, and expectation. Track them honestly with dates and specifics, and expect some false starts.
Blood Tests Arrive: The tTG Era
Before a reliable blood test existed, confirming celiac meant an intestinal biopsy. That is how my own diagnosis arrived in 2014. The lab side changed in stages. Endomysial antibody testing matured through the 1980s. In 1997, Walburga Dieterich and colleagues at the University of Oslo published an enzyme-linked assay for tissue transglutaminase antibodies in The Lancet. A blood draw could now screen for the autoimmune response behind celiac disease far more cheaply and simply than before.
That advance carries a practical point many people miss. Celiac blood tests look for antibodies the immune system makes while gluten is still in the diet. If you stop eating gluten weeks before the draw, the marker can drift toward normal and the result can look falsely reassuring. The standard instruction from celiac centers is to keep eating gluten until testing is complete. If you have already gone gluten-free and want a clear celiac workup, your doctor needs to weigh a supervised gluten challenge. That decision belongs in a clinic.
The NCGS Puzzle: What Blinded Trials Found
For decades the clinical world recognized two clean categories: celiac disease and wheat allergy. Neither explained everyone who insists they feel better without wheat. Researchers gave that group a name: non-celiac gluten sensitivity, or NCGS.
The first double-blind, placebo-controlled rechallenge trial of NCGS appeared in 2011, led by Jessica Biesiekierski and colleagues. Thirty-four adults who identified as gluten-sensitive but did not have celiac disease received gluten or placebo under controlled conditions. The 2011 paper reported that gluten reproduced symptoms in a portion of the participants. A 2013 follow-up from the same group tightened the protocol by first reducing fermentable carbohydrates, the FODMAPs. Once those were controlled, most participants in the follow-up did not show a specific symptom response to isolated gluten. Something in wheat was agitating people. Gluten looked like the wrong suspect for many of them, with fructans and other wheat components taking some of the blame.
That finding punctures the quiz-show version of gluten testing. No home test cleanly separates celiac disease, wheat allergy, NCGS, fructose malabsorption, and a gut irritated by processed food. The research does not support that tidy a sort. What the research does support is older and less glamorous: a careful, structured change in what you eat, watched over time.
The Culture Move Outpaced the Lab Work
Three dates show how slowly the science moved. Dicke published his thesis in 1950. The Oslo team published the first reliable blood screening paper in 1997. Researchers ran the first blinded NCGS trials in 2011 and 2013. Gluten-free became a mass-market category during roughly that same stretch, the late 2000s into the 2010s, propelled by bestselling books and celebrity endorsements. Millions of people adopted the diet faster than researchers could define who stood to benefit. That visibility made everyday life easier for celiac households like mine, with more dedicated aisles and clearer restaurant menus. It also made gluten into a punchline and muddied the water for anyone trying to figure out whether removing it was medicine or preference.
What I Tell a Friend Who Asks
When a friend asks whether gluten is her problem, I do not hand her a spice rack. I hand her a notebook and a list of questions for her doctor.
The order matters. Lab questions come before food experiments.
- See your doctor first. Ask for celiac blood tests while you are still eating gluten regularly. If you have already stopped, mention that so a supervised gluten challenge can be considered.
- If celiac disease and wheat allergy are ruled out, a structured elimination and reintroduction can become a useful observational step.
- Track with dates and specifics rather than adjectives. Write down what you ate, when, and what changed, for a few weeks. That page helps a clinician more than a one-sentence summary from memory.
I am not a doctor, and this is not medical advice. I am a mom who has read the same studies you are probably knee-deep in right now. The research has not changed as much as the packaging. The first test was a famine. The best test is still a careful watch over time, now supported by a blood draw and a doctor who listens.
If you are in the thick of trying to figure this out, start with your clinician and keep a simple journal. And when you do get answers, the next hard part is rebuilding your kitchen. That is where I can actually help. Our free Clean Monday Meals Recipe App has hundreds of gluten-free and dairy-free recipes, many built around the same clean seasonings and ramen our family uses every week. No need to start from scratch. Get the app and come cook with us.