COVID and Celiac: The COVID-Induced Celiac Pandemic That Never Happened
COVID has caught me again, so I am not going to be doing much today.
But while I sit here feeling sorry for myself, let’s talk about an interesting piece of celiac research history.
Early in the pandemic, researchers wondered whether COVID-19 might trigger celiac disease and lead to a noticeable increase in new cases.
The concern was reasonable.
Viral infections have long been investigated as possible environmental triggers for autoimmune diseases. COVID-19 can affect the gastrointestinal tract, cause inflammation and disrupt the intestinal barrier—all things that could theoretically matter in the development of celiac disease.
Researchers had a biologically plausible question:
Could SARS-CoV-2 infection help activate celiac disease in someone who was already genetically susceptible?
The answer was not obvious in 2020.
Several years later, however, the expected wave of new celiac diagnoses has not clearly appeared.
Why researchers thought COVID might trigger celiac disease
Celiac disease requires more than simply eating gluten.
A person generally needs compatible genetics, exposure to gluten and an immune system that begins responding to gluten inappropriately. But researchers still do not completely understand what causes that immune response to begin when it does.
Infections have therefore received considerable attention as possible environmental triggers.
Some gastrointestinal infections have been associated with an increased likelihood of later developing celiac disease. Researchers have also investigated viruses including rotavirus, reovirus and enteroviruses.
COVID raised similar questions because the virus does not affect only the lungs.
Cells lining the small intestine express ACE2 receptors, which SARS-CoV-2 uses to enter cells. Some people with COVID experience diarrhea, vomiting, abdominal pain and other gastrointestinal symptoms. Infection can also produce inflammation and changes in intestinal permeability.
A 2023 review from researchers at the Columbia University Celiac Disease Center described the proposed mechanism: inflammation caused by SARS-CoV-2 in intestinal cells might theoretically disturb the intestinal barrier and contribute to celiac disease in a genetically susceptible person.
At the time, though, this remained a hypothesis. There was not yet population-level evidence showing that COVID was actually causing more celiac disease.
The large Swedish study found no increased risk
A nationwide Swedish study published in 2023 examined whether people who had documented COVID-19 were subsequently more likely to be diagnosed with celiac disease.
Researchers identified more than 85,000 people with confirmed COVID-19 and compared them with more than 430,000 people without a recorded COVID infection.
The incidence of verified celiac disease was:
- 21.1 cases per 100,000 person-years among people who had COVID-19
- 22.4 cases per 100,000 person-years among people without documented COVID-19
Those rates were essentially the same.
The researchers found no increased risk even when they examined different time periods following infection. Their conclusion was straightforward: COVID-19 did not appear to be a risk factor for developing celiac disease.
Read the full study:
The Risk for Celiac Disease After COVID-19 Infection
PubMed record:
The Risk for Celiac Disease After COVID-19 Infection—PubMed
That is strong evidence against the idea that COVID produced a broad surge in clinically recognized celiac disease.
It does not prove that an infection could never contribute to the development of celiac disease in one individual. Population studies are designed to detect patterns across large groups, not reconstruct every biological event that occurred in a particular person.
But if COVID were a major new trigger of celiac disease, we would expect to see a meaningful difference between infected and uninfected populations.
This study did not find one.
A newer study means the question is not completely closed
Science rarely provides the satisfaction of an absolutely final answer.
In 2025, researchers published results from the Swedish TRIAD screening study, which looked at adolescents between 13 and 16 years old.
The researchers tested participants for evidence of previous SARS-CoV-2 infection and screened them for autoimmunity associated with celiac disease, type 1 diabetes and thyroid disease.
They reported a potential association between previous SARS-CoV-2 infection and screening-detected celiac autoimmunity.
Read the study:
Risk of Celiac Disease, Type 1 Diabetes, and Thyroid Disease Autoimmunity During the SARS-CoV-2 Pandemic in South of Sweden
PubMed record:
TRIAD Study—PubMed
That finding deserves attention, but it does not overturn the earlier population study.
The 2025 study found an association with screening-detected autoimmunity. In other words, researchers found celiac-related antibodies through population screening.
That is not exactly the same outcome as demonstrating a wave of newly diagnosed, biopsy-confirmed celiac disease caused by COVID.
Celiac autoantibodies can be an important sign of developing disease, but an association between previous infection and positive screening results does not, by itself, establish that COVID caused the autoimmunity.
There may also be differences in who was infected, who developed measurable antibodies, who participated in screening and when testing occurred.
The authors appropriately concluded that additional research is needed.
Did COVID cause more celiac disease?
The most accurate answer right now is:
COVID has not been shown to cause the widespread increase in confirmed celiac disease that researchers initially feared.
A large population study found no increased risk of verified celiac disease after COVID infection.
A newer adolescent screening study found a possible association with celiac autoantibodies, which means the question should remain open rather than being declared permanently settled.
Both findings can be true.
One study asked whether people with documented COVID were later diagnosed with verified celiac disease at higher rates.
The other looked for autoimmune markers through active screening in a particular adolescent population.
Those are related questions, but they are not identical questions.
COVID may also have changed when celiac disease was diagnosed
The pandemic made celiac disease statistics more complicated for another reason: many people delayed medical care.
Endoscopies were postponed. Routine appointments moved online or were canceled. Some patients avoided healthcare settings. Others may have had symptoms for longer before being evaluated.
That means changes in diagnosis numbers during and after the pandemic do not automatically tell us whether COVID biologically triggered celiac disease.
A later increase in diagnoses could represent:
- Cases missed during lockdowns
- Delayed endoscopies
- People returning to medical care
- Greater awareness of gastrointestinal symptoms
- More active screening
- A true change in disease incidence
- Some combination of those factors
Diagnosis rates are not always the same thing as disease-development rates.
That distinction matters.
What this research does—and does not—tell us
This research does not prove that infections are irrelevant to celiac disease.
It does not prove that no individual developed celiac disease after having COVID.
It also does not tell a person exactly why their celiac disease became active when it did.
Celiac disease can exist silently before symptoms become obvious. A major infection may lead someone to notice symptoms, seek medical care or receive testing for a disease that was already developing.
The fact that celiac disease was diagnosed after COVID does not automatically mean COVID caused it.
“After” and “because of” are not interchangeable.
What the evidence currently tells us is narrower:
COVID has not produced a clearly demonstrated population-wide surge in confirmed celiac disease.
This is what science is supposed to do
Researchers began with a reasonable concern.
They proposed a plausible biological mechanism.
Then they collected data.
The strongest population evidence did not show the dramatic increase that had been feared. Later screening research raised a smaller and more nuanced question that still deserves investigation.
That is not science failing to make up its mind.
That is science working.
Evidence accumulates. Questions become more specific. Early theories are supported, rejected or narrowed.
We make the best decisions we can using the body of evidence available today.
Then we remain willing to change our understanding when better evidence requires it.
That is the best any of us can do.
FAQ
Can COVID-19 cause celiac disease?
Current research has not shown that COVID-19 causes a broad increase in confirmed celiac disease. A large Swedish population study found similar celiac diagnosis rates among people with and without documented COVID-19.
Can a viral infection trigger celiac disease?
Viral infections are being investigated as possible environmental contributors to celiac disease in genetically susceptible people. An association does not necessarily prove that a particular infection directly caused the disease.
Why was COVID suspected as a celiac trigger?
COVID can affect intestinal cells, cause gastrointestinal inflammation and alter the intestinal barrier. Researchers therefore considered whether infection might contribute to the development of celiac disease.
Did celiac disease diagnoses increase during the pandemic?
Diagnosis patterns were disrupted by postponed endoscopies, delayed appointments and reduced access to healthcare. Changes in recorded diagnoses do not necessarily represent changes in the number of people biologically developing celiac disease.
What did the 2025 study find?
The 2025 TRIAD study found a possible association between prior SARS-CoV-2 infection and screening-detected celiac autoimmunity in adolescents. It did not establish that COVID caused a widespread increase in confirmed celiac disease.
Sources
- Lexner J, et al. The risk for celiac disease after COVID-19 infection. BMC Gastroenterology. 2023.
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PubMed - Lind A, et al. Risk of celiac disease, type 1 diabetes, and thyroid disease autoimmunity during the SARS-CoV-2 pandemic in South of Sweden: insights from the TRIAD study. Autoimmunity. 2025.
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PubMed - Cohen BS, Lebwohl B. COVID-19 and celiac disease: a review. 2023.
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