Celiac and Other Autoimmune Diseases

Celiac disease is an autoimmune condition. Unfortunately, autoimmune diseases tend to cluster. If you have one, you’re at increased risk for others.

Understanding this helps you know what to watch for and what to discuss with your doctor.

Why Autoimmune Diseases Cluster

The tendency to develop autoimmune disease has a genetic component. The same genetic factors (particularly HLA genes) that predispose to celiac also predispose to other autoimmune conditions.

It’s not that celiac causes other diseases. It’s that the underlying genetic susceptibility can manifest in multiple ways.

Think of it like a loaded gun. Genes are the gun. Environmental triggers pull the trigger. If your genes load multiple guns, multiple triggers can fire.

Conditions Associated with Celiac

Hashimoto’s Thyroiditis / Graves’ Disease

What: Autoimmune thyroid diseases. Hashimoto’s causes hypothyroidism (underactive). Graves’ causes hyperthyroidism (overactive).

Prevalence in celiacs: About 5-10% have thyroid autoimmunity (compared to 2-4% general population).

Symptoms to watch:

• Unexplained fatigue
• Weight changes (gain with Hashimoto’s, loss with Graves’)
• Temperature sensitivity
• Hair changes
• Heart rate changes

Screening: Thyroid function tests (TSH, free T4). Consider periodic screening even without symptoms.

Type 1 Diabetes

What: Autoimmune destruction of insulin-producing pancreatic cells.

Prevalence: About 5-10% of people with Type 1 diabetes also have celiac (much higher than the 1% general population rate).

The relationship often goes the other way: Type 1 diabetes is often diagnosed first, then celiac discovered on screening.

Important: If you’re diagnosed with one, screen for the other.

Dermatitis Herpetiformis

What: A skin manifestation of celiac disease, itchy, blistering rash.

Prevalence: Some estimates suggest 15-25% of people with celiac have or will develop DH.

Relationship: DH is essentially celiac presenting in the skin. The same gluten-triggered immune process causes skin damage instead of (or in addition to) intestinal damage.

Treatment: GF diet. Also often treated with dapsone for symptom control.

Autoimmune Liver Disease

What: Autoimmune hepatitis, primary biliary cholangitis, and related conditions.

Prevalence in celiacs: Elevated, though exact numbers vary by study.

Note: Some celiacs have elevated liver enzymes that normalize on a GF diet, not full autoimmune liver disease, but subclinical liver involvement.

Sjögren’s Syndrome

What: Autoimmune attack on moisture-producing glands, causing dry eyes and dry mouth.

Prevalence in celiacs: Elevated compared to general population.

Symptoms: Dry, gritty eyes; dry mouth; difficulty swallowing.

Other Conditions

Elevated risk (though less strongly associated):

• Rheumatoid arthritis
• Lupus
• Addison’s disease
• Autoimmune myocarditis
• Alopecia areata (autoimmune hair loss)

The clustering effect means many autoimmune conditions appear more frequently in celiacs than expected.

Does GF Diet Help?

This is an important question: if I follow the GF diet strictly, does it reduce my risk of other autoimmune conditions?

The evidence is mixed:

Some studies suggest earlier diagnosis and strict GF diet are associated with lower rates of additional autoimmune diseases.

Other studies show the elevated risk persists regardless of GF adherence.

The current thinking: The genetic predisposition exists regardless. Strict GF diet definitely prevents celiac-specific complications and may reduce overall inflammatory burden. Whether it specifically prevents other autoimmune conditions isn’t definitively proven.

Bottom line: The GF diet is necessary for celiac regardless. Its effect on preventing other conditions is a bonus if it helps, but not the primary reason to be strict.

What To Do

Tell Your Doctor

Ensure your doctor knows you have celiac and understands the autoimmune clustering phenomenon. This should inform screening decisions.

Know Your Family History

Autoimmune diseases in family members increase your risk further.

Screening Considerations

Discuss with your doctor whether periodic screening makes sense for:

• Thyroid function (TSH): many recommend periodic screening
• Blood glucose (for diabetes): especially with symptoms
• Liver function: usually checked with celiac monitoring anyway

Watch for Symptoms

Know the symptoms of common associated conditions. Report new, persistent symptoms to your doctor:

• Unexplained fatigue (beyond what you’d expect from celiac)
• Skin changes (especially blistering rashes)
• Temperature intolerance
• Significant weight changes
• New joint pains
• Dry eyes or mouth

Don’t Panic

Elevated risk doesn’t mean certainty. Most celiacs won’t develop another autoimmune condition.

Awareness is helpful. Anxiety is not. Know what to watch for, get appropriate screening, live your life.

If You Develop Another Condition

If another autoimmune condition is diagnosed:

You’re not alone. Multiple autoimmune conditions is a recognized pattern. There are many of us.

Treatment often helps. Most autoimmune conditions are manageable with appropriate treatment.

The GF diet still matters. Whatever else you’re dealing with, controlling celiac is still important.

Connect with support. For each condition and for the overall experience of living with multiple conditions.

The Bigger Picture

Celiac disease taught me to manage a chronic condition. Those skills transfer if another condition develops:

• Working with doctors
• Understanding your body
• Advocating for yourself
• Adapting to restrictions
• Finding community

The diagnosis is hard. The management becomes routine. You’ve already proven you can do this.

A Note on Prevention

Research continues into whether there’s anything that truly prevents autoimmune disease development. Currently, there’s no proven prevention for most conditions beyond:

• Early celiac diagnosis and treatment (may help)
• Maintaining overall health
• Managing stress
• Avoiding known triggers

We can’t control our genes. We can control how we respond to what develops.