Celiac Disease: Common Questions Answered

An autoimmune condition in which gluten damages the lining of the small intestine.

Key takeaways

• Trigger: gluten, found in wheat, barley and rye
• Testing: blood tests, then usually an upper endoscopy with biopsy
• Most useful single change: Ask for testing before removing gluten from your diet.
• Commonest mistake: Going gluten-free before testing, which can make results falsely normal.
• See a doctor if any of the signs under "When to speak to a doctor" below apply to you.

What is Celiac Disease?

An autoimmune condition in which gluten damages the lining of the small intestine.

Why does it matter?

It is substantially underdiagnosed, and removing gluten before testing makes the diagnosis much harder to establish.

Gluten-free labeling for Celiac Disease?

FDA rules require less than 20 parts per million of gluten.

What is the single most useful thing to do?

Ask for testing before removing gluten from your diet.

What is the most common mistake?

Going gluten-free before testing, which can make results falsely normal.

When should I see a doctor?

See your doctor for persistent diarrhea, bloating, unexplained weight loss, mouth ulcers, fatigue or iron-deficiency anemia. Do not remove gluten before testing. Go to the emergency room or call 911 for severe abdominal pain, persistent vomiting or significant blood in the stool.

More questions, answered

Is a little gluten okay occasionally?

No. Even small amounts of gluten can cause intestinal damage in people with celiac disease, sometimes without any symptoms you would notice. A strict diet is needed to allow the intestine to heal and to reduce the risk of long-term complications such as bone thinning.

Can celiac disease develop later in life?

Yes. Celiac disease can develop at any age, even in people who have eaten gluten without problems for decades. New digestive symptoms, unexplained anemia, bone thinning or raised liver enzymes in adults can be the first signs, so it is worth asking about testing.

Are oats safe?

Pure oats labeled gluten-free are safe for most people with celiac disease. Regular oats are often contaminated with wheat during growing or processing. A small number of people react to oat protein itself, so introduce them carefully and discuss it with your dietitian.

How long does it take to feel better?

Many people notice improvement within weeks of going gluten-free, but complete healing of the intestine can take months in children and up to a couple of years in adults. Antibody levels usually fall over months, which is one way your doctor tracks progress.

What is non-celiac gluten sensitivity?

Some people report gut or other symptoms after eating gluten but do not have celiac disease. The cause is not clear, and in some cases other components of wheat, such as fermentable carbohydrates, may be responsible. Celiac disease should be ruled out first, while you are still eating gluten.

Is gluten-free food covered by insurance?

Gluten-free food is generally not covered by health insurance, but visits with a registered dietitian may be, along with follow-up blood tests and bone density scans when your doctor orders them. Naturally gluten-free staples such as rice, potatoes and beans are often cheaper than specialty products.

Related topics

• The Evidence on Anemia, Without the Hype (Blood Health)
• The Evidence on Dietary Fiber, Without the Hype (Nutrition)
• Gut Health and Immunity: What the Evidence Actually Says (Immunity)
• Mouth Ulcers: What Published Guidance Supports (Oral Health)

Where to go next

• Celiac Disease: What Published Guidance Supports
• Celiac Disease, Explained Without the Jargon
• Celiac Disease — the reference entry
• Digestive Health: The Complete Guide
• Bloating: Sorting the Evidence From the Noise
• What the Guidance Really Says About Diarrhea

When to speak to a doctor

See your doctor for persistent diarrhea, bloating, unexplained weight loss, mouth ulcers, fatigue or iron-deficiency anemia. Do not remove gluten before testing. Go to the emergency room or call 911 for severe abdominal pain, persistent vomiting or significant blood in the stool.

Where this comes from

• National Institute of Diabetes and Digestive and Kidney Diseases — Celiac Disease
• FDA — Gluten-Free Means What It Says

How this page was put together

Every figure, recommendation and warning above is taken from the guidance named in Where this comes from. Nothing on this page is inferred, summarized or generalized beyond what those bodies publish: where they give a number, it is their number, and where they are silent, so are we. Pages are rebuilt whenever the underlying record changes. Sign-off by a named clinician, where it has happened, is shown at the top of the page along with the date.

Medical disclaimer

This article is general information, not medical advice. It cannot account for your own history, medication or circumstances. Always speak to your doctor, pharmacist or another qualified health professional before making changes that affect your treatment, and never delay seeking medical advice because of something you have read here. In an emergency, call 911.