What Causes Celiac Disease
The exact cause of celiac disease isn’t known, but it involves a complex link between genes and lifestyle factors. Celiac disease is inheritable and often runs in families. If you have a first-degree relative with the condition (a parent, sibling, or child), your risk of developing celiac increases by up to 20% (Freeman, 2010).
Variations of the HLA-DQ2 and HLA-DQ8 genes are linked to celiac disease. However, not everyone who carries these genes will develop the disease. An outside trigger such as stress, infection, pregnancy, or changes to gut bacteria, can activate celiac in people who carry these genes (Skoracka et al., 2024).
Who Is At Risk
Adults and children of all ages can develop celiac disease. It affects more women than men and is more common in people with Down’s Syndrome or another autoimmune condition, like Type 1 diabetes or autoimmune thyroid disease (Daley & Haseeb, 2025).
An estimated 1% of the global population has celiac disease, but the true number is likely to be higher as many people remain undiagnosed (Admou, 2012).
What Are The Symptoms
With celiac disease the autoimmune damage happens in the small intestine but symptoms can appear throughout the body. Celiac commonly causes digestive symptoms such as:
Diarrhea
Constipation
Abdominal pain
Nausea and vomiting
But can also present with non-digestive symptoms including:
Iron deficiency anemia
Headaches
Fatigue
Osteomalacia (soft bones)
Deficiencies in B12, folate, calcium, magnesium, and vitamin D
An itchy skin rash called dermatitis herpetiformis
Nerve damage
Depression
Cognitive symptoms like brain fog
Weight loss
Difficulty getting pregnant
Because celiac doesn’t always cause digestive problems, it’s frequently misdiagnosed or not investigated. A small percentage of people have “silent celiac”. This form of celiac doesn’t have obvious symptoms but still causes damage in the small intestine and nutrient malabsorption.
Some people react to gluten but don’t have celiac disease. This is called Non-Celiac Gluten Sensitivity (NCGS). It can cause gluten-related symptoms but doesn’t involve an autoimmune attack on the small intestine and people don’t always need to avoid gluten for the rest of their lives.
There’s no test or biomarker for NCGS. A diagnosis is reached by ruling out wheat allergy and celiac disease, and monitoring symptoms while following a gluten-free diet.
How Is Celiac Disease Diagnosed
The first step to investigating celiac disease is a blood test for tTG-IgA (Tissue Transglutaminase-IgA) antibodies. These are produced by your immune system in response to gluten. It’s important to eat gluten-containing foods every day for at least 6 weeks before the test, otherwise there may be a false negative result.
You might also have a total serum IgA test, to check your levels of IgA (immunoglobulin A, a type of antibody). This test checks for IgA deficiency which can cause a false negative result in the tTG-IgA test.
The next stage depends on what these results show. Recent changes to the diagnosis guidelines mean that a small intestine biopsy is no longer recommended for adults under 45 and children if the tTG-IgA levels are more then 10x the upper normal limit, as confirmed by a second blood sample (Al-Toma et al., 2025). In other circumstances, your specialist may discuss the option of a biopsy.
If you have dermatitis herpetiformis (the skin manifestation of celiac disease), a skin biopsy can be used for diagnosis.
How Is Celiac Disease Treated With Regenerative Therapies
Currently, the only way to effectively manage celiac disease is to follow a lifelong gluten-free diet. In my experience as a nutritionist, I have seen how difficult and costly this can be, and how easy it is to accidentally ingest gluten. This usually happens because of cross-contamination during food preparation or because of poor labeling on food products.
Oats are a good example of this. They don’t contain gluten but can be cross-contaminated with gluten-containing grains during harvesting and packaging. It’s important for people with celiac to choose certified gluten-free oats to avoid this problem. Also, a subset of people with celiac (less than 5%) are sensitive to avenin, a protein in oats that is structurally similar to gluten.
Nutritional therapy
A nutritional therapist can support you with a sustainable, healthy, gluten-free diet. They can help manage any nutrient gaps caused by celiac disease and suggest vitamin and mineral supplements, if needed.
Probiotics therapy
Probiotics are supplements that contain live, beneficial bacteria. They are used to improve the balance of bacteria in the gut and support the immune system.
Small-scale studies suggest possible benefits for managing some celiac symptoms. For example, in their double-blind, placebo-controlled trial, Soheilian Khorzoghi et al. (2023) reported that a 12-week course of probiotics reduced fatigue, muscle discomfort, and bloating, compared to the placebo. However, larger and higher-quality studies are needed to know for sure.
Stem cell therapy
Stem cell therapy is an emerging area of interest. So far, the evidence comes from case studies using stem cell transplants. The participants in these studies had refractory celiac - a form of the disease that does not respond to a gluten-free diet. As yet there are no larger clinical trials to support this therapy for refractory or typical celiac disease.
What Are Possible Complications
Celiac disease affects how you absorb nutrients and how your immune system works. This means untreated celiac disease can have wide-ranging effects on the body. In children, it can lead to vitamin and mineral deficiencies, as well as poor growth and development. In adults, the immune response and nutrient deficiencies can cause:
Iron deficiency anemia
Osteomalacia (soft bones)
Osteoporosis (“porous” bones that break easily)
An increased risk of developing other autoimmune conditions
Lactose intolerance (lactose is the natural sugar found in milk and milk products)
Delayed recovery from other infections
Pregnancy-related complications
If you think you may have celiac disease, it’s best to see your healthcare provider as soon as possible. Early diagnosis can minimize the risk of long-term complications.
Can Celiac Disease Be Prevented
It's not possible to prevent celiac disease, but early diagnosis can lead to better health outcomes. If you have:
A first-degree relative with the condition
Another autoimmune condition
Or you carry a genetic marker that increases your risk of developing celiac
Ask for a screening test, even if you don’t have any obvious symptoms.
If you know you have celiac disease, the best way to minimize the risk of symptom flare-ups is to optimize a healthy, gluten-free diet.
Takeaway
Celiac disease is a lifelong condition caused by an immune reaction to gluten in foods. This reaction damages the lining of the small intestine and affects nutrient absorption. The condition affects more women than men and can develop at any age.
There is currently no cure for celiac. If you have the condition, you need to follow a gluten-free diet. A qualified nutritionist or dietician can help with this, and with understanding vitamin and mineral supplements. Some evidence shows that probiotics may relieve symptoms like bloating and fatigue. However, larger, more robust trials are needed to confirm this.
