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What I need to know about Celiac Disease

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What is celiac disease?

Celiac disease is an immune disease in which people can’t eat gluten because it will damage their small intestine. Gluten is a protein found in wheat, rye, and barley. Gluten may also be used in products such as vitamin and nutrient supplements, lip balms, and some medicines. Other names for celiac disease are celiac sprue and gluten intolerance.

Your body’s natural defense system, called the immune system, keeps you healthy by fighting against things that can make you sick, such as bacteria and viruses. When people with celiac disease eat gluten, their body’s immune system reacts to the gluten by attacking the lining of the small intestine. The immune system’s reaction to gluten damages small, fingerlike growths called villi. When the villi are damaged, the body cannot get the nutrients it needs.

Celiac disease is hereditary, meaning it runs in families. Adults and children can have celiac disease. As many as 2 million Americans may have celiac disease, but most don’t know it.

*See the Pronunciation Guide for tips on how to say the words in bold type.

Drawing of villi on the lining of the small intestine. A cutaway section shows the various tissue of the small intestine. An enlarged inset drawing shows fine details of the villi.
Villi on the lining of the small intestine help absorb nutrients.


Is celiac disease serious?

Yes. Celiac disease can be very serious. It often causes long-lasting digestive problems and keeps your body from getting all the nutrition it needs. Over time, celiac disease can cause anemia, infertility, weak and brittle bones, an itchy skin rash, and other health problems.


What are the symptoms of celiac disease?

Symptoms of celiac disease include

  • stomach pain
  • gas
  • diarrhea
  • extreme tiredness
  • change in mood
  • weight loss
  • a very itchy skin rash with blisters
  • slowed growth

Some people with celiac disease may not feel sick or have symptoms. Or if they feel sick, they don’t know celiac disease is the cause. Most people with celiac disease have one or more symptoms. Not all people with celiac disease have digestive problems. Having one or more of these symptoms does not always mean a person has celiac disease because other disorders can cause these symptoms.


How is celiac disease diagnosed?

Celiac disease can be hard to diagnose because some of its symptoms are like the symptoms of other diseases. People with celiac disease may go undiagnosed and untreated for many years. If your doctor thinks you have celiac disease, you will need a blood test. You must be on your regular diet before the test. If not, the results could be wrong.

If your blood test results show you might have celiac disease, your doctor will perform a biopsy, which involves taking a tiny piece of tissue from your small intestine. A biopsy may be performed at a hospital or outpatient center.

Drawing of a female health care provider drawing blood from a woman’s arm. The drawing includes a close-up image of the needle being inserted into the woman’s arm vein.

Your doctor will provide you instructions about how to prepare for a biopsy. Generally, no eating or drinking is allowed 8 hours before a biopsy. Smoking and chewing gum are also prohibited during this time. Tell your doctor about any health conditions you may have, especially heart and lung problems, diabetes, and allergies. Also tell your doctor about any medicines you take. You may be asked to stop taking them for a short time before and after the test.

To perform the biopsy, the doctor inserts a long, narrow tube into your mouth, down through your stomach, and into your small intestine. At the end of the tube are small tools that the doctor uses to snip out a bit of tissue. The tissue will then be viewed with a microscope to look for signs of celiac disease damage. You will take medicine before the biopsy that makes you sleepy and keeps you from feeling any pain. Many people sleep through the procedure.


How is celiac disease treated?

The only treatment for celiac disease is a gluten-free diet. If you avoid gluten, your small intestine will heal. If you eat gluten or use items that contain gluten, celiac disease will continue to harm your small intestine.

Have regular checkups so your doctor can diagnose and treat problems from celiac disease. Celiac disease can cause problems, such as weak or brittle bones, even if you are on a gluten-free diet.


Eating, Diet, and Nutrition

A dietitian can help you select gluten-free foods. A dietitian is an expert in food and healthy eating. You will learn how to check labels of foods and other items for gluten.

The following chart lists examples of foods you can eat and foods you should stay away from if you have celiac disease. This list is not complete. A dietitian can help you learn what other foods you can and can’t eat on a gluten-free diet.

Drawing of a man talking with a female dietitian. They are seated across from one another at a desk. The dietitian is showing the man a document.

Foods You Can Eat
Indian rice grass
Job’s tears
Wild Rice
Foods that Contain Gluten
  • Including einkorn, emmer, spelt, kamut
  • Wheat starch, wheat bran, wheat germ, cracked wheat, hydrolyzed wheat protein
Triticale (a cross between wheat and rye)
Other Wheat Products that Contain Gluten
Bromated flour
Durum flour
Enriched flour
Graham flour
Phosphated flour
Plain flour
Self-rising flour
White flour
Processed Foods that May Contain Wheat, Barley, or Rye*
Bouillon cubes
Brown rice syrup
Chips/potato chips
Cold cuts, hot dogs, salami, sausage
Communion wafer
French fries
Imitation fish
Rice mixes
Seasoned tortilla chips
Self-basting turkey
Soy sauce
Vegetables in sauce
* Most of these foods can be found gluten-free. When in doubt, check with the food manufacturer.
Source: Thompson T. Celiac Disease Nutrition Guide, 2nd ed. Chicago: American Dietetic Association; 2006. © American Dietetic Association. Adapted with permission.

For a complete copy of the Celiac Disease Nutrition Guide, please visit www.eatright.org.


Points to Remember

  • Celiac disease is an immune disease in which people can’t eat gluten or use items with gluten in them.
  • Celiac disease harms the small intestine.
  • People with untreated celiac disease can’t get needed nutrients.
  • Without treatment, people with celiac disease can develop other health problems.
  • Celiac disease is diagnosed by blood tests and a biopsy of the small intestine.
  • The only treatment for celiac disease is to avoid gluten.
  • A dietitian can help people choose the right foods.


Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.

What are clinical trials, and are they right for you?
Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.

What clinical trials are open?
Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.

This information may contain content about medications and, when taken as prescribed, the conditions they treat. When prepared, this content included the most current information available. For updates or for questions about any medications, contact the U.S. Food and Drug Administration toll-free at 1-888-INFO-FDA (1-888-463-6332) or visit www.fda.gov. Consult your health care provider for more information.

The U.S. Government does not endorse or favor any specific commercial product or company. Trade, proprietary, or company names appearing in this document are used only because they are considered necessary in the context of the information provided. If a product is not mentioned, the omission does not mean or imply that the product is unsatisfactory.


Pronunciation Guide

biopsy (BY-op-see)

celiac disease (SEE-lee-ak) (dih-ZEEZ)

dietitian (dy-uh-TISH-uhn)

gluten (GLOO-tuhn)

intestine (in-TESS-tin)


This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings through its clearinghouses and education programs to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.

The NIDDK would like to thank:
William F. Stenson, M.D., Washington University; Alice Bast and Nancy Dickens, National Foundation for Celiac Awareness; Cynthia Kupper, R.D., C.D., Gluten Intolerance Group; Elaine Monarch, Celiac Disease Foundation

This information is not copyrighted. The NIDDK encourages people to share this content freely.


September 2013