What is celiac disease?

Celiac disease is a long-term (chronic) digestive problem that hurts your small intestine. It stops your body from taking in nutrients from food. It is different from gluten sensitivity or intolerance.

You may have celiac disease if you are allergic to gluten. Gluten is a kind of protein. It is found in wheat, rye, and barley. It is sometimes found in small amounts in mixed oats.

When you have celiac disease and you eat foods with gluten, your body has a reaction that is not normal. The part of your body that fights disease (the immune system) starts to hurt your small intestine. It attacks the tiny bumps (villi) that line your small intestine.

The villi help your body take in nutrients from food into your blood. Without the villi, your small intestine can’t get enough nutrients, no matter how much food you eat.

Celiac disease is genetic. This means it can be passed down from parent to child.

Studies show that as many as 1 in every 141 Americans may have celiac disease. They may not know they have it.

Celiac disease is more common in people:

  • Whose ancestors came from Europe
  • Who are white
  • Who have type 1 diabetes
  • Who have Down syndrome
  • Who have other autoimmune diseases
  • Who can't have children (are infertile)
  • Who have irritable bowel syndrome with diarrhea

What causes celiac disease?

Celiac disease is a genetic disease that runs in families. You may have celiac disease and not know it because you don’t have any symptoms.

Some things that may make symptoms start to appear are:

  • Too much stress
  • Pregnancy
  • Surgery
  • Physical injury
  • Infection
  • Childbirth

What are the symptoms of celiac disease?

Celiac disease affects people in different ways. Some have symptoms as children. Others have symptoms only as adults. Some people have diarrhea and belly (abdominal) pain. Others may feel moody or depressed.

Each person’s symptoms may vary. Common signs of celiac disease include:

  • Constant (chronic) diarrhea or constipation
  • Weight loss
  • Gas
  • Pale, bad-smelling stool
  • Unexplained low blood count that makes you feel tired (anemia)
  • Tingling, numb feeling in the legs
  • Missed menstrual periods (linked to too much weight loss)
  • Infertility
  • Weak and brittle bones (osteoporosis) at a young age, or bone fractures
  • Teeth changing color or losing their enamel

Celiac disease can be painful. Some common pain symptoms are:

  • Stomach pain or swelling (bloating) that keeps coming back
  • Muscle cramps or bone pain
  • Pain in the joints
  • Painful, itchy skin rash

Children who have celiac disease may not grow at a normal rate.

You may have celiac disease but not have any symptoms. That is because the part of your small intestine that is not hurt can still take in enough nutrients. But you may still be at risk for problems of the disease.

Celiac disease symptoms may seem like other health problems. Always see your healthcare provider to be sure.

How is celiac disease diagnosed?

Celiac disease can be hard to diagnose. Its symptoms may seem like symptoms of other digestive problems such as:

  • Crohn's disease
  • Irritable bowel syndrome
  • Ulcerative colitis
  • Infected colon (diverticulitis)
  • Intestinal infections
  • Small intestinal bacterial overgrowth

To see if you have celiac disease, your healthcare provider will look at your past health and do a physical exam. You may also have tests such as:

  • Blood work. This is done to check the level of infection-fighting cells (antibodies) you have to gluten in your blood. People with celiac disease have higher than normal levels of these cells. Your immune system makes these cells to help fight things (such as gluten) that the body feels are a danger.
  • Biopsy. This is the most accurate way to tell if you have celiac disease. A tissue sample (biopsy) is taken from your small intestine to check for damage to the villi. To do this, you are first given medicine to help you relax (sedation). The healthcare provider puts a long, thin tube (endoscope) in your mouth, down to your stomach, and into your small intestine. They take a tissue sample using tools passed through the tube. The sample is checked in a lab.

What is the treatment for celiac disease?

If you have celiac disease, you must stop eating gluten. Eating gluten will do more damage to your small intestine. Eliminating gluten is the only treatment for this disease. You must not eat gluten for the rest of your life. In most cases, taking gluten out of your diet will stop your symptoms. And any damage to your intestine will heal. It will also stop any more damage from happening.

Removing gluten from your diet can be hard. This is because gluten can contaminate many foods. It can be found in condiments, salad dressings, and other unexpected places. For this reason, your healthcare provider may refer you to a dietitian who specializes in celiac disease. The Celiac Disease Foundation also has a lot of information.

After you stop eating foods with gluten, your symptoms will likely get better in a few days to weeks. Your small intestine should heal completely in 3 to 6 months. In some cases, it can take longer for full healing, even though you may feel better. Your villi will be back and working again. If you are older, it may take up to 2 years for your body to heal.

If you have low vitamin levels, your healthcare provider may advise certain supplements.

Your healthcare provider will follow your progress through blood tests. And sometimes you may need another upper endoscopy with biopsies.

Key points about celiac disease

  • Celiac disease is a digestive problem that hurts your small intestine. It stops your body from taking in nutrients from food.
  • You may have celiac disease if you are allergic to gluten.
  • Celiac disease is genetic. It is more common in people who are white, have type 1 diabetes, are obese, or have ancestors from Europe.
  • You may have celiac disease and not know it because you don’t have any symptoms.
  • It can be hard to diagnose. Its symptoms can seem like those of other digestive problems.
  • The only treatment is to stop eating gluten. Once you stop eating gluten, your body will start to heal.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your healthcare provider tells you.
  • At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your healthcare provider gives you.
  • Know why a new medicine or treatment is prescribed and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your healthcare provider if you have questions, especially after office hours and on weekends and holidays.

Diet for celiac disease

Gluten-Free Diet for Celiac Disease

Celiac disease means that you are sensitive to a protein called gluten. Gluten is found in certain grains. When you eat gluten, your immune system causes harm to your small intestines. The treatment for celiac disease is to stay away from foods and products that contain gluten. You will need to do this for the rest of your life. Resist the temptation to “cheat.” Even a small amount of gluten can cause symptoms to return. And it can harm your body.

This sheet gives you the basics about a gluten-free diet. If you need help, a registered dietitian can teach you what foods and other products have gluten and how to keep away from them.

Man reading nutrition label on package of bread.

Always read labels!

Many foods may contain gluten, even if you think they don't. Get into the habit of reading ingredient labels before you eat.

Choosing foods

The most common source of gluten is wheat flour (this includes white flour). Wheat flour is used to make many baked goods, including breads, pastas, cereals, pastries, and pizza dough. Gluten is also found in many foods that you might not think would have it.

You will need to read food labels to look for gluten in everything you eat. But your diet does not need to be boring. Many foods are naturally gluten-free. And many foods commonly made with wheat flour now come in gluten-free forms. 

Foods to stay away from Foods you can eat

Bread, cereals, pasta, pastries, couscous, or pizza dough made with wheat flour (including white flour, farina, farro, emmer, durum, graham, and semolina)

Bread, cereals, pasta, pastries, or pizza dough made with rice flour, almond flour, beans, potatoes, and other gluten-free substitutes

Foods containing rye, barley (including malt), spelt, kamut, triticale, brewer's yeast, and bulgur

Foods containing corn, cassava, rice, amaranth, buckwheat, millet, quinoa, arrowroot, teff, soy, and tapioca

Processed meats

Fresh meats and seafood (beef, chicken, turkey, lamb, pork, fish, shellfish), beans, and tofu

Some dairy products with additives

Many plain dairy products

Many sauces, gravies, dressings, and condiments, including traditional soy sauce

Vinegar, oils, and gluten-free substitutes, tamari

Some granola bars and energy bars

Granola bars and energy bars labeled gluten-free

Some beers and spirits

Wine, and gluten-free beers and distilled spirits

Some soups

Gluten-free soups

Fruits and vegetables that are fried or breaded

Fresh fruits and vegetables

Many packaged foods

Packaged foods labeled gluten-free

Oats, especially if processed in a facility containing gluten products (check with your healthcare provider)

Gluten-free oats

Communion wafers

Gluten-free communion wafers

If you are exposed to gluten by accident

Staying gluten-free means always being aware. Even if you are very careful, mistakes can happen. The food you eat can't come into contact with gluten. This is called cross-contamination. Your meals must be made with utensils that have not touched foods that contain gluten. Shared knives, cutting boards, toasters, and storage containers are risks for gluten exposure. Shared condiments may have crumbs that contain gluten.

At restaurants, parties, and other places where you eat food prepared by others, ask how the food was made. Gluten can also be found in some nonfood items. Some medicines contain gluten. So do some vitamin supplements. Ask your pharmacist before taking a medicine or supplement.

Also, some shampoos, lotions, toothpastes, makeup, lipsticks as well as lip gloss and lip balm, glues, soaps, and other products contain gluten. It can be possible to ingest some gluten when using these projects. For example, this can happen if you use a lotion that has gluten and then touch food you eat. Children's clay and similar products have gluten. Any adult or child with celiac disease should wash their hands after handling these.

There is not much you can do if you have accidentally had gluten. Here are tips that might help you recover after being exposed to gluten:

  • Drink plenty of fluids
  • Eat small, frequent meals
  • Eat simple gluten-free soups or broths
  • Stay away from very spicy or fatty foods
  • Drink ginger or peppermint tea
  • Rest and relax
  • Get medical attention if you have severe symptoms such as vomiting or diarrhea

Coping with gluten-free living

Living gluten-free can be hard. But it can be done. Groceries have many gluten-free foods, but it's still a big change for many people. You may be upset that you can't eat your favorite foods, or eat freely at restaurants, parties, or over the holidays. Household members may also be upset by the strict controls over food.

If you face problems like these, think about joining a celiac disease support group. Support groups offer tips on how to make a gluten-free lifestyle easier on you and the people you live with. You can find ways to involve the people in your household. There are many ways to make gluten-free group meals. See the section on more resources below for help in finding a group.

Bring safe foods that you enjoy to parties and school or work events. This can help you not give in to the urge to grab something you shouldn’t eat.

Following up with your healthcare provider

You should see your healthcare provider at least once a year for a checkup. A simple blood test can show if your celiac disease is under control. If you are having symptoms, your healthcare provider can help you find sources of gluten you may have missed.

To learn more