A new virtual education series, Foundations of Celiac Disease, is working to address a major gap in care: many individuals diagnosed with celiac disease receive little to no formal nutrition guidance after diagnosis.
Developed by the Celiac Disease Foundation Dietitian Advisory Council, the free, multi-session program provides evidence-based education on how to manage a gluten-free diet and navigate long-term care. It is especially designed for those who lack access to specialized celiac centers or nutrition counseling.
Today’s session focused on what those with celiac disease can expect after diagnosis and how to manage ongoing symptoms.
One of the main takeaways was that healing after starting a gluten-free diet takes time.
Symptoms such as fatigue, bloating, abdominal pain, and irregular bowel movements may continue for months while the intestine heals. Blood markers can also remain elevated early on, which does not necessarily indicate poor disease control.
The speakers emphasized that not all symptoms are caused by gluten exposure.
Another important point was that symptoms do not always reflect disease activity.
Some individuals may have little or no noticeable symptoms after gluten exposure, but intestinal damage can still occur. Over time, repeated exposure may increase the risk of complications such as malnutrition and bone loss.
While occasional exposure may happen, consistent exposure over time is the greater concern.
Unintentional gluten exposure remains common, even for those carefully following the diet. Cross-contact, hidden ingredients, and miscommunication in food preparation are frequent sources.
For symptom management, the guidance focused on supportive care rather than quick fixes. Hydration, rest, and gentle foods (such as soft-cooked vegetables, soups, and smoothies) were recommended. Small, practical strategies such as sipping fluids rather than drinking large amounts at once, or choosing electrolyte drinks with sugar for better absorption, were also discussed. The session also cautioned against common misconceptions.
Detoxes, fasting, activated charcoal, and “gluten-digesting” enzyme supplements were not supported by evidence and may create a false sense of protection.
Finally, speakers emphasized the importance of ongoing follow-up care, including regular blood work to monitor nutrient levels (such as iron, B vitamins, and vitamin D), screening for related conditions like thyroid disease, and working with a healthcare team when possible.
Key Questions from Attendees
Is there such a thing as “mild” celiac disease? Speakers clarified that celiac disease is not classified as mild or severe. A diagnosis is considered definitive regardless of symptom severity, and even individuals with minimal symptoms can have significant intestinal damage.
What conditions should people with celiac disease be monitored for? Common areas of follow-up include nutrient deficiencies (such as iron, B vitamins, and vitamin D), thyroid disease, bone density issues, and other autoimmune conditions. Routine blood work and, in some cases, bone density scans may be recommended.
Who should be part of a care team for celiac disease? Core providers typically include a primary care physician, a gastroenterologist, and a dietitian, with additional specialists involved depending on symptoms (e.g., dermatology, neurology, or mental health support).
Are over-the-counter medications safe after gluten exposure? Standard symptom-relief medications (such as those for pain, nausea, or diarrhea) are generally considered appropriate, but patients are encouraged to confirm options with their healthcare provider. In contrast, supplements marketed to “neutralize” gluten are not supported by evidence.
Do medications need to be gluten-free? Most medications are gluten-free, and gluten-containing medications are considered extremely rare. Patients are advised to communicate their diagnosis to providers but do not need to assume medications are a common source of exposure.
What if someone with celiac disease cannot afford a dietitian? Speakers pointed to free resources, including webinars, nonprofit organizations, and even grocery store dietitians, as alternative ways to access reliable guidance.
