When you're diagnosed with celiac disease, the focus is usually on the gut - bloating, diarrhea, weight loss. But what if your liver enzymes are high, and your doctor says it’s not alcohol, not hepatitis, not fatty liver from obesity? That’s when things get confusing. Turns out, celiac disease and liver problems are more connected than most people realize - and fixing one often fixes the other.
Why Your Liver Shows Up Abnormal with Celiac Disease
Up to 40% of people newly diagnosed with celiac disease have elevated liver enzymes - mostly ALT and AST - even if they feel fine. These aren’t random spikes. They’re a direct signal that something’s off inside. In most cases, the liver isn’t damaged by toxins or viruses. It’s reacting to the same immune chaos happening in the small intestine. Celiac disease isn’t just about gluten hurting the gut. It’s an autoimmune condition where the body attacks its own tissues. That same misfired immune response can target the liver. Studies show that 4-6.4% of people with autoimmune hepatitis also have celiac disease. That’s not coincidence. It’s shared biology. The immune system gets confused. It sees gluten as a threat, then starts attacking liver cells too. There’s also the gut-leakiness factor. When gluten damages the intestinal lining, it creates gaps. Toxins, bacteria, and undigested food particles slip through into the bloodstream. The liver, your body’s main filter, gets flooded. It’s not designed to handle this kind of daily assault. Over time, that leads to inflammation and fat buildup - even in people who aren’t overweight.What Liver Problems Are Common With Celiac Disease?
The most frequent finding? Elevated transaminases. In one study of 67 biopsy-proven celiac patients, 70% had both ALT and AST higher than normal. That pattern is a red flag for celiac-related liver stress. Less common but more serious are conditions like:- Autoimmune hepatitis - where the immune system attacks liver cells directly
- Primary biliary cholangitis - damage to the bile ducts
- Primary sclerosing cholangitis - scarring of bile ducts
- MASLD (metabolic dysfunction-associated steatotic liver disease) - fat accumulation in the liver
How Often Does the Liver Heal?
Here’s the good news: in most cases, the liver heals - if you stick to a strict gluten-free diet. A 2015 study by Dr. Daniel Leffler tracked 100 celiac patients with abnormal liver enzymes. After 18 months on a gluten-free diet, 79% had normal liver function tests. That’s not a fluke. It’s the rule. The liver doesn’t need drugs or surgery. It just needs to be free from gluten-triggered inflammation. But timing matters. Most people see improvement within 6 months. By 12 months, 85% are back to normal. If enzymes haven’t dropped after a year, doctors start looking for other causes - like autoimmune hepatitis or undiagnosed MASLD. That’s why follow-up blood work is non-negotiable.
Why This Gets Missed
Liver enzyme elevations in celiac disease are usually mild - 2 to 5 times the upper limit of normal. That’s not the kind of spike that sends you to the ER. Most doctors assume it’s early fatty liver or a lab error. They don’t connect it to celiac disease unless you’re already diagnosed. Even worse, many people with celiac disease have no digestive symptoms. They’re tired, have joint pain, or get migraines. Their liver enzymes are high, but no one checks for celiac. That’s why 68% of people surveyed by BeyondCeliac.org didn’t know about the liver connection before diagnosis. In fact, 4.7% of people diagnosed with cryptogenic cirrhosis - liver scarring with no clear cause - were later found to have undiagnosed celiac disease. Once they went gluten-free, their liver function improved dramatically. That’s why the European Association for the Study of the Liver now recommends testing all patients with unexplained liver disease for celiac disease.What You Should Do If You Have Celiac Disease
If you’ve been diagnosed with celiac disease, here’s your action plan:- Get liver enzymes checked at diagnosis - ALT, AST, ALP, and bilirubin. Don’t skip this.
- Repeat tests every 3-6 months until numbers normalize. Most do within a year.
- Work with a registered dietitian who specializes in celiac disease. They’ll help you avoid processed gluten-free junk that causes MASLD.
- Focus on whole foods: vegetables, fruits, lean meats, eggs, legumes, quinoa, buckwheat, and brown rice. Skip the gluten-free cookies and pasta.
- If enzymes don’t improve after 12 months, ask for a liver ultrasound and tests for autoimmune hepatitis or other liver conditions.
The Bigger Picture
Celiac disease doesn’t just affect the gut. It’s a whole-body condition. The liver is one of the most common extra-intestinal organs involved. And unlike other liver diseases - viral hepatitis, alcohol damage, or even some forms of fatty liver - celiac-related liver problems can be reversed without medication. Just remove gluten. Let the gut heal. Let the liver recover. The latest research confirms this. A 2025 meta-analysis found that siblings with celiac disease had double the risk of chronic liver disease compared to their unaffected brothers and sisters. That’s a powerful clue: it’s not lifestyle. It’s the disease itself. Researchers are now looking at genetic markers to predict who’s most at risk. Early data suggests people with two copies of the HLA-DQ2 gene (homozygous) have 2.3 times higher risk of liver abnormalities than those with just one copy. That could lead to personalized screening in the future.What’s Next
The medical world is catching on. In 2015, only 65% of doctors ordered liver tests when diagnosing celiac disease. By 2024, that number jumped to 92%. More clinics now include liver panels as standard. Insurance companies are starting to cover follow-up liver scans for celiac patients with persistent enzyme elevations. Pharmaceutical companies are also paying attention. Takeda’s Phase II trial tested a new enzyme therapy designed to break down gluten before it reaches the gut - potentially reducing liver inflammation too. While it’s not a cure, it could help those who accidentally ingest gluten. But the real solution is still simple: eat real food. Avoid processed gluten-free junk. Give your gut and liver time to heal. And don’t ignore those abnormal blood tests. They’re not noise. They’re a message.Can celiac disease cause liver damage?
Yes. Celiac disease can cause liver damage through autoimmune reactions, increased gut permeability, and malabsorption of protective nutrients. Common findings include elevated liver enzymes, fatty liver (MASLD), and in rare cases, autoimmune hepatitis or fibrosis. The good news: strict gluten-free diet adherence reverses these changes in most people.
Do liver enzymes return to normal on a gluten-free diet?
Yes, in about 79% of cases. Most people see improvement within 6 months, and 85% normalize within 12 months. If enzymes don’t improve after a year, further testing for coexisting liver conditions like autoimmune hepatitis is needed.
Is fatty liver common in celiac disease?
Yes - but not always for the reasons you think. Before diagnosis, malabsorption often prevents fat buildup. After going gluten-free, many people eat processed gluten-free foods high in sugar and unhealthy fats, which can trigger MASLD. This is why a whole-food, nutrient-dense gluten-free diet is critical.
Should I get tested for celiac disease if I have unexplained liver problems?
Yes, especially if you have cryptogenic cirrhosis or persistently elevated liver enzymes with no clear cause. Studies show 4.7% of people with unexplained liver disease have undiagnosed celiac disease. Testing is simple - a blood test for tTG-IgA antibodies followed by an endoscopy if positive.
What’s the best diet for liver health with celiac disease?
Focus on whole, unprocessed foods: vegetables, fruits, lean proteins, eggs, legumes, and naturally gluten-free whole grains like quinoa, buckwheat, and brown rice. Avoid gluten-free baked goods, snacks, and sugary cereals. Work with a dietitian who understands celiac disease to avoid hidden sugars and fats that harm the liver.
How often should liver enzymes be checked after a celiac diagnosis?
Check at diagnosis, then every 3-6 months until levels normalize. Most patients normalize within 12 months. If enzymes remain elevated after a year, further testing for autoimmune liver disease or MASLD is recommended.
