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Is there a relationship between liver disease and celiac disease? As a dietitian specializing in celiac disease, I’m going to be exploring the connection between the two.
Please note that this nor any of the resources I provide should ever take the place of 1:1 care from your healthcare team. Always discuss any changes to your lifestyle, questions, or concerns you have with them as they are aware of your unique needs.
I also want to acknowledge that many things can contribute to liver disease and damage. For the most part, this post will solely be focused on the ones related to celiac.
That said, let’s get into it…
But first, were you ever taught how to identify gluten properly on a food label? If not, sign up for my FREE USA Food Label-Reading Class where I show you EXACTLY what you need to look for on a food label to stay celiac-safe in the USA. Stop stressing over grocery shopping in just 4-simple steps with this FREE training!
Before we get into the connection between liver disease and celiac disease, we need to understand what celiac is.
Celiac is a serious autoimmune disease that occurs in genetically predisposed people where the ingestion of gluten leads to damage in the small intestine. When people with celiac disease eat gluten (a protein found in wheat, rye, barley, and contaminated foods like oats), their body mounts an immune response that attacks the small intestine.
These attacks lead to damage to the villi, small fingerlike projections that line the small intestine, that promote nutrient absorption. When the villi get damaged, nutrients cannot be absorbed properly into the body.
This inflammatory response to gluten and related nutrient deficiencies can cause a wide variety of symptoms in people with celiac. From bloating, headaches, constipation, joint pain, bone health complications, infertility, weight gain, weight loss, and more.
This can start at any age, and occur in any body, as long as someone is eating gluten and has the celiac genes. If left untreated, celiac disease can lead to additional serious health problems.
Next, to understand the relationship between liver disease and celiac, we need to know what liver disease means.
First, the liver is important in cleansing toxins from the blood, metabolizing macronutrients, making bile to digest fat, and storing energy.
The term “liver disease” refers to any of several conditions that can affect and damage your liver. Per Medline Plus, these conditions include:
Over time, liver disease can cause cirrhosis (scarring). As more scar tissue replaces healthy liver tissue, the liver can no longer function properly. Left untreated, liver disease can lead to liver failure and liver cancer.
When discussing liver disease and celiac disease, you’ll also want to know how doctors evaluate liver function. Typically liver function is checked through a series of tests. These tests include evaluating ALT, AST, ALP, Albumin, Total Protein, Bilirubin, and more
ALT is short for Alanine Transaminase. It’s an enzyme that helps create energy from protein for liver cells. If the liver is damaged, ALT can be released into the bloodstream, causing high ALT in testing.
AST is short for Aspartate Transaminase. It is another liver enzyme that helps make protein usable by the body. Normally present in low levels, when the liver is damaged, you might see a higher AST in testing too.
ALP is short for Alkaline Phosphatase. It helps break down proteins in the liver and bones. Just like with ALT and AST, damage to the liver could cause higher levels in the blood. However, this could also be indicative of other conditions as well.
Albumin and total protein are used to evaluate a lot of different things. When considered with liver labs, it might help unravel the puzzle of liver disease or damage.
Lastly, bilirubin lab tests can also potentially indicate liver disease. Bilirubin is created from the normal breakdown of red blood cells. It passes through the liver and then flushed out of the body through your poop. If it’s not being removed by the liver and body properly, it might cause high levels to build up in the blood.
There are other tests often used to evaluate liver status, this is just a summary of the bigger ones I’ve seen from working in healthcare facilities as a dietitian. Of course, if you’re concerned about your liver health or labs, always discuss them with your healthcare provider. This is not meant to substitute that care.
Now that we know what liver disease and celiac disease are, we can talk about if there’s a connection. From leaky gut giving more work to the liver, to the autoimmune reaction potentially damaging the liver, there is an interesting connection between these two conditions that aren’t often discussed.
So the first question you might have is can celiac disease cause liver disease? Unmanaged or untreated celiac disease can cause damage to the liver. This is suggested to be because of two reasons.
The first reason is that gluten consumption with celiac causes an autoimmune reaction that causes damage to the small intestine. But it’s suggested these elevated antibodies may also cause damage to the liver.
The second reason is that because gluten causes damage to the small intestine with celiac, it causes a leaky gut (medically known as increased intestinal permeability). This is a buzzword in the wellness world but it’s actually quite uncommon for people to have this and if they do have it, it’s because something serious is going on that needs to be addressed, like celiac disease.
This leaky gut from gluten damage with celiac then allows toxins, antigens, and cytokines to build up and stress the liver. Thus, causing damage to the liver with celiac.
In some cases, liver damage may be the sole manifestation of undiagnosed celiac according to Tapia and Murray. And even if it’s not the only manifestation, abnormalities in liver panels are common in patients with celiac disease.
The good news is that a 2007 study found that a gluten-free diet (GFD) leads to the normalization of serum transaminases (AST, ALT) in 75% to 95% of patients with CD, usually within a year of staying gluten-free. Meaning, if you properly go gluten-free, the liver can heal in most cases.
When talking about liver disease and celiac disease, we also have to acknowledge wellness and diet culture. Often, people will say that gluten wreaks havoc on the body. Causing leaky gut and damage to essential organs like the liver.
While gluten can cause leaky gut and damage to the liver with celiac, there’s no evidence to suggest that people without gluten-related disorders will experience this damage from gluten too.
Basically, if you don’t have celiac disease, gluten is likely not the cause of damage to your liver.
Damage to the liver with celiac disease might not always be because of celiac. You might also experience liver disease outside of celiac, like potentially autoimmune hepatitis (AIH).
Autoimmune hepatitis is liver inflammation that occurs when your body’s immune system turns against liver cells. The exact cause of autoimmune hepatitis is unclear, but genetic and environmental factors appear to interact over time in triggering the disease.
Unfortunately, when you have one autoimmune condition such as celiac, you are at risk for another autoimmune condition. Approximately 95% of patients with celiac disease have the gene HLA-DQ2, which has a strong association with the gene HLA-DR3 found in autoimmune hepatitis. Thus, the prevalence of celiac disease in AIH is higher compared to that in the general population and is thought to be around 4-6.4%.
Managing liver disease and celiac disease at the same time can be challenging. A gluten-free diet for celiac can already feel restrictive. Adding on recommendations for liver disease might feel absolutely suffocating.
Remember that 2007 study that found that a gluten-free diet leads to the normalization of serum transaminases (AST, ALT) in 75% to 95% of patients with CD, usually within a year of staying gluten-free? In general, if liver complications are being caused by celiac, going gluten-free should be enough to see improvements.
Additionally, a diet focused on gluten-free fiber sources (including gluten-free whole grains), can be helpful. It’s also important to make sure you’re getting enough protein throughout the day to help manage blood sugars and energy.
Lastly, being mindful of your fat and sugar sources may be helpful. This isn’t to say you can’t have gluten-free french fries or ice cream ever, but that making sure you’re balancing them in your diet is important.
And of course, if you have any questions about balancing your diet for these two conditions, these are just general tips, discuss any individualization with your healthcare team.
Now that we know the power of a generally balanced gluten-free diet for liver disease and celiac, let’s talk about specific foods that may be especially helpful. (NOTE: you do not have to eat these foods to heal but they may help. The most impactful thing you can do to heal celiac-related liver damage is properly avoid gluten).
Don’t like any of the things listed. That’s fine! These are not required to support your liver health, just narrowed down options supported by research. A gluten-free diet has been shown to be effective within a year of strictly following it. So be gentle with yourself.
Additionally, assess safety and suitability for yourself and be sure to discuss and diet changes with your healthcare team to make sure they are safe and appropriate for you. As always, all of my content is meant for educational purposes only.
While not widely discussed, there is a connection between liver disease and celiac disease. Celiac disease is a complex condition that primarily impacts the small intestine but can also impact other organs like the liver.
There are two thoughts behind why celiac can cause liver damage. The first is that a leaky gut caused by gluten can cause damaging particles to slip through to the liver. The second is that the autoantibodies from a celiac reaction may also damage the liver.
Not only can celiac potentially damage the liver but celiac patients are also at risk of autoimmune hepatitis. This is where the body attacks its own liver cells.
A doctor will run a liver panel and determine what steps to take from there. There are a few foods that are beneficial to the liver such as coffee, green tea, grapefruit, beet, and berries. But the most powerful thing you can do for celiac-related liver damage is eat gluten-free diet.
If you need help with knowing what foods are actually gluten-free in the USA. I teach you how to identify gluten on a food label in the USA in just 4-simple steps in my TOTALLY free label-reading class. Click here or the button below to watch the free class now.