What Recent Research Says About Celiac Disease and the Gluten-Free Diet

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Written by: Janell Chang, MS, Dietetic Intern

Over the past few years, researchers have continued to study celiac disease, other gluten-related conditions, and how a gluten-free diet affects digestive health. While not every question has been answered, there are a few updates that can help people better understand testing, treatment, and everyday nutrition.

 

Understanding Diagnosis1

Celiac disease can show up in many ways. Some people have digestive symptoms such as diarrhea, constipation, bloating, stomach pain, nausea, or unexplained weight loss. Others may notice fatigue, iron-deficiency anemia, mouth ulcers, skin issues, or, in children, poor growth. Because symptoms can vary so much, it is worth talking with a doctor when problems persist without a clear explanation. It is also important not to start a gluten-free diet before testing, since removing gluten too early can affect test results. Doctors usually begin with blood work in adults. Diagnosis is still commonly confirmed with a biopsy of the small intestine. When blood test results and biopsy findings do not clearly match, genetic testing can help rule out celiac disease. 

If celiac disease is ruled out, you may have non-celiac gluten sensitivity or a wheat allergy. Currently, there is no specific test for non-celiac gluten sensitivity. Instead, it is usually considered after celiac disease and wheat allergy have been ruled out, and whether your symptoms improve on a gluten-free diet.

A wheat allergy can be diagnosed by an allergist. However, having a wheat allergy does not automatically rule out celiac disease or non-celiac gluten sensitivity. Following up with your healthcare team for a full evaluation can help you better understand your symptoms and how to manage them. If you are diagnosed with celiac disease, the recommendation is to follow a gluten-free diet and check in regularly with your healthcare team or a registered dietitian. Follow-up monitoring is usually recommended every three to six months during the first year, and then every one to two years after that. There has been some debate about whether follow-up biopsies should be done routinely. While biopsies can provide useful information about healing in the small intestine, they are still invasive procedures.

 

Testing updates

Although biopsy is still considered the standard procedure for diagnosing celiac disease in adults, some guidelines now allow for a no-biopsy diagnosis of celiac disease in certain children.1 In some pediatric cases, when blood antibody levels are very high and confirming tests are positive, a biopsy may not be needed to diagnose celiac disease. Biopsies are still useful for evaluating damage to the lining and understanding the severity of celiac disease. In adults, they remain an important part of diagnosis.

Doctors may use several tools during follow-up visits to track how a person is doing on a gluten-free diet. However, research has shown that certain questionnaires may reflect improvement in a similar way.2 This could one day help reduce the need for frequent blood testing and make follow-up care easier for some patients.

Gluten-Free Diet Components

Following a gluten-free diet can sometimes lead to missing nutrients commonly found in wheat-based products. These include fiber, thiamin, riboflavin, niacin, iron, and folate/folic acid. As gluten-free substitutes become more common and easier to find, research continues to examine how their nutrient content compares with wheat-based foods.

There are many gluten-free grains and plant-based alternatives that can help fill the gaps.  At this time, gluten-free grains and flours are not required to be enriched or fortified in the same way as wheat-based products. With that in mind, here are some options to consider:

  • Amaranth – high in fiber, protein, calcium, and iron
  • Buckwheat (also known as kasha) – high in fiber, B vitamins, iron, magnesium, phosphorus, and zinc
  • Quinoa – high in fiber, protein, vitamin E, copper, iron, magnesium, phosphorus, and zinc
  • Teff – high in protein, calcium, copper, iron, and zinc
  • Flaxseed (seeds or flour) or chia seeds – high in fiber, protein, and thiamin; also contains some folate and iron3
  • Nut flours – generally high in fiber and protein; varying levels of niacin, folate, and iron4

 

Check out this article for a full list of grain and flour alternatives that can help support a more varied diet and reduce the risk of nutrient deficiencies.

It’s important to note that ancient wheat varieties, such as spelt or Kamut®, are still not safe for someone following a gluten-free diet. Some studies suggest that certain ancient wheat grains may contain different forms of gluten than modern wheat. However, they still contain gluten and are not considered safe for people with celiac disease or non-celiac gluten sensitivity. The recommendation remains to avoid all forms of wheat on a gluten-free diet.

Oats can be a helpful substitute for wheat-based cereals, but a small percentage of people may still be sensitive to certain oat proteins. Choosing GFCO-certified oats can help reduce the risk of cross-contact with gluten. At the same time, you know your body best. If oats continue to seem like a trigger, even when using certified gluten-free options, it may be best to avoid them for now.

As always, eating a variety of foods can help reduce the risk of nutrient deficiencies. This is especially important on a gluten-free diet where several grains and grain-based foods must be avoided. Including a range of gluten-free grains and flours can help make sure you are still getting the nutrients often found in wheat-based foods.

 

The Impact of a Gluten-Free Diet on Other Medical Concerns

There has been growing interest in gluten as more people are diagnosed with celiac disease and other gluten-related conditions. Researchers are also beginning to explore whether gluten may play a role in other digestive conditions, such as eosinophilic esophagitis (EoE) and irritable bowel syndrome (IBS). Since gluten can trigger inflammation in some people, this is an important area of study, especially when overlapping conditions may be present. However, because the research is ongoing, we do not recommend eliminating gluten for everyone without guidance. Instead, it is best to speak with a registered dietitian or your healthcare team about the latest research and what next steps make sense for you.

EoE can sometimes be treated with an elimination diet, but the more foods that must be removed, the harder the diet can be to follow. Recent research has looked at two-, four-, and six-food elimination diets, and how manageable they are for patients. 6 The six major allergens commonly linked to EoE symptoms are: cow’s milk, wheat, egg, soy, peanuts/tree nuts, fish, and seafood. Avoiding all six allergens led to the greatest symptom improvement, but many participants found that plan too difficult to maintain. They were usually more successful with less restrictive approaches. In particular, avoiding cow’s milk, wheat, and egg was linked with significant symptom improvement, and people reported that avoiding three foods felt more manageable than avoiding all six.  People who stopped consuming cow’s milk, wheat, and eggs felt the largest decrease in their symptoms.

In a recent study, people with non-constipated IBS followed either a traditional IBS diet, a low FODMAP diet, or a gluten-free diet. Those on the gluten-free diet saw similar improvements to those following the other two approaches. This suggests that gluten may be a trigger for some people with IBS. At the same time, many gluten-free foods are also lower in FODMAP sugars, so the benefit may not come from gluten alone. In some cases, people may feel better because they are reducing both gluten and FODMAPs at the same time.

If you have any questions about any of these updates or are thinking about making changes based on these recommendations, we always suggest checking in with your healthcare team and/or registered dietitian first. They can help you create an approach that is both safe and nutritionally balanced.

References
  1. Raiteri A, Granito A, Giamperoli A, Catenaro T, Negrini G, Tovoli F. Current guidelines for the management of celiac disease: A systematic review with comparative analysis. World J Gastroenterol. 2022;28(1):154-176. doi:doi.org/10.3748/wjg.v28.i1.154
  2. dos Santos Ribeiro C, Harumi Uenishi R, dos Santos Domingues A, et al. Gluten-free diet adherence tools for individuals with celiac disease: A systematic review and meta-analysis of tools compared to laboratory tests. Nutrients. 2024;16(15):2428-2428. doi:doi.org/10.3390/nu16152428
  3. U.S. Department of Agriculture. FoodData Central Food Details: Seeds, flaxseed. USDA Agricultural Research Service. Published April 1, 2019. Accessed March 5, 2026. fdc.nal.usda.gov/food-details/169414/nutrients
  4. U.S. Department of Agriculture. FoodData Central Food Details: Nuts, hazelnuts or filberts. USDA Agricultural Research Service. Published April 1, 2019. Accessed March 5, 2026. fdc.nal.usda.gov/food-details/170581/nutrients
  5. Colombo F, Di Lorenzo C, Biella S, Bani C, Restani P. Ancient and modern cereals as ingredients of the gluten-free diet: are they safe enough for celiac consumers? Foods. 2021;10(4):906. doi:doi.org/10.3390/foods10040906
  6. Dhar A, Haboubi HN, Attwood SE, et al. British Society of Gastroenterology (BSG) and British Society of Pediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) joint consensus guidelines on the diagnosis and management of eosinophilic esophagitis in children and adults. Gut. 2022;71:1459-1487. doi:doi.org/10.1136/gutjnl-2022-327326
  7. Rej A, Sanders DS, Shaw CC, et al. Efficacy and acceptability of dietary therapies in non-constipated irritable bowel syndrome: a randomized trial of traditional dietary advice, the low FODMAP diet, and the gluten-free diet. Clin Gastroenterol Hepatol. 2022;20(12). doi:doi.org/10.1016/j.cgh.2022.02.045