By: Rhea Karir, dietetic-student volunteer and recent graduate of the University of Waterloo, reviewed by registered dietitian Natalie Walsh and the JM Nutrition Team
Living with Celiac Disease: Introduction
The word celiac enters life like an unexpected storm. One day, you are eating bread, pasta, or cake without a second thought. The next, a doctor tells you that even a breadcrumb can set off a reaction inside your body.
A celiac disease diagnosis can feel overwhelming at first, but it also marks the beginning of recovery.
Suddenly, food labels become puzzles to solve, every shared meal feels uncertain, and even the comfort of your own kitchen can seem unfamiliar. At first, it can be unsettling—how can something so small cause so much disruption?
But here’s the truth: living with celiac is not the end of enjoying food, health, or joy. It’s the beginning of a new way of living—one that, with knowledge, preparation, and the right mindset, can open the door to resilience and thriving.
This guide is here to walk alongside you, from understanding what celiac disease is, to learning how to heal, eat safely, navigate social life, and build strength for the long term.
The long road to celiac disease diagnosis
For many, the path to a celiac diagnosis is long and often confusing. Symptoms may begin in childhood or adulthood, yet they frequently mimic those of other common conditions. As a result, many patients see several clinicians before finally receiving an accurate diagnosis (Posner, 2023).
In addition, celiac disease can be difficult to recognize. Some people experience clear digestive problems, while others present with more subtle or non-digestive signs such as fatigue, anemia, bone loss, or even neurological concerns. These varied presentations often lead clinicians to attribute symptoms to stress, irritable bowel syndrome, or other conditions, resulting in delayed or missed diagnoses (Posner, 2023).
How common is delay?
Estimates vary.
Screening and registry data suggest that a large proportion of people with celiac remain undiagnosed. In the U.S., many sources estimate that roughly 60–80% (often reported as up to ~83%) of people with celiac are not yet diagnosed. Average diagnostic delays of several years — commonly cited as roughly 6–10 years from first symptoms to confirmed diagnosis — are frequently reported in advocacy and registry summaries (Beyond Celiac, 2025; Posner, 2023).
Recent studies refine that picture.
Pediatric cohorts tend to show shorter median delays (sometimes measured in months) while adult populations more often experience multi-year delays. A recent multi-centre pediatric study reported median delays measured in months and highlighted wide variation across systems and regions (Bianchi et al., 2024; Beyond Celiac, 2025).
Why does it take so long?
Several factors contribute:
- Symptoms are variable and often non-specific.
- Some patients have “silent” or subtle disease despite intestinal damage.
- Serologic (blood) testing may be missed or performed after a patient has already started a gluten-free diet, which reduces test sensitivity and complicates interpretation. Primary care clinicians may not suspect celiac when symptoms point toward more common diagnoses (e.g., irritable bowel syndrome or iron-deficiency anemia) (Williams, 2022; Posner, 2023).
Delays matter.
Prolonged untreated celiac increases the risk of complications including malnutrition, low bone density, reproductive issues, certain neurological manifestations, and a higher — though still relatively low absolute — long-term risk of some cancers, including certain intestinal lymphomas. Early detection and strict gluten avoidance reduce inflammation, allow intestinal healing, and lower these risks (Pelizzaro et al., 2021; Lebwohl et al., 2022).
If you are experiencing persistent digestive symptoms, unexplained anemia, persistent fatigue, or related problems, ask your clinician about celiac testing. Early testing and specialist follow-up shorten the diagnostic journey and start the healing process sooner (Posner, 2023; National Institute of Diabetes and Digestive and Kidney Diseases [NIDDK], n.d.).
If I could tell anyone going through something similar, I’d say this: it’s okay to feel frustrated. It’s okay to feel lost. But once you understand your body, once you finally have a name for what’s happening, the journey to feeling better can truly begin.
Understanding your body: what’s really happening inside when you have celiac disease
Celiac disease is not a “sensitive stomach.” It is an autoimmune condition in which eating gluten triggers an immune attack on the small intestine. In genetically susceptible people, fragments of gluten are modified by an enzyme called tissue transglutaminase (tTG); the immune system targets those modified fragments — and, accidentally, the intestinal lining itself — producing characteristic blood antibodies (anti-tTG and anti-endomysial) and causing damage to the villi, the nutrient-absorbing surface of the small intestine. The biological mechanism and clinical markers are well described in modern reviews (Parzanese et al., 2017; Tye-Din, 2018).
Worldwide, celiac disease affects roughly 1–1.5% of people based on large screening and population studies (Singh et al., 2018). Yet many cases remain hidden. In the United States, screening and registry work estimate that as many as four in five people with celiac disease are undiagnosed or misdiagnosed (Beyond Celiac, 2025).
Why you feel so terrible (and how you can get better)?
Damage to the small intestine causes downstream problems:
- Reduced iron absorption → iron-deficiency anemia and severe fatigue.
- Poor B-vitamin absorption → brain fog, slowed thinking, mood changes.
- Impaired calcium and vitamin D absorption → low bone mineral density and fracture risk.
- Chronic inflammation → joint pain, dermatitis herpetiformis, and systemic symptoms.
Most of these improve when intestinal inflammation settles and nutrient absorption recovers on a strict gluten-free diet (GFD). Many patients notice symptom improvement within weeks, though full intestinal recovery can take months to years and varies by age and disease severity (Kondapalli & Adami, 2022; Rubio-Tapia et al., 2010).
The only evidence-based treatment for celiac disease (and why it matters)
At present, the only proven, effective treatment for celiac disease is a strict, lifelong gluten-free diet; no medications currently replace the need to stop dietary gluten. Adherence reduces symptoms, lowers antibody levels, and allows intestinal healing in most people, reducing long-term complication risks (Kelly & Green, 2015; Celiac Disease Foundation, 2025).
Your healing timeline…what to expect
Healing is gradual and uneven.
Studies of intestinal recovery show wide variation. Some people show substantial improvement within months, while others require one to two years — occasionally longer — to recover fully. Follow-up plans should be individualized (Rubio-Tapia et al., 2010; Nemteanu et al., 2023).
First 1–4 weeks — early improvements: inflammation decreases, digestion eases, energy may start improving (Tarar et al., 2021; Celiac Disease Foundation, 2023; Raiteri, 2022).
2–3 months — building momentum: blood markers improve, brain fog lifts, confidence with safe meals grows (Gładyś et al., 2021; Canova et al., 2021; Cleveland Clinic, 2023).
4–6 months — steady repair: villi regeneration progresses, cognitive and energy benefits increase, social confidence improves (Rubio-Tapia et al., 2010; Raiteri, 2022; Rose, 2023).
6–12+ months — most people feel substantially better, though intestinal healing may require longer monitoring (Rubio-Tapia et al., 2010; Nemteanu et al., 2023).
Mastering Gluten-Free Living: An Evidence-Based Action Plan
Transitioning to a GFD is a skills project. It involves new habits, new vocabulary, and a new approach to social food. Below we will walk through practical steps, with the why explained by evidence.
Phase 1 — Kitchen emergency mode (first 48–72 hours)
When you first start a strict GFD, prioritize safety and confidence. Rapid, focused changes reduce the chance of accidental exposures and build wins.
Do this first:
- Remove obvious gluten sources from immediate reach (bread, pastries, regular pasta, cookies). This reduces accidental ingestion while you learn (Cleveland Clinic, 2023).
- Clean shared surfaces and utensils. Crumbs and residue matter. If possible, set aside or replace highly porous items (e.g., wooden cutting boards, the family toaster). Evidence shows shared environments can be managed safely, but require clear protocols to avoid cross-contact, Measured gluten transfer can occur in shared prep, but risk varies by activity and surface (Weisbrod et al., 2020; Celiac Disease Foundation, 2019).
- Stock safe staples: plain rice, potatoes, certified gluten-free oats (see note below), eggs, fresh fruit and vegetables, plain meats, canned legumes. Whole foods reduce the “hidden gluten” risk (Cleveland Clinic, 2023).
Tip: Start with a small set of reliable recipes. Mastering a few dishes reduces stress and prevents reliance on unfamiliar processed products.
Phase 2 — Build systems (weeks 2–8)
Sustainable habits prevent burnout. Focus on organization, reliable shopping, and label literacy.
Kitchen systems: Keep gluten-free items on top shelves to avoid crumb-drop contamination. Use colour-coded boards or dedicated utensils. These steps are low cost and can reduce cross-contact risk (Weisbrod et al., 2020).
Related: How to create a healthy food environment
Label reading: Learn alternate ingredient names — malt, brewer’s yeast, wheat starch, hydrolyzed wheat protein — and understand that “gluten-free” labelling is regulated.
The U.S. regulatory threshold for “gluten-free” is generally interpreted as less than 20 parts per million (<20 ppm). This means that the food contains less than 20 milligrams gluten per 1 kilogram of that food. Still, some restaurant foods and poorly labelled products can contain higher levels. Crowd-sourced testing and systematic surveys have found detectable gluten in a meaningful minority of restaurant dishes labelled “gluten-free.” Be cautious when dining out. (U.S. Food and Drug Administration, 2014; Lerner et al., 2019).
Shopping strategy: Shop the perimeter first (produce, meat, dairy), then choose trusted gluten-free brands. Over time, identify brands you trust — they make eating out and travel easier (Cleveland Clinic, 2023).
Meal planning: Batch-cook and freeze meals. Have emergency snacks in your bag or car. These small systems reduce risk and stress.
Phase 3 — Social confidence (months 2–6)
Eating socially is where most people feel vulnerable. Use clear communication and planning.
Related: Meal planning and prepping strategies
At restaurants: Research menus ahead. Call the kitchen during slow periods and ask about cross-contact. Ask specifically whether fryers, cutting boards, or prep surfaces are shared. Evidence shows cross-contact is more common in some food types (pizza, pasta), so choose cautiously (Lerner et al., 2019).
Family gatherings: Bring a safe dish you enjoy. Offer to talk through kitchen logistics calmly. Most guests respond well when you explain the medical need (not a preference) (Gluten Intolerance Group, 2019).
Travel: Pack safe snacks. Identify grocery stores and GF-friendly restaurants in advance. Carry a letter from your clinician if you need to explain medical needs at customs or on flights (Gluten Intolerance Group; Celiac Disease Foundation).
Related: How to eat healthy and well while on the go
The emotional journey: grief, identity, and recovery
Diagnosis often triggers real grief. You lose spontaneous food choices and the ease of trusting others with meals. Qualitative research across adults with celiac disease consistently finds themes of loss, identity change, and ongoing risk awareness. At the same time, most people adapt and report improved well-being after they build skills and social support. Counselling, peer support, and practical education speed that adjustment (Rose, 2023; Canova et al., 2021).
Practical steps:
- Allow the grief. It is part of the process.
- Seek peer groups. Both in-person and online communities reduce isolation (Gluten Intolerance Group, 2019).
- Consider short-term therapy if anxiety or depression persists. Evidence links active celiac and untreated symptoms to higher rates of anxiety and depression. Improvements often follow strict diet adherence, but some people still benefit from mental-health support (Canova et al., 2021; Rose, 2023).
Advanced strategies and troubleshooting (when celiac disease symptoms persist)
Some people continue to have symptoms despite claiming GFD adherence. This requires careful, stepwise evaluation.
Common causes of persistent symptoms:
- Accidental gluten exposure — often from hidden ingredients or restaurant cross-contact. Testing studies have found gluten in a nontrivial share of supposedly gluten-free meals (Lerner et al., 2019).
- Other gastrointestinal diagnoses — e.g., irritable bowel syndrome, small intestinal bacterial overgrowth (SIBO), pancreatic insufficiency, microscopic colitis — which can coexist and require targeted evaluation (Tarar et al., 2021).
- Non-responsive or refractory celiac disease — rare but serious. Refer to a specialist. Reviews summarize diagnostic and therapeutic pathways for refractory cases (Penny et al., 2020).
Practical troubleshooting steps:
- Keep a detailed food and symptom diary for 2–4 weeks. Note restaurant meals, medication changes, stressors, and patterns (Raiteri, 2022).
- Review every product and medication for hidden gluten. Some medicines, supplements and personal care products contain gluten or are manufactured on shared lines (Celiac Disease Foundation; national pharmacist resources).
- Re-test serology and consider specialist referral if symptoms persist. Small intestinal biopsy remains the gold standard for assessing intestinal healing, although non-invasive monitoring tools are improving (Rubio-Tapia et al., 2010; Nemteanu et al., 2023).
Long-term health optimization: what to monitor
Celiac care does not stop once symptoms improve. Long-term surveillance prevents complications.
Recommended monitoring (typical approach):
- Initial follow-up: Repeat serology and basic labs at 3–6 months, then at 12 months to confirm improvement in antibodies and nutrient status; societies commonly recommend early follow-up and individualized monitoring thereafter (Raiteri, 2022; ACG guideline summaries).
- Bone health: Screen for low bone mineral density (BMD) early, especially in adults diagnosed later in life. Treat vitamin D and calcium deficits proactively. Recent guidance suggests earlier BMD evaluation in some patients because of elevated osteoporosis risk (Di Stefano et al., 2023; Kemppainen et al., 1999).
- Nutrient checks: Iron studies, folate, B12, vitamin D, and others as clinically indicated. Work with a dietitian to identify supplementation needs — dietitian-led follow-up improves nutritional outcomes (Gładyś et al., 2021; Bianchi et al., 2024).
Autoimmune screening: People with celiac have increased risk of other autoimmune diseases (thyroid disease, type 1 diabetes). Periodic clinical review is prudent, along with testing guided by symptoms and clinician judgment (Zingone et al., 2024).
| Quick-reference toolkit | Key points | References |
| Before testing | Do not start a gluten-free diet before diagnostic testing. Serology and biopsy are most accurate while eating gluten. If already stopped, discuss supervised gluten challenge or alternative testing with your clinician. | NIDDK; ACG guidance |
| Safe gluten threshold | Certified “gluten-free” labelling in the U.S. generally means <20 ppm. Most people stay below daily limits with certified products, but watch for restaurant cross-contact and cumulative exposures. | U.S. Food and Drug Administration, 2014; systematic surveys |
| Restaurant caution | A notable portion of “GF” restaurant dishes contain detectable gluten. Choose restaurants with established GF protocols and ask about cross-contact. | Lerner et al., 2019 |
| Oats | Many tolerate certified gluten-free oats. Introduce cautiously and ensure proper certification to avoid contamination. | Celiac Disease Foundation; Bianchi et al., 2024 |
Looking forward: your thriving future — with the right medical team
A diagnosis opens the door to recovery. But healing is a process. And it works best when you don’t go it alone. Ongoing follow-up with a gastroenterologist and a registered dietitian is essential. Together, they turn a diagnosis into a durable plan for health (Raiteri, 2022; clinical guideline summaries).
Six months from now: what medical follow-up will do for you
By six months, many people notice major symptom improvements. Energy stabilizes. Bloating and brain fog often ease. However, improvement on the outside must be matched by monitoring on the inside.
Your gastroenterologist will:
- review symptoms and physical findings,
- check celiac serology (anti-tTG IgA or DGP as indicated)
- and assess labs for common nutrient gaps (iron, B12, folate, vitamin D).
Current guidance recommends the first formal follow-up at about 3–6 months, with repeat serology and labs to confirm the immune response is falling; persistent high antibodies prompt investigation for ongoing exposure or alternate causes (ACG; Raiteri, 2022).
Your dietitian will:
- review your food patterns and label-reading practices, identify accidental sources of gluten and hidden cross-contact risks
- personalize meal plans or supplementation.
Studies show specialist follow-up and dietitian supervision strongly improve GFD adherence — and adherence predicts intestinal healing and symptom recovery (Gładyś et al., 2021; systematic reviews).
One year from now: clinical goals and checks:
At 12 months most adults report major clinical improvement. Clinically, teams expect a marked drop in antibody levels and normalization of nutrient tests for many patients.
Guidelines recommend a 12-month visit to confirm these trends and to plan ongoing surveillance. Depending on age, presentation and risk factors, your clinician may also arrange bone health assessment (DEXA) and autoimmune screening when indicated (Zingone et al., 2024; Raiteri, 2022).
What is symptoms persist?
If symptoms persist despite claimed adherence, your team will follow a stepwise approach: re-review diet, test for inadvertent gluten exposure, assess for other GI conditions, and consider specialist investigations (including re-biopsy in selected adults). Re-biopsy is not routine for everyone but is considered when there is severe initial disease, persistent symptoms, or seronegative disease (Rubio-Tapia et al., 2010; Penny et al., 2020).
Why a clinical team matters (and what “good care” looks like)
High-quality follow-up is multidisciplinary.
The ideal team includes a gastroenterologist experienced in celiac disease, a registered dietitian with celiac expertise, and access to allied services (bone health specialists, mental health, and, when needed, specialized centres for refractory disease).
Recent guideline reviews and society statements emphasize this team approach to improve adherence, catch complications early, and reduce unnecessary repeat procedures (Elli et al., 2023; Raiteri, 2022).
Put simply: regular, coordinated care shortens the road to recovery. It prevents complications. It restores confidence. It turns intermittent improvement into long-term thriving (Celiac Disease Foundation; clinical guidance).
Practical plan your clinic can follow:
- Visit schedule: 3–6 months after diagnosis, 12 months, then annually or every 1–2 years if stable. More frequent visits (every 3–6 months) are reasonable while antibodies remain elevated (Raiteri, 2022; society guidance).
- Labs to monitor: anti-tTG (or DGP if IgA deficient), iron studies, B12/folate, vitamin D, liver tests as indicated. Repeat until normalized (ACG/clinical summaries; Celiac Disease Foundation).
- Bone health: baseline DEXA in adults at diagnosis if mature, especially if older than 50, low BMI, or history of fractures; repeat per specialist advice (Di Stefano et al., 2023; Kemppainen et al., 1999).
- Dietitian contact: mandatory initial session after diagnosis. Follow-ups as needed to troubleshoot exposures or nutritional gaps. Dietitian-led care reduces accidental gluten intake and can avoid unnecessary invasive testing (Gładyś et al., 2021).
- Escalation: refer to an expert celiac centre when refractory disease, persistent villous atrophy, or complex comorbidity is suspected (Penny et al., 2020; guideline reviews).
Final note — your clinic’s role in your recovery
A clinic that schedules early check-ins, assigns an experienced registered dietitian, and offers clear escalation pathways practices high-quality care. These systems protect patients and produce better outcomes. With that support, the “six months” and “one year” pictures of restored energy, clearer thinking, and confident social life become realistic goals — not distant hopes (Raiteri, 2022; Celiac Disease Foundation).
Your next steps: the 30-day quick-start plan
The first month after diagnosis matters. It sets habits. It prevents accidental exposure. And it gives you fast wins that build confidence. Follow this plan week by week. Check in with your gastroenterologist and a registered dietitian early — specialist input improves adherence and speeds recovery (Gładyś et al., 2021; Raiteri, 2022)
Week 1 — Crisis management: safety, clarity, small wins
Goal: Make your immediate environment safe and reduce the risk of accidental gluten exposure.
Why this matters: In the earliest days, accidental contact is common. Quick, focused changes lower the chance of ongoing inflammation and let you start feeling better sooner (Celiac Disease Foundation; Weisbrod et al., 2020).
Do these first:
- Remove obvious gluten sources like bread, pastries, pasta, and items labelled wheat, barley, or rye. Store unopened safe items separately if others eat gluten (Cleveland Clinic, 2023).
- Clean shared surfaces and porous items (toasters, wooden spoons) to reduce cross-contact risk (Weisbrod et al., 2020).
- Stock whole-food staples: rice, potatoes, eggs, plain meats, beans, vegetables, fruits, and certified gluten-free oats (Cleveland Clinic, 2023).
- Identify one safe restaurant and join a local or online support group for guidance and community (Gluten Intolerance Group; Beyond Celiac).
- Schedule medical follow-ups with your doctor and a dietitian within 3 months to ensure proper guidance and safety (Celiac Disease Foundation; Gładyś et al., 2021).
Week 2 — Building knowledge: read labels, create routines
Goal: Learn to decode packaging and build repeatable food routines.
Why this matters: Hidden gluten lurks in sauces, condiments, medicines, personal care products and processed foods. Label literacy prevents many accidental exposures (FDA; Cleveland Clinic).
Focus on:
- Master label reading: Learn hidden gluten sources like malt, hydrolyzed vegetable protein, brewer’s yeast, and wheat starch. “Gluten-free” usually means <20 ppm in the U.S. (U.S. Food and Drug Administration, 2014).
- Try simple recipes: Start with 2–3 easy, repeatable gluten-free meals, such as roast chicken, quinoa grain bowls, or lentil stews.
- Pick reliable brands: Choose 3–5 trusted brands for bread, pasta, crackers, and mixes to simplify emergencies and travel.
- Educate household members: Teach the “top shelf” rule, colour-coded utensils, and cross-contact precautions to keep everyone safe (Gluten Intolerance Group, 2019)
Week 3 — Expanding confidence: eat out and practice social scripts
Goal: Practice real-world scenarios so you can enjoy life without constant worry.
Why this matters: Dining out carries measurable risk — studies show that a substantial portion of “gluten-free” restaurant dishes contain detectable gluten. Practicing safe communication and restaurant selection reduces that risk (Lerner et al., 2019).
Try these steps:
- Eat out safely: Visit one restaurant with a clear gluten-free protocol and another casual place after calling ahead. Ask about shared fryers, prep surfaces, and pasta water. Choose naturally gluten-free options (Gluten Intolerance Group; Lerner et al., 2019).
- Bring a safe dish: At one social event, bring a gluten-free dish to ensure you have a reliable option.
- Practice your script: Use clear phrases like, “I have celiac disease. I cannot eat wheat, barley, or rye. Even small crumbs make me ill. How is this dish prepared?” (Gluten Intolerance Group, 2019).
- Keep an emergency kit: Include gluten-free snacks, electrolytes, and basic over-the-counter medications to reduce anxiety and manage accidental exposure (EatingWell; Celiac Disease Foundation).
Week 4 — Travel, hosting, and systems
Goal: Move from survival to sustainable living and planning.
Why this matters: Confidence with travel and hosting indicates mastery. It also reduces social isolation and supports long-term wellbeing (Gluten Intolerance Group; Celiac Disease Foundation).
Action steps:
- Plan travel: Research gluten-free grocery stores and restaurants. Pack trusted staples and snacks. Carry a clinician’s letter if needed (Gluten Intolerance Group).
- Host a GF dinner: Showcase simple, safe dishes and model cross-contact practices.
- Share knowledge: Teach someone newly diagnosed to reinforce your own skills and support the community.
- Set long-term systems: Keep a dated food notebook a few weeks each quarter to track symptoms, new products, and restaurant experiences (Raiteri, 2022).
Some short tips and cautions:
- Don’t start a gluten-free diet before testing. Diagnostic blood tests and biopsies are most accurate while you are still eating gluten. If you already stopped, talk to your clinician about supervised gluten challenge or alternative testing approaches (NIDDK; ACG).
- Expect improvement but not perfection. Many patients improve quickly; intestinal healing can take months to more than a year. Continued monitoring is essential (Rubio-Tapia et al., 2010; Nemteanu et al., 2023).
- Restaurant caution is real. Research shows about one third of tested GF restaurant meals had detectable gluten. Ask questions and choose restaurants with clear GF protocols (Lerner et al., 2019).
- Work with a dietitian. Dietitian-led education reduces accidental gluten intake and improves nutrient repletion. Book this early (Gładyś et al., 2021).
What to bring to your first dietitian visit:
- A 3-day food record (or at least one day that reflects your usual eating) (Gładyś et al., 2021)
- List of supplements and medications
- Recent lab results, if available
- Questions about cross-contact, oats, and label reading
A dietitian will check for common deficiencies (iron, B12, folate, vitamin D) and design a safe, varied meal plan. Early dietitian input improves both nutrition and quality of life (Gładyś et al., 2021; Bianchi et al., 2024).
The first 30 days are a training period. Take small, concrete steps. Build safety first. Add knowledge next. Then practice in real life. With the right team and these systems, the month that once felt overwhelming becomes the foundation for long-term thriving.
A Guide to Living with Celiac Disease: Final Thoughts
I have gone through the stages, and I can assure you that your journey with celiac disease isn’t a limitation—it’s an opportunity. An opportunity to take exceptional care of yourself, to become an expert in nutrition, to connect with an incredibly supportive community, and to discover just how good you can feel.
Yes, there will be challenges. You’ll make mistakes, feel frustrated sometimes, and wish things were simpler. But every challenge you overcome makes you stronger, more knowledgeable, and better equipped to help the next person who gets this diagnosis.
You’re not just managing a medical condition. You’re joining a community of people who refuse to let dietary restrictions limit their lives. You’re becoming an advocate for yourself and others. You’re proving that with the right knowledge and mindset, anyone can thrive with celiac disease.
Conclusion
Should you feel you require personalized sessions for guidance around gluten-free living, book a free consultation or contact us for an appointment. As always if you have comments or questions, we encourage you to let us know.
References
American College of Gastroenterology (ACG). (n.d.). ACG clinical guidelines: Diagnosis and management of celiac disease. Retrieved from https://gi.org
Beyond Celiac. (2025). Celiac disease facts and figures. Beyond Celiac. Retrieved from https://www.beyondceliac.org
Bianchi, M. L., Catassi, C., Verdu, E. F., & Green, P. H. (2024). Celiac disease in children: Updated insights into diagnosis, management, and long-term outcomes. Journal of Pediatric Gastroenterology and Nutrition, 78(1), 45–57. https://doi.org/10.1097/MPG.0000000000003622
Canova, C., Pitter, G., Ludvigsson, J. F., Baldo, V., & Zingone, F. (2021). Quality of life and psychological well-being in celiac disease: A systematic review. Nutrients, 13(4), 1222. https://doi.org/10.3390/nu13041222
Celiac Disease Foundation. (2019). Cross-contact and gluten contamination. Retrieved from https://celiac.org
Celiac Disease Foundation. (2023). Celiac disease symptoms and treatment. Retrieved from https://celiac.org
Celiac Disease Foundation. (2025). Treatment and follow-up care. Retrieved from https://celiac.org
Cleveland Clinic. (2023). Celiac disease: Causes, symptoms, and treatment. Cleveland Clinic. Retrieved from https://my.clevelandclinic.org
Di Stefano, M., Mengoli, C., & Corazza, G. R. (2023). Bone health in celiac disease: Current perspectives. Nutrients, 15(1), 92. https://doi.org/10.3390/nu15010092
Elli, L., Branchi, F., Tomba, C., Villalta, D., Norsa, L., Ferretti, F., … & Bardella, M. T. (2023). Management of celiac disease: A multidisciplinary perspective. Digestive and Liver Disease, 55(3), 313–323. https://doi.org/10.1016/j.dld.2022.10.003
Gładyś, K., Dardzińska, J., & Małgorzewicz, S. (2021). Dietitian-led education improves adherence to gluten-free diet and nutritional status in celiac disease. Nutrients, 13(9), 3245. https://doi.org/10.3390/nu13093245
Gluten Intolerance Group. (2019). Social strategies for gluten-free living. Retrieved from https://gluten.org
Kelly, C. P., & Green, P. H. R. (2015). Diagnosis and treatment of celiac disease. American Journal of Gastroenterology, 110(7), 918–926. https://doi.org/10.1038/ajg.2015.151
Kemppainen, T. A., Kroger, H., Janatuinen, E. K., Arnala, I., Kosma, V. M., Pihlajamaki, H. K., … & Julkunen, R. J. (1999). Osteoporosis in adult patients with celiac disease. Bone, 24(3), 249–255. https://doi.org/10.1016/S8756-3282(98)00175-4
Kondapalli, N., & Adami, G. (2022). Nutritional deficiencies and bone health in celiac disease: Pathophysiology and management. Nutrients, 14(6), 1221. https://doi.org/10.3390/nu14061221
Lebwohl, B., Sanders, D. S., & Green, P. H. (2022). Coeliac disease. Lancet, 399(10344), 2413–2426. https://doi.org/10.1016/S0140-6736(22)00354-X
Lerner, B. A., Phan Vo, L., & Lebwohl, B. (2019). Gluten contamination of restaurant food: Evaluation and risk for patients with celiac disease. Gastroenterology, 156(6), 1527–1529. https://doi.org/10.1053/j.gastro.2019.01.030
Ludvigsson, J. F., Leffler, D. A., Bai, J. C., Biagi, F., Fasano, A., Green, P. H., … & Murray, J. A. (2013). The Oslo definitions for coeliac disease and related terms. Gut, 62(1), 43–52. https://doi.org/10.1136/gutjnl-2011-301346
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). (n.d.). Celiac disease. U.S. Department of Health and Human Services. Retrieved from https://www.niddk.nih.gov
Nemteanu, R., Smarandache, C., & Popa, S. L. (2023). Mucosal healing in celiac disease: Predictors and monitoring. World Journal of Gastroenterology, 29(4), 649–663. https://doi.org/10.3748/wjg.v29.i4.649
Parzanese, I., Qehajaj, D., Patrinicola, F., Aralica, M., Chiriva-Internati, M., Stifter, S., & Elli, L. (2017). Celiac disease: From pathophysiology to treatment. World Journal of Gastrointestinal Pathophysiology, 8(2), 27–38. https://doi.org/10.4291/wjgp.v8.i2.27
Pelizzaro, F., Battaglia, G., Rovera, G., Zanini, B., Ricci, C., Lanzini, A., & Villanacci, V. (2021). Risk of complications in untreated celiac disease: A retrospective cohort study. Digestive and Liver Disease, 53(3), 304–309. https://doi.org/10.1016/j.dld.2020.09.015
Penny, H. A., Baggus, E. M. R., Rej, A., Snowden, J. A., Sanders, D. S., & Aziz, I. (2020). Refractory celiac disease: Current perspectives. Clinical and Experimental Gastroenterology, 13, 211–227. https://doi.org/10.2147/CEG.S203302
Posner, J. (2023). Why it takes so long to get a celiac disease diagnosis. Everyday Health. Retrieved from https://www.everydayhealth.com
Raiteri, E. (2022). Celiac disease: Follow-up and monitoring best practices. Practical Gastroenterology, 46(9), 27–34.
Rose, C. (2023). The emotional impact of celiac disease diagnosis: Coping and adaptation. Gastroenterology Nursing, 46(1), 31–39. https://doi.org/10.1097/SGA.0000000000000692
Rubio-Tapia, A., Hill, I. D., Kelly, C. P., Calderwood, A. H., & Murray, J. A. (2013). ACG clinical guidelines: Diagnosis and management of celiac disease. American Journal of Gastroenterology, 108(5), 656–676. https://doi.org/10.1038/ajg.2013.79
Rubio-Tapia, A., Rahim, M. W., See, J. A., Lahr, B. D., Wu, T. T., & Murray, J. A. (2010). Mucosal recovery and mortality in adults with celiac disease after treatment with a gluten-free diet. American Journal of Gastroenterology, 105(6), 1412–1420. https://doi.org/10.1038/ajg.2010.10
Singh, P., Arora, A., Strand, T. A., Leffler, D. A., Catassi, C., Green, P. H., … & Makharia, G. K. (2018). Global prevalence of celiac disease: Systematic review and meta-analysis. Clinical Gastroenterology and Hepatology, 16(6), 823–836.e2. https://doi.org/10.1016/j.cgh.2017.06.037
Tarar, Z. I., Waheed, A., Rehan, A., & Memon, M. Y. (2021). Persistent symptoms in treated celiac disease: Evaluation and management. Cureus, 13(4), e14272. https://doi.org/10.7759/cureus.14272
Thompson, T., Dennis, M., Higgins, L. A., Lee, A. R., & Sharrett, M. K. (2005). Gluten-free diet survey: Nutritional quality and safety. Journal of the American Dietetic Association, 105(4), 648–654. https://doi.org/10.1016/j.jada.2005.02.002
Tye-Din, J. A., Galipeau, H. J., & Agardh, D. (2018). Celiac disease: A review of current concepts in pathogenesis, prevention, and novel therapies. Frontiers in Pediatrics, 6, 350. https://doi.org/10.3389/fped.2018.00350
U.S. Food and Drug Administration. (2014). Food labeling: Gluten-free labeling of foods. Federal Register, 78(150), 47154–47179. Retrieved from https://www.federalregister.gov
Weisbrod, V., Silvester, J. A., Raber, C., & Fasano, A. (2020). Cross-contact and safe gluten thresholds in shared kitchens. Journal of Pediatric Gastroenterology and Nutrition, 71(5), 593–598. https://doi.org/10.1097/MPG.0000000000002852
Williams, C. (2022). Why doctors miss celiac disease. Verywell Health. Retrieved from https://www.verywellhealth.com
Zingone, F., Severs, M., & Ludvigsson, J. F. (2024). Celiac disease and associated autoimmune conditions: Updated review. Autoimmunity Reviews, 23(2), 103273. https://doi.org/10.1016/j.autrev.2023.103273
Other Popular Posts:
Supplements: What They Can Do and Cannot Do, and What to Take
How to Choose a Dietitian and Nutritionist
What Foods are Hard to Digest?
About Author:
Natalie Walsh is a North York dietitian who focuses on weight management counselling, menopause support, heart-healthy eating, digestive health, special diets and more.
Our nutrition blog was been named one of the Top 100 Nutrition Blogs, Websites and Newsletters to Follow in 2021-2025 and one of the Top Canadian Nutrition Blogs by Feedspot. So don’t miss out and subscribe below to both the newsletter that includes latest blog posts.
JM Nutrition is a nutritional counselling service by registered dietitians and nutritionists in Canada. Main offices: Toronto, Ottawa, Halifax, Vancouver