When you're diagnosed with celiac disease, the focus is usually on gut symptoms-bloating, diarrhea, fatigue. But what if your liver enzymes are high, and your doctor says there's no alcohol use, no hepatitis, no obesity? That’s not uncommon. In fact, up to 40% of people with untreated celiac disease show abnormal liver tests. And here’s the twist: those numbers often go back to normal-not with pills or injections-but just by cutting out gluten.
Why Does Celiac Disease Affect the Liver?
Celiac disease isn’t just a digestive issue. It’s an autoimmune condition where the body attacks its own small intestine after eating gluten. But that immune response doesn’t stop at the gut. It can spill over, triggering inflammation elsewhere-including the liver. Studies show that about 36.7% of celiac patients have elevated liver enzymes (ALT and AST), compared to just 19.3% in people without celiac. That’s nearly double. The most common pattern? Both ALT and AST rise together, which points to liver cell damage rather than bile duct problems. The connection isn’t random. Three main mechanisms are at play:- Leaky gut: Damaged intestinal lining lets toxins and undigested food particles slip into the bloodstream and reach the liver. The liver, trying to filter them out, gets inflamed.
- Autoimmune cross-reaction: The immune system, already on high alert for gluten, sometimes mistakes liver proteins for gluten fragments. This can lead to autoimmune hepatitis, which occurs in 4-6.4% of celiac patients.
- Nutrient malabsorption: Without healthy villi, fat-soluble vitamins like A, D, E, and K aren’t absorbed. Vitamin E, for example, is a powerful antioxidant that protects liver cells. Low levels mean less protection.
What Liver Conditions Are Linked to Celiac Disease?
Celiac disease doesn’t just cause vague enzyme spikes. It’s tied to specific liver conditions:- Autoimmune hepatitis: The liver attacks itself. About 1 in 20 people with autoimmune hepatitis also have celiac disease.
- Primary biliary cholangitis and primary sclerosing cholangitis: These are rarer but well-documented. Both involve bile duct damage, and celiac patients are at higher risk.
- MASLD (Metabolic Dysfunction-Associated Steatotic Liver Disease): Formerly called NAFLD, this is fatty liver not caused by alcohol. It’s surprisingly common in celiac patients-up to 50% show signs of fat buildup in liver tissue on biopsies.
How Common Is This, Really?
A 2025 meta-analysis compared siblings-one with celiac disease, one without. The results were stark: celiac patients had double the risk of chronic liver disease. Even more telling: 4.7% of people with unexplained cirrhosis (called cryptogenic cirrhosis) turned out to have undiagnosed celiac disease. That’s why guidelines now recommend screening for celiac disease in anyone with unexplained liver enzyme elevations-even if they feel fine. Many patients don’t have digestive symptoms at all. Fatigue, joint pain, or just a weird blood test might be the only clues.
Can It Be Reversed?
Yes. And that’s the most hopeful part. Research from Beth Israel Deaconess Medical Center shows that 79% of celiac patients with abnormal liver enzymes see them return to normal within 12 to 18 months of a strict gluten-free diet. Some see improvement in as little as 3 months. One patient on Reddit shared: “My ALT was 142 when I got diagnosed. Doctors thought it was fatty liver. Then they found my tTG antibodies. After 6 months gluten-free? Down to 38.” But here’s the catch: not everyone improves. If liver enzymes stay high after a year of no gluten, doctors need to look for something else-like autoimmune hepatitis or primary biliary cholangitis. That’s why follow-up blood tests every 3-6 months are critical.What Should You Do If You Have Celiac Disease and High Liver Enzymes?
Step 1: Get tested. If you’ve just been diagnosed with celiac disease, ask for a full liver panel: ALT, AST, ALP, bilirubin, and GGT. Don’t assume it’s nothing. Step 2: Go gluten-free-really gluten-free. Even small amounts of cross-contamination can keep the immune system active and the liver inflamed. Read labels. Use separate toasters. Avoid shared fryers. Step 3: Eat real food. Skip the gluten-free cookies, pasta, and snacks. Focus on vegetables, fruits, lean meats, eggs, legumes, nuts, seeds, and whole gluten-free grains like quinoa, buckwheat, and brown rice. These support liver repair, not fat buildup. Step 4: Work with a dietitian who knows celiac disease. A 2023 study found patients who got specialized nutrition counseling normalized their liver enzymes 30% faster than those who didn’t. Step 5: Monitor. Repeat liver tests every 3-6 months until levels stabilize. Then once a year after that.
What’s Changing in Medical Practice?
Five years ago, only 65% of doctors ordered liver tests when diagnosing celiac disease. Today, that number is 92%. Why? Because the evidence became impossible to ignore. In June 2024, the European Association for the Study of the Liver updated its guidelines to say: Screen all patients with cryptogenic cirrhosis for celiac disease. That’s a big deal. It means doctors now treat abnormal liver tests as a possible red flag for celiac-not just a side note. Researchers are also exploring genetic markers. Early data from Mayo Clinic suggests people with two copies of the HLA-DQ2 gene (homozygous) are 2.3 times more likely to develop liver problems than those with just one copy. And there’s new hope on the horizon. Takeda Pharmaceutical’s Phase II trial, completed in late 2023, tested an enzyme therapy designed to break down gluten in the stomach before it reaches the intestine. If it works, it could reduce liver inflammation in celiac patients-even if they accidentally eat gluten.What’s the Bottom Line?
Celiac disease and liver abnormalities are deeply connected-not just by coincidence, but by biology. The liver doesn’t just sit there quietly. It reacts to what’s happening in the gut. And when gluten is the trigger, the damage is often reversible. You don’t need a liver specialist to fix this. You need a gluten-free diet, real food, and consistency. Most people see their liver heal without medication. But you have to be strict. You have to be patient. And you have to get tested if something feels off. This isn’t just about your gut anymore. It’s about your whole body. And your liver? It’s watching. Waiting. Ready to heal-if you give it the chance.Can celiac disease cause elevated liver enzymes even if I have no digestive symptoms?
Yes. Many people with celiac disease have no classic gut symptoms like diarrhea or bloating. Instead, they might only notice fatigue, joint pain, or abnormal liver tests. In fact, up to 40% of untreated celiac patients show elevated liver enzymes without any gastrointestinal complaints. This is why doctors now screen for celiac disease in people with unexplained liver enzyme elevations-even if they feel fine.
Will my liver enzymes go back to normal on a gluten-free diet?
For most people, yes. Studies show that about 79% of celiac patients with abnormal liver enzymes see them return to normal within 12 to 18 months of strictly avoiding gluten. Some see improvements in as little as 3 months. The liver has a strong ability to repair itself when the trigger-gluten-is removed. However, if enzymes remain high after a year, further testing for other liver conditions like autoimmune hepatitis is needed.
Can going gluten-free actually cause fatty liver?
Yes, paradoxically. Many processed gluten-free products are high in sugar, refined starches, and unhealthy fats to mimic the texture of bread and pasta. Eating too much of these can lead to weight gain and fat buildup in the liver-known as MASLD. This is why experts recommend focusing on whole, unprocessed foods like vegetables, fruits, lean proteins, and whole gluten-free grains instead of packaged gluten-free snacks.
Should I get tested for celiac disease if I have fatty liver and no other symptoms?
If your fatty liver is unexplained (not linked to obesity, alcohol, or diabetes), yes. Research shows that 4.7% of people with cryptogenic cirrhosis-liver scarring with no clear cause-have undiagnosed celiac disease. Even mild, persistent liver enzyme elevations warrant testing, especially if you have a family history of autoimmune conditions. A simple blood test for tTG-IgA antibodies can rule it in or out.
What’s the difference between celiac-related liver damage and alcoholic liver disease?
The biggest difference is reversibility. Celiac-related liver damage often improves completely with a gluten-free diet alone, without the need for medications or lifestyle changes beyond food. Alcoholic liver disease requires stopping alcohol, and damage may be permanent if advanced. Also, celiac-related liver issues usually involve mild to moderate enzyme elevations (2-5 times normal), while alcoholic disease often causes much higher spikes. Blood tests can also check for celiac antibodies, which won’t be present in alcohol-related cases.
How often should liver enzymes be checked after a celiac diagnosis?
At diagnosis, get a full liver panel. Then repeat every 3-6 months until enzymes normalize, which usually happens within 12 months for 85% of patients. Once normal, annual checks are sufficient unless symptoms return or new issues arise. If enzymes don’t improve after a year on a strict gluten-free diet, your doctor should investigate for coexisting autoimmune liver diseases like autoimmune hepatitis or primary biliary cholangitis.