Celiac disease affects roughly 1 in 100 people worldwide, yet experts estimate that the majority of those affected remain undiagnosed. As a gastroenterologist, I regularly meet patients who have struggled for years with unexplained digestive symptoms, fatigue, or anemia before learning that gluten was the cause. The good news is that celiac disease is highly manageable once it is correctly diagnosed. This guide explains what celiac disease is, how it is diagnosed, and how to live well on a gluten-free diet.
What Is Celiac Disease?
Celiac disease is an autoimmune disorder, not a simple food allergy or intolerance. When a person with celiac disease eats gluten — a protein found in wheat, barley, and rye — their immune system mistakenly attacks the lining of the small intestine. Over time, this damages the tiny, finger-like projections called villi that absorb nutrients from food. The result is poor nutrient absorption and a wide range of symptoms throughout the body.
Because the immune response is triggered every time gluten is eaten, even small amounts can cause ongoing damage, whether or not symptoms are obvious.
Recognizing the Symptoms
Celiac disease can look very different from one person to the next. Some people have classic digestive symptoms, while others have few or no digestive complaints at all.
Digestive Symptoms
- Chronic diarrhea or constipation
- Bloating, gas, and abdominal pain
- Nausea and vomiting
- Pale, foul-smelling, or fatty stools
Symptoms Beyond the Gut
- Iron-deficiency anemia that does not respond to supplements
- Fatigue and weakness
- Unexplained weight loss
- Bone or joint pain and reduced bone density
- An itchy, blistering skin rash (dermatitis herpetiformis)
- Headaches, "brain fog," or tingling in the hands and feet
- Delayed growth in children
Who Is at Risk?
Celiac disease has a strong genetic component. You are at higher risk if you have a first-degree relative (parent, sibling, or child) with the condition. Risk is also higher in people with other autoimmune conditions, including type 1 diabetes, autoimmune thyroid disease, and certain genetic disorders such as Down syndrome and Turner syndrome.
How Celiac Disease Is Diagnosed
One of the most important things to know is this: do not start a gluten-free diet before being tested. Removing gluten can heal the intestine enough to make test results falsely normal, which can delay an accurate diagnosis.
Blood Tests
Diagnosis usually begins with blood tests that look for specific antibodies, most commonly tissue transglutaminase (tTG-IgA). These tests are accurate only while you are still eating gluten regularly.
Upper Endoscopy with Biopsy
If blood tests suggest celiac disease, the diagnosis is confirmed with an upper endoscopy. During this brief, sedated procedure, I take small tissue samples from the small intestine to look for the characteristic damage to the villi. This remains the gold standard for diagnosis in adults.
The Only Treatment: A Strict Gluten-Free Diet
There is currently no medication that cures celiac disease. The treatment is a strict, lifelong gluten-free diet. When gluten is completely removed, the intestine heals, symptoms improve, and the risk of long-term complications drops dramatically.
Foods That Contain Gluten
- Wheat (including spelt, farro, durum, and semolina), barley, and rye
- Most breads, pasta, cereals, crackers, and baked goods
- Many sauces, gravies, soups, and processed foods that use wheat as a thickener
- Beer and other malt beverages
Naturally Gluten-Free Foods
- Fresh fruits and vegetables
- Plain meat, poultry, fish, eggs, and legumes
- Rice, corn, quinoa, buckwheat, and certified gluten-free oats
- Most dairy products
Hidden Sources of Gluten
Gluten can hide in unexpected places. Careful label reading becomes a habit. Watch for gluten in soy sauce, salad dressings, processed meats, seasoning blends, certain medications and supplements, and even some lip balms. Cross-contamination is also a concern — shared toasters, cutting boards, and fryers can transfer enough gluten to cause a reaction.
Tips for Living Gluten-Free
- Learn to read labels: Look for "certified gluten-free" and check ingredient lists for wheat, barley, rye, and malt.
- Prevent cross-contamination at home: Use separate toasters and utensils, and clean surfaces thoroughly.
- Ask questions when dining out: Tell your server you have celiac disease, not just a preference, so the kitchen takes care to avoid cross-contact.
- Work with a dietitian: A registered dietitian who specializes in celiac disease can help you eat a balanced, satisfying diet.
Nutrition and Long-Term Health
Because celiac disease can interfere with nutrient absorption, newly diagnosed patients are often checked for deficiencies in iron, vitamin D, calcium, B vitamins, and folate. Once the intestine heals, absorption usually improves. Ongoing follow-up helps confirm the diet is working and that antibody levels are falling toward normal.
What Happens If Celiac Disease Goes Untreated?
Left untreated, celiac disease can lead to anemia, osteoporosis, infertility, vitamin deficiencies, and, rarely, an increased risk of certain intestinal cancers. This is why an accurate diagnosis and a consistent gluten-free diet matter so much — even when symptoms feel mild.
When to See a Gastroenterologist
If you have persistent digestive symptoms, unexplained anemia or fatigue, or a family history of celiac disease, talk with a gastroenterologist before changing your diet. Proper testing leads to an accurate diagnosis and a clear path forward.
Expert Digestive Care in Mountainside, NJ
At GastroCares, board-certified gastroenterologist Dr. Amber Khan provides personalized evaluation and treatment for patients across Union County and New Jersey. Take the first step toward better digestive health today.