Celiac Disease Causes and Risk Factors (2024)

Celiac disease is an autoimmune condition triggered by gluten, a protein found in grains like wheat, rye, and barley. While it is, in part, hereditary, experts believe other factors need to combine to trigger the disease, especially when it shows up until later in life.

Besides genetics, some risk factors may increase your chances of developing celiac disease.

This article explores the causes, what causes celiac disease later in life, the known risk factors, and what can make celiac symptoms flare up.

What Causes Celiac Disease?

In celiac disease, the gluten you eat triggers white blood cells to attack the tiny, finger-like projections called villi that line your small intestine. Eventually, the villi erode away.

Villi help you digest food, and when they're damaged or gone, you can't absorb vitamins, minerals, and other nutrients from food.

So far, researchers have nailed down two causal factors for celiac disease:

• Genetics
• Eating gluten

However, some people have the genes and eat gluten their whole lives without developing celiac disease. For this reason, researchers believe environmental factors may play a role as well.

Other people don't have a problem with gluten until later in life. Meanwhile, some young children have celiac symptoms as soon as gluten enters their diets.

Genetics: Is Celiac Disease Hereditary?

The two main genes involved in celiac disease are:

• HLA-DQ2
• HLA-DQ8

About 96% of people diagnosed with celiac disease have one or both of those genes. Certain subsets of the HLA-DQ2 gene can increase or decrease your risk.

It's likely that other, as-yet-unidentified genes also play a role.

HLA genes are part of what's called the human leukocyte antigen complex. They help your immune system distinguish between good proteins and those made by infectious agents (viruses, bacteria).

In celiac disease, these genes are faulty. They make your immune system misidentify a protein in gluten—called gliadin—as an infectious agent.

That's why your immune system attacks villi as they're absorbing gluten.

Your Genetic Risk

If you don't have either of these, your odds of developing the condition are very low—but not zero.

About 30% of the population has one of the celiac genes, but only 3% of those people develop the condition. Thus, it's clear other causes are in play.

You only need to inherit these genes from one parent to be at risk for celiac. If you get one from each parent, some evidence suggests your risk is higher.

If you want to know what your personal risk is, your healthcare provider can test you for these genes, or you can even use an at-home test.

The process is simple: a swab collects cells from your mouth or you can spit into a vial. The sample is then sent to a lab for analysis.

What Triggers Celiac Disease Later in Life?

Factors that trigger celiac disease later in life are not yet understood, but some trends have emerged. Some people report symptoms developing soon after:

• Getting pregnant or giving birth
• Having surgery
• A seemingly unrelated illness
• A stressful event or period of time

Researchers are also looking into whether some viral illnesses might trigger some cases of celiac.

Gluten Exposure

It's hard not to be exposed to gluten due to the widespread use of wheat and other gluten-containing grains in the Western diet. They're in:

• Bread and breading
• Baked goods
• Pasta
• Most cereal
• Cookies and crackers
• Some nutritional supplements
• Some toothpaste and cosmetics (like lipstick)

With more awareness of celiac disease and non-celiac gluten sensitivity, a wide array of gluten-free products now exist. That makes it easier to avoid problem foods.

Early Gluten Exposure

Experts can't say for sure whether early gluten exposure triggers celiac disease in some children who carry the genes.

Ongoing research is examing whether feeding patterns in the first year of life make a difference in developing celiac. So far, they've found no associations with breastfeeding or when gluten is first introduced to the diet.

Weak evidence suggests that if a genetically prone child eats a lot of gluten around the time they're weaned from the breast or bottle, it might increase their celiac disease risk.

Celiac Disease Risk Factors

Besides genetics, health-related risk factors for celiac disease include having:

• Lymphocytic colitis (inflammation of the large intestine)
• Down syndrome
• Turner syndrome (a genetic condition involving a missing sex chromosome)
• Type 1 diabetes
• Hashimoto's autoimmune thyroiditis (low thyroid function)
• Addison's disease (also called adrenal insufficiency)
• Thrombocytopenia and other blood disorders

The disease is also more common in people assigned female at birth (AFAB) and in people of northern European ancestry.

Summary

Celiac disease is caused by specific genes, eating gluten, and possibly by some other triggers such as childbirth, surgery, stress, or other autoimmune disorders. However, medical science is still working to understand the roles of these potential causal factors.

So far, neither breastfeeding nor when gluten is introduced to a baby's diet have been shown to play roles in childhood celiac disease. It's usually not clear what triggers celiac later in life.