People with celiac disease seem to develop one type of fatty liver disease at higher rates. The connection may be at least partially due to weight gain from consuming gluten-free products high in sugar and unhealthy fats.

Celiac disease is an autoimmune disorder triggered by the consumption of the protein gluten, which is found in grains such as wheat, barley, and rye.

Fatty liver disease involves the buildup of fat in your liver. The most common form was previously called non-alcohol-related fatty liver disease (NAFLD), but since 2023 it has been called metabolic dysfunction-associated steatotic liver disease (MASLD). It’s most common in people with overweight or obesity.

Celiac disease has been associated with higher rates of MASLD. The cause of this connection is not entirely clear, but it may be partially due to weight gain as a result of increased fat and sugar intake from gluten-free packaged foods.

Read on to learn more about the connection between fatty liver disease and celiac disease.

MASLD appears to be more common in people with celiac disease than in the larger population.

In a 2022 study, researchers reviewed health data from commercial databases for almost 70 million people and found that 0.2% had a diagnosis of celiac disease.

Among people with celiac disease, 0.7% had MASLD. People with celiac disease had a 3.21 times higher chance of having MASLD than those without celiac disease.

Similarly, in a smaller 2018 study, researchers examined the prevalence of MASLD in 202 people with celiac disease who were following a gluten-free diet and an equal number in a control group.

The researchers found that 34.7% of people with celiac disease had MASLD and that the risk of MASLD in people with celiac disease was 2.9 times higher than in people without celiac disease who were matched for age, sex, and MASLD risk factors.

The relative risk of MASLD was highest in people with celiac disease who did not have overweight or obesity. These people had a 5.71 times higher risk than those without celiac disease who did not have overweight or obesity.

Why might celiac disease and MASLD be related?

The main treatment for celiac disease is a gluten-free diet. Weight gain due to intestinal healing is typical after starting a gluten-free diet. However, many people become overweight when starting a gluten-free diet.

Gluten-free diets have been associated with an increased intake of sugar and fat, especially when consuming packaged foods labeled “gluten-free.” Some researchers have proposed that the poor nutritional composition of many packaged gluten-free foods leads to higher rates of obesity.

Obesity is the top risk factor for NAFLD. About 50% to 60% of people with overweight and 60% to 70% of people with obesity have dyslipidemia, which involves having unhealthy levels of fats in your blood. Dyslipidemia increases your chances of developing MASLD since excess fat may be stored in your liver.

People with one autoimmune disease have a higher risk of developing another.

Celiac disease has been associated with higher rates of autoimmune hepatitis, which is liver damage that develops when your immune system mistakenly attacks healthy cells in your liver. The prevalence of celiac disease in people with autoimmune hepatitis is around 4% to 6.4%.

Celiac disease and elevated liver enzymes

People with celiac disease commonly have mild to moderately elevated liver enzymes, which often return to normal levels after they start a gluten-free diet.

It’s unclear exactly why people with celiac disease have increased liver enzymes, but predisposition to autoimmune hepatitis may play a role. Another possible factor is increased intestinal permeability, which can allow toxins to flood into your bloodstream and through your liver.

MASLD doesn’t usually cause symptoms even if it advances to cirrhosis. Some people with advanced MASLD develop tiredness or pain in the upper right side of their abdomen.

It’s important to contact a doctor if you have potential symptoms of celiac disease and haven’t received a diagnosis. Potential symptoms include:

First, it’s important to treat celiac disease.

If MASLD persists after celiac disease treatment, a doctor may recommend weight loss if you have overweight or obesity. A doctor may also recommend medications such as glucagon-like peptide-1 receptor (GLP-1) agonists to manage associated conditions, including:

Excessive weight gain is common in people with celiac disease after starting a gluten-free diet. Some weight gain is typical and healthy, but developing overweight or obesity can increase your risk of MASLD and other health problems.

Many gluten-free packaged foods contain unhealthy fats and excess sugar. It’s OK to consume these foods occasionally, but you can reduce your risk of MASLD by making whole, unprocessed foods the basis of your diet. Examples include:

  • fruits and vegetables
  • low fat dairy products
  • lean fish, poultry, and meat
  • eggs
  • beans, seeds, and legumes
  • some grains or starches, such as quinoa, rice, and flax

Learn more about eating a gluten-free diet.

People with celiac disease seem to develop MASLD at higher rates than people without celiac disease. The connection may be at least partially explained by excess weight gain in people who consume many highly processed gluten-free foods that are high in sugar and unhealthy fats.

You may be able to reduce your risk of MASLD while following a gluten-free diet by minimizing your intake of processed gluten-free products such as cookies and biscuits. Instead, it’s a good idea to consume mostly whole, unprocessed foods, including fruit, vegetables, and lean fish and meat.