Celiac disease
Autoimmune conditionAn autoimmune reaction to gluten (in wheat, barley, and rye) that damages the lining of the small intestine and blocks nutrient absorption.
What happens
In people with certain genes (HLA-DQ2 or DQ8), gluten triggers an immune attack on the villi, the finger-like projections that absorb nutrients. Over time this can lead to low iron, B12, folate, vitamin D, and calcium, even with a healthy diet.
Who gets it
About 1 in 100 people has celiac disease, and it's diagnosed more often in women. Risk is higher with a parent, sibling, or child who has it, and with type 1 diabetes or autoimmune thyroid disease.
Common signs
- Bloating, gas, diarrhea, or constipation
- Abdominal pain
- Fatigue
- Iron-deficiency anemia that doesn't improve with iron
- An itchy, blistering rash (dermatitis herpetiformis)
- Mouth ulcers
- Headaches or tingling
- Low bone density, infertility, or miscarriage
- Many adults have few or no gut symptoms
Labs to ask about
- tTG-IgA antibody with total IgA (you must be eating gluten before testing)
- Endomysial antibodies (EMA)
- Endoscopy with small-intestine biopsy to confirm
- Ferritin, B12, folate, and vitamin D
How it's usually treated
- A strict, lifelong gluten-free diet, which is the only treatment
- Correcting nutrient deficiencies
- Repeat antibody tests to confirm the gut is healing
- Bone density testing for some people
Supportive steps to discuss with your provider
- Don't go gluten-free before testing. It can make the tests falsely negative.
- Work with a dietitian. Hidden gluten and cross-contact matter.
- Ask about testing your parents, siblings, and children.
- Rebuild iron, B12, folate, and vitamin D based on your labs.
See a doctor promptly if you have
- Unintended weight loss
- Blood in the stool or black stools
- Ongoing diarrhea or vomiting
- Symptoms that continue despite a strict gluten-free diet
Related conditions
Hashimoto's thyroiditis
The most common cause of an underactive thyroid in the US. The immune system slowly damages the thyroid, so it makes less hormone over time.
Learn more →Type 1 diabetes
The immune system destroys the insulin-making cells in the pancreas, so the body can't make enough insulin to control blood sugar.
Learn more →Crohn's disease & ulcerative colitis
Immune-mediated conditions in which the immune system drives chronic inflammation of the digestive tract. They're often grouped with autoimmune diseases.
Learn more →
Wondering if your symptoms fit a pattern?
Dr. Lesher is a naturopathic doctor who specializes in women's autoimmune and chronic conditions. Since 2020, she has helped more than 900 patients overcome and heal from their conditions.