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Celiac Disease

An autoimmune disease in which gluten — found in wheat, barley and rye — damages the small intestine. Get tested before cutting out gluten; a strict, lifelong gluten-free diet is the only treatment.

Don’t go gluten-free before you are tested. If you think you might have celiac disease, talk with your doctor about testing first. Avoiding gluten before testing can make the results inaccurate (NIDDK, MedlinePlus), and celiac blood tests are only accurate while you are still eating gluten (Celiac Disease Foundation).

See a doctor about testing if you have:

Family members: parents, brothers, sisters and children of someone with celiac disease have about a 1 in 10 chance of having it too (Celiac Disease Foundation). Guidelines say these first-degree relatives should be tested if they have possible signs, and that testing should be considered even if they have none (ACG guideline, 2023). People with type 1 diabetes should also ask their doctor about testing (NIDDK).

What is celiac disease?

Celiac disease is a long-term digestive and immune disorder that damages the small intestine. It is triggered by eating gluten, a protein found naturally in wheat, barley and rye (NIDDK). In people with celiac disease, gluten sets off an immune attack on the villi — tiny finger-like projections lining the small intestine that absorb nutrients. When the villi are damaged, the body can’t absorb food properly (Celiac Disease Foundation). It is also called celiac sprue, nontropical sprue or gluten-sensitive enteropathy (NIDDK).

How common is it, and who gets it?

Experts estimate about 2 million people in the United States have celiac disease, and about 1 percent of people worldwide; many of them have not been diagnosed (NIDDK). It can only develop in people with certain genes, and it is more likely if someone in your family has it. It affects children and adults everywhere; in the U.S. it is more common in white Americans, and it is diagnosed more often in females than males. It is also more common in people with Down syndrome, Turner syndrome and Williams syndrome (NIDDK). Celiac disease can start at any age after a person begins eating gluten (Celiac Disease Foundation).

Symptoms in adults and children

Symptoms vary widely and can come and go. Digestive symptoms are more common in children than in adults (NIDDK). Some people have no symptoms at all but still have damage to the intestine and are at risk of long-term complications (Celiac Disease Foundation).

  • Digestive symptoms can include bloating, gas, ongoing diarrhea, constipation, loose, greasy, bulky, bad-smelling stools, nausea or vomiting, belly pain, and lactose intolerance caused by the intestinal damage (NIDDK). See our Bowel Problems guide for other causes of these symptoms.
  • In children, poor absorption of nutrients during growth can lead to failure to thrive, slowed growth and short height, weight loss, delayed puberty, damage to the enamel of the permanent teeth, and mood changes or irritability (NIDDK).
  • Symptoms outside the gut can include tiredness, joint or bone pain, depression or anxiety, headaches, balance problems, seizures or nerve tingling (peripheral neuropathy), infertility or missed periods, repeated miscarriages, and mouth problems such as canker sores, a dry mouth, or a red, smooth, shiny tongue (NIDDK). In older children, recurring mouth sores that look like canker sores can be a clue (Celiac Disease Foundation), and a dentist may be the first to notice enamel defects or canker sores (NIDDK).
  • Dermatitis herpetiformis is an itchy, blistering rash, usually on the elbows, knees, buttocks, back or scalp. It affects about 2 to 3 percent of children and 10 to 20 percent of adults with untreated celiac disease, and some people have the rash and no other symptoms (NIDDK).

Related conditions

Some people with celiac disease also have other immune-related disorders, including type 1 diabetes; thyroid diseases such as Hashimoto’s and Graves’ disease; Addison’s disease; selective IgA deficiency; Sjögren’s syndrome; and some autoimmune liver diseases (NIDDK).

Why treatment matters: complications

Without treatment, long-term complications can include osteoporosis or bone softening (osteomalacia), anemia, malnutrition, nervous system problems and reproductive problems. Rare complications include a cancer of the small intestine (adenocarcinoma), non-Hodgkin lymphoma, and liver damage that can lead to cirrhosis or liver failure (NIDDK). People who have no symptoms can still develop complications over time if they are not treated (NIDDK).

How it is diagnosed

Already gluten-free? Your doctor may suggest a “gluten challenge” — eating gluten again for a period so antibodies can build up before testing. It should only be done under the supervision of a doctor experienced in celiac disease, and never during pregnancy (Celiac Disease Foundation).

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Diagnosis with blood tests and an intestinal biopsy, then a strict, lifelong gluten-free diet taught by a registered dietitian, with follow-up blood tests, checks for vitamin and mineral shortfalls and bone density, and vaccine review. Upper endoscopy with biopsy about $990–$4,483 self-pay in published examples; genetic tests run into the hundreds of dollars. Medicare covers dietitian visits (medical nutrition therapy) only for diabetes or kidney disease. Antibody blood test cost being researched. Most people improve on the diet, often within days to weeks; the intestine can take months (children) to years (adults) to heal. There is no cure, and no medicine yet replaces the diet.
Chiropractic Being researched — coming soon.
Acupuncture Being researched — coming soon.
Herbal medicine No herb, pill or enzyme supplement treats celiac disease or makes gluten safe. The useful role is checking supplements for hidden gluten and correcting proven deficiencies with your clinician. Cost estimate being researched. “Gluten-digesting” enzyme products have no scientific basis for protecting people with celiac disease, and probiotics are unproven for it. Talk with your doctor or pharmacist first.
Massage therapy Being researched — coming soon.
MBHA Wellness Coach Reading labels, avoiding cross-contact at home and when eating out, choosing oats safely, budgeting, balanced nutrition, and coping with a lifelong diet at home, school and work. Cost estimate being researched. Packaged gluten-free foods cost far more than regular versions in a U.S. price study. Practical habits that make the gluten-free diet easier to stick to — the key to healing — alongside, never instead of, medical care.

Approach 1 of 6

Conventional medicine (AMA)

The only treatment for celiac disease is a strict gluten-free diet for life (Celiac Disease Foundation). There is no cure (MedlinePlus), and current care means strict adherence to the diet plus lifelong medical follow-up (ACG guideline, 2023).

1. A strict, lifelong gluten-free diet

Following a gluten-free diet relieves symptoms and heals the small intestine, and it must be followed for life to keep symptoms and damage from coming back (NIDDK). Many people feel better within days to weeks (NIDDK); children and teens typically respond well, and most children feel much better after two weeks on the diet (Celiac Disease Foundation). Healing of the intestine most often takes 3 to 6 months in children and may take 2 to 3 years in adults (MedlinePlus). Even small amounts of gluten, such as crumbs from a shared cutting board or toaster, can trigger damage (Celiac Disease Foundation). Some problems, such as short height and tooth damage, may not improve if diagnosis came late (NIDDK).

2. A registered dietitian

Your doctor may refer you to a registered dietitian who specializes in celiac disease, to teach you how to check labels for gluten, plan everyday meals and make healthy choices (NIDDK). Guidelines describe an interview with a dietitian experienced in the gluten-free diet as the standard way to check how well the diet is going (ACG guideline, 2023).

3. Checking nutrients and bones

4. Follow-up visits

Follow-up may include blood tests for celiac antibodies, which typically return to normal with treatment, and sometimes another biopsy to see whether the intestine has healed (NIDDK). The Celiac Disease Foundation recommends seeing your doctor 3 to 6 months after diagnosis and yearly after that (Celiac Disease Foundation). The dermatitis herpetiformis rash may take 6 months to 2 years on the diet to clear, and a medicine such as dapsone may be prescribed in the meantime (NIDDK).

5. When the diet doesn’t seem to work

In about 20 percent of people, symptoms continue or come back despite a gluten-free diet. The usual cause is small, hidden amounts of gluten; other causes include irritable bowel syndrome, lactose intolerance, microscopic colitis, pancreas problems or bacterial overgrowth (NIDDK). Rarely, the intestine stays damaged even on a strict diet. This is called refractory celiac disease; it can lead to malnutrition or a type of lymphoma and needs specialized care (NIDDK, ACG guideline, 2023).

New medicines

Several drug treatments are being tested in clinical trials, but for now the gluten-free diet remains the only available treatment (Celiac Disease Foundation).

What it costs

  • Upper endoscopy with biopsy: prepaid self-pay prices of about $990–$4,483; a typical hospital cash price of about $1,367 may not include anesthesia or the lab fee for examining the biopsy (The Pricer, 2026). Ask each provider for a written estimate.
  • Genetic testing: runs into the hundreds of dollars and may be covered by some insurance plans (Celiac Disease Foundation).
  • Dietitian visits: Medicare covers medical nutrition therapy with a registered dietitian only for people with diabetes or kidney disease, or a kidney transplant in the last 36 months (Medicare.gov), so celiac disease alone doesn’t qualify. Check what your plan covers.
  • Antibody blood tests: MBHA cost estimate being researched.

Find a medical doctor in our directory

Approach 4 of 6

Herbal medicine

No pill lets you eat gluten safely. The gluten-free diet is the only treatment for celiac disease (Celiac Disease Foundation). Products sold as “gluten-digesting” enzymes are dietary supplements, not approved medicines. A 2017 review of 14 of them found their claims to break down harmful gluten had no scientific basis; their own labels said they had not been evaluated by the FDA and were not meant to treat or prevent any disease (Krishnareddy et al., 2017). A 2015 lab study found that five such supplements left the harmful parts of gluten largely intact (Janssen et al., 2015). Don’t use them to eat gluten or as a safety net.

Supplements can contain hidden gluten

Herbal and nutritional supplements and vitamins can contain gluten, so ask a pharmacist about the ingredients (NIDDK). Dietary supplements labeled “gluten-free” must meet the same FDA rule as foods (Celiac Disease Foundation). One “gluten-digesting” enzyme product in the 2017 review even declared wheat as an allergen (Krishnareddy et al., 2017).

Probiotics

The 2023 ACG guideline found too little evidence to recommend for or against probiotics for celiac disease; despite their wide use, a benefit has not been shown (ACG guideline, 2023). Probiotics are sold as supplements that don’t need FDA approval, and some products have contained microbes not listed on the label (NCCIH).

Correcting deficiencies — with your clinician

Vitamins and minerals do have a role when tests show you are low: your doctor may recommend or prescribe them (NIDDK, MedlinePlus). Talk with your doctor before taking any supplement or complementary product (NIDDK). We don’t list doses here.

Approach 6 of 6

MBHA Wellness Coach

Living gluten-free is a big change. An MBHA Wellness Coach can help you turn your doctor’s and dietitian’s advice into everyday habits — a coach supports, but doesn’t replace, your dietitian.

Reading labels

Avoiding cross-contact at home

A word on oats

Most people with celiac disease can eat moderate amounts of oats, but oats are often cross-contaminated with wheat, so choose only oats labeled gluten-free (NIDDK). A small number of people react to oats themselves, so ask your doctor or dietitian before adding them and watch for symptoms (ACG guideline, 2023, Celiac Disease Foundation).

Eating out and social events

  • Look for restaurants with gluten-free menus, check menus online or call ahead, tell your server you have celiac disease, and ask how food is prepared (NIDDK).
  • The FDA suggests asking what the restaurant means by “gluten-free,” what ingredients are used, and how the dish is prepared (FDA).
  • Tell hosts ahead of gatherings, and bring safe food if you’re not sure there will be any (NIDDK).

Budgeting

Packaged gluten-free foods tend to cost more, and restaurants may charge more for gluten-free dishes (NIDDK). In a U.S. price study (prices collected in 2016), gluten-free products cost 183% more than their wheat-based versions overall, with bread and pasta about 229% and 227% more (Lee et al., 2019). Building meals around naturally gluten-free foods — meat, fish, fruit, vegetables, rice and potatoes — is the most cost-effective and healthy approach (Celiac Disease Foundation, NIDDK).

Eating well, not just gluten-free

A gluten-free diet planned without expert help may fall short on fiber, iron and calcium, and some packaged gluten-free foods are higher in fat and sugar (NIDDK). People with celiac disease are also often low in B vitamins such as folate, niacin, riboflavin and B12 (Celiac Disease Foundation). A coach can help you plan varied meals with naturally gluten-free grains such as rice, corn, quinoa, buckwheat and amaranth (NIDDK), and keep track of the checks your dietitian recommends.

The emotional side

A lifelong diet completely free of gluten can be costly and challenging (Celiac Disease Foundation), and depression and anxiety can be part of celiac disease itself (NIDDK). Support groups can help as you adjust (NIDDK, MedlinePlus), and specialists recommend referral to a mental health professional when needed for coping with the diet or with problems affording food (Celiac Disease Foundation).

School and work

  • In federally funded schools, families can request a Section 504 plan to arrange accommodations for a child with celiac disease; a letter from the child’s doctor helps (Celiac Disease Foundation).
  • Classroom materials such as modeling dough and baking projects can expose children to gluten, so gluten-free alternatives and good handwashing matter (Celiac Disease Foundation).
  • At work and when traveling, a coach can help you plan safe lunches and snacks and practice explaining your needs — the same steps as for eating out (NIDDK).

Another approach

Celiac disease, gluten sensitivity or wheat allergy?

All three can cause symptoms after eating wheat, but they are different conditions — one more reason to be tested before changing your diet.

  • Celiac disease is an autoimmune disease: gluten from wheat, barley and rye triggers immune damage to the small intestine, and the gluten-free diet must be strict and lifelong (NIDDK, NIDDK).
  • Non-celiac gluten (or wheat) sensitivity can cause similar symptoms, such as belly pain and tiredness, but it does not damage the small intestine the way celiac disease does (NIDDK). It is identified when symptoms improve without gluten after celiac disease and wheat allergy have been ruled out. Researchers are still studying its cause, and parts of wheat other than gluten may play a role (Celiac Disease Foundation).
  • Wheat allergy is a food allergy. It can cause hives, a rash, stomach upset or a runny nose, and occasionally anaphylaxis, a life-threatening reaction. It is diagnosed by an allergist with skin-prick or blood tests, is most common in children, and is often outgrown (ACAAI). It does not cause long-term damage to the small intestine (NIDDK). Many people with a wheat allergy can eat other grains, but not everyone, so ask your allergist (ACAAI). See our Allergies guide for the signs of anaphylaxis.

Going gluten-free “just in case” isn’t harmless: researchers have found no evidence that a gluten-free diet improves health or helps weight loss for people without a gluten-related condition, and it can make celiac testing inaccurate (NIDDK).

Still being researched: Chiropractic, Acupuncture, Massage therapy. We add each approach once its costs and results are sourced. Are you a practitioner with experience treating Celiac Disease? Tell us.

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This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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