Celiac Disease and Liver Abnormalities: What Links Them

When you’re diagnosed with celiac disease, the focus is usually on your gut - bloating, diarrhea, weight loss. But what if your liver is also sending warning signs? Many people don’t realize that celiac disease doesn’t just mess with the small intestine. It can quietly affect the liver, too. In fact, up to 40% of people with untreated celiac disease show abnormal liver enzyme levels before they even know they have the condition. And here’s the surprising part: for most, the fix isn’t a pill. It’s removing gluten.

Why Does Celiac Disease Affect the Liver?

The link between celiac disease and liver problems isn’t random. It’s biological. When someone with celiac eats gluten, their immune system attacks the lining of the small intestine. But that immune response doesn’t stay confined. It can cross-react with liver tissue, especially in people who carry certain genetic markers like HLA-DQ2 homozygosity - which doubles the risk of liver complications.

Another major player is gut permeability. A damaged intestine lets toxins, bacteria, and undigested food particles leak into the bloodstream. These travel straight to the liver via the portal vein. The liver, trying to clean up the mess, gets inflamed. Over time, this can lead to fatty buildup, scarring, or even autoimmune liver diseases like autoimmune hepatitis.

Malabsorption plays a role too. Celiac disease damages the villi - tiny finger-like projections that absorb nutrients. Without them, the body can’t absorb fat-soluble vitamins like E and D, which protect the liver. Low levels of these vitamins leave the liver more vulnerable to damage.

What Do Liver Abnormalities Look Like in Celiac Patients?

The most common sign is elevated liver enzymes - specifically ALT and AST. In one study of 67 biopsy-proven celiac patients, 70% had both ALT and AST higher than normal. About 21% had only ALT elevated, and 9% had only AST. These levels are usually mild to moderate - often 2 to 5 times above the upper limit of normal. That’s not high enough to trigger panic, but it’s high enough to be ignored… until it’s not.

The liver conditions most often linked to celiac disease include:

• Non-alcoholic fatty liver disease (now called MASLD) - found in 25% to 50% of untreated celiac patients
• Autoimmune hepatitis - about 4% to 6.4% of people with autoimmune hepatitis also have celiac disease
• Primary biliary cholangitis and primary sclerosing cholangitis - rarer, but strongly associated

Even more telling: about 10% to 15% of celiac patients show early signs of liver fibrosis on biopsy. That’s scarring. Left unchecked, it can lead to cirrhosis.

How Common Is This? The Numbers Don’t Lie

A 2025 meta-analysis compared siblings - one with celiac, one without. The results were stark: celiac patients had double the risk of chronic liver disease. Even more surprising, 4.7% of people diagnosed with cryptogenic cirrhosis (liver failure with no clear cause) turned out to have undiagnosed celiac disease. That’s not a coincidence. It’s a red flag.

And the trend is growing. Since 2023, when MASLD replaced NAFLD as the official term, researchers have found a stronger connection between metabolic dysfunction and celiac disease. Why? Because many people with celiac gain weight after going gluten-free - not from eating healthier, but from swapping bread and pasta for processed gluten-free snacks packed with sugar and unhealthy fats. That’s a recipe for fatty liver.

Can You Fix It? Yes - But Only If You Act Fast

The good news? For most people, the liver damage caused by celiac disease is reversible. A 2015 study by Dr. Daniel Leffler tracked 100 celiac patients with elevated liver enzymes. After 18 months on a strict gluten-free diet, 79% saw their liver enzymes return to normal. That’s nearly 8 out of 10 people - no medication needed.

But timing matters. The longer you wait, the harder it gets. Patients who start the gluten-free diet within six months of diagnosis normalize their enzymes 30% faster than those who delay. And if enzymes haven’t improved after a year? That’s a signal to dig deeper. You might have another condition - like autoimmune hepatitis - that needs separate treatment.

Here’s what the guidelines recommend:

1. Check liver enzymes at diagnosis - not optional, standard practice now
2. Repeat tests every 3 to 6 months until levels normalize
3. If enzymes stay high after 12 months, test for autoimmune liver diseases

And here’s the catch: many doctors still don’t check liver enzymes when diagnosing celiac. In 2015, only 65% of clinics did. By 2024, that number jumped to 92%. Progress - but not universal. If your doctor doesn’t mention it, ask.

Gluten-Free Doesn’t Mean Healthy - The MASLD Trap

This is where things get tricky. Going gluten-free often means eating more packaged foods - gluten-free crackers, cookies, pasta, bread. These are usually high in refined carbs, sugar, and unhealthy fats. For someone with celiac, this can trigger MASLD - fatty liver - even if they’re avoiding gluten.

One patient on Reddit shared: "My ALT was 142 when I was diagnosed. My doctor said it was fatty liver. I went gluten-free, ate all the gluten-free snacks, and my weight went up. My ALT didn’t drop - it got worse."

That’s the paradox. The treatment for celiac can cause the very problem it’s supposed to fix.

The solution? Eat real food. Focus on:

• Fruits and vegetables
• Lean meats, fish, eggs
• Gluten-free whole grains like quinoa, buckwheat, brown rice
• Healthy fats - avocado, olive oil, nuts

Work with a dietitian who specializes in celiac disease. Studies show patients who do this normalize liver enzymes faster and avoid weight gain.

What If Your Liver Doesn’t Improve?

If your enzymes stay high after 12 months on a strict gluten-free diet, it’s time to suspect another condition. Autoimmune hepatitis is the most common culprit - and it’s treatable, but not with diet alone. You’ll need medication like steroids or immunosuppressants.

Other possibilities: primary biliary cholangitis, viral hepatitis, or even undiagnosed alcohol use. Your doctor should order:

• Autoantibody tests (ANA, SMA, AMA)
• Ultrasound or FibroScan to check for liver stiffness
• Possible liver biopsy if needed

Don’t assume it’s just "celiac liver." Rule out the rest.

What’s Changing in 2025?

Research is accelerating. The European Association for the Study of the Liver now recommends screening all patients with cryptogenic cirrhosis for celiac disease. That’s huge. It means if your liver fails and no one can explain why, they’ll test you for gluten sensitivity.

Researchers at the University of Helsinki are tracking 500 celiac patients over 10 years to see if how long you ate gluten before diagnosis predicts liver damage. Early data suggests the longer you go undiagnosed, the higher your risk.

And there’s new hope on the horizon. Takeda Pharmaceutical’s Phase II trial, completed in late 2023, tested an enzyme therapy that breaks down gluten in the gut before it triggers an immune response. If it works, it could reduce liver inflammation in celiac patients who accidentally ingest gluten.

Genetic research is also moving forward. People with two copies of the HLA-DQ2 gene (homozygous) are 2.3 times more likely to develop liver abnormalities than those with one copy. That could one day help doctors identify high-risk patients before damage starts.

What Should You Do?

If you have celiac disease:

• Get your liver enzymes checked at diagnosis - and every 3 to 6 months after
• Follow a whole-food, nutrient-dense gluten-free diet - not the processed kind
• Work with a celiac-specialized dietitian to avoid MASLD
• If enzymes don’t drop after a year, push for autoimmune liver testing
• Don’t ignore fatigue or nausea - they can be signs of liver stress

If you have unexplained liver problems - especially fatty liver or cryptogenic cirrhosis - ask: Could this be celiac? A simple blood test for tTG antibodies could change everything.

The liver doesn’t scream. It whispers. But if you’re listening - and you’re gluten-free - it can heal.