On MyMSTeam, more than 200 members report having both multiple sclerosis (MS) and celiac disease. Both are autoimmune conditions, so does their appearance together suggest a connection?

Multiple sclerosis develops when the immune system attacks the nervous system, leading to lesions on myelin — the protective coating surrounding nerve fibers in the brain and spinal cord. People with MS may have comorbidities (coexisting conditions), including other autoimmune disorders such as celiac disease. With celiac disease, consuming gluten — a protein found in wheat, barley, and rye — prompts the immune system to attack the small intestine.

A gluten-free diet is the key treatment for celiac disease, and MyMSTeam members have also discussed the impact of gluten on their MS symptoms. One member wrote, “I’ve been hearing that going gluten free helps with symptoms. I’ve eaten some gluten-free foods and like them. Does anyone else have gluten sensitivity? If anyone is eating gluten free, has it helped your MS symptoms?”

Although some people are living with both multiple sclerosis and celiac disease, research has found a limited connection between the two conditions. Your risk of getting celiac disease is about the same whether you have or have not MS, and having celiac disease doesn’t increase your odds of developing MS. Also, there’s no link between eating gluten and MS. However, if you do have both MS and celiac disease, there are effective ways to manage both conditions.

MS and Celiac Disease: What the Research Says

A 2022 systematic review summarizing studies on more than 31,000 people living with multiple sclerosis found that few of them also had celiac disease. The results showed that their risk of celiac disease was no higher than that of healthy controls (participants who didn’t have MS).

However, an older, smaller study suggested that up to 11 percent of people with MS were affected by celiac disease. The researchers found that people with MS were more likely to have signs of celiac disease in their immune system compared with the general population. Specifically, the participants with MS were more likely to have antibodies to gluten, the protein that can trigger an immune response in people with celiac disease. The findings suggested that a gluten-free diet may be helpful for people with MS.

A 2019 systematic review of research into a gluten-free diet on MS symptoms showed mixed results, pointing to the need for additional studies before guidelines can be developed.

What’s Driving the Link?

Any connection between multiple sclerosis and celiac disease isn’t well understood, but researchers have several hypotheses. For example, the two conditions may share genetic factors. According to the University of Chicago Celiac Disease Center, MS and celiac disease involve some of the same genes.

According to another hypothesis, a lack of “good bacteria” in the digestive tract could make people more likely to have autoimmune diseases like MS, along with the gastrointestinal (GI) inflammation that is characteristic of celiac disease.

Some researchers also hypothesize that overlapping symptoms of celiac disease and multiple sclerosis lead to the underdiagnosis of one condition or the other. Celiac disease is commonly misdiagnosed, and people with both MS and celiac disease can experience delays in getting a proper celiac disease diagnosis.

When Celiac Disease Resembles MS

Celiac disease and MS share several symptoms, because diseases affect the nervous system.

Celiac disease symptoms are caused by inflammation from the immune system’s response to gluten. Common neurological manifestations of celiac disease include:

• Peripheral neuropathy (tingling in the hands and feet)
• Balance problems
• Cognitive impairment (trouble remembering, learning new things, concentrating)
• Joint pain

With multiple sclerosis, many symptoms are related to the immune system attacking the nerves of the central nervous system (CNS), which includes the brain and spinal cord. The main symptoms of MS include:

• Tingling
• Ataxia (lack of coordination)
• Vertigo
• Headache
• Cognitive problems

The shared characteristics may delay a diagnosis of either celiac disease or multiple sclerosis in people living with both conditions.

Shared Causes and Risk Factors

MS and celiac disease share some causes and risk factors. One risk factor is a genetic predisposition — an increased chance of getting the condition if you have first-degree relatives with it.

Multiple Sclerosis

The exact cause of MS is unknown, though researchers believe that genetic and environmental factors play a role. But genetics isn’t always the cause — a person could develop MS even if they have no known family history of the disease. Environmental factors are thought to also contribute to the onset and development of MS.

Factors that affect how the immune system works may trigger MS symptoms or put someone at increased risk of developing MS. Risk factors vary from person to person but may include:

• Age — The typical onset of MS is 20 to 40 years old.
• Race — Studies have shown that people of Northern European ancestry have a higher risk of developing MS.
• Sex — Women are up to three times more likely than men to have MS, according to Mayo Clinic.
• Vitamin D deficiency — Low levels of vitamin D, usually from lack of sunlight, have been linked to MS development.
• Infections — Viruses such as Epstein-Barr are correlated with MS.
• Smoking — People who smoke are more likely to develop relapsing-remitting MS than those who don’t smoke.
• Other autoimmune diseases — The risk of MS is higher in people with type 1 diabetes, inflammatory bowel disease, and psoriasis.

Celiac Disease

In people with celiac disease, consuming gluten causes an immune system response that harms the small intestine and affects its ability to absorb nutrients. This damage can lead to complications such as:

• Anemia (low red blood cells)
• Osteoporosis (bone weakening)
• Migraine
• Epilepsy
• Infertility

Celiac disease is diagnosed with blood tests that look for genetic markers (parts of DNA that help scientists figure out if a person has a certain gene or trait) and antibodies that show an immune response to gluten. A diagnosis is usually confirmed by a small bowel biopsy, an examination of tissue in the small intestine.

Like MS, celiac disease does not have a clear cause. The condition is hereditary (passed through families), but not all people with a genetic predisposition develop celiac disease. According to Mayo Clinic, factors such as infant-feeding practices, gut bacteria, and infections in the gastrointestinal system may contribute to the condition’s development.

In some cases, celiac disease doesn’t become active until after one of the following events:

• Surgery
• Viral infection
• Severe emotional stress
• Pregnancy
• Childbirth

Besides family history, risk factors for celiac disease include having type 1 diabetes, an autoimmune thyroid disease, or Down syndrome. These shared risk factors, particularly the presence of other autoimmune disorders, may help explain why some people have both MS and celiac disease.

Living With MS and Celiac Disease

Living with both multiple sclerosis and celiac disease can be more challenging than living with just one of the conditions. You may need to seek health care from two types of medical specialists: a neurologist who specializes in disease of the brain, spinal cord, and nerves; and a gastroenterologist, who specializes in disorders of the GI tract. You may also need to try different treatments for each condition and make sure your medications don’t negatively interact.

Although having both conditions is difficult, the good news is that MS and celiac disease are both manageable. Having MS does not appear to make symptoms of celiac disease worse and vice versa.

Managing Multiple Sclerosis and Celiac Disease

MS and celiac disease treatments target the symptoms of each condition.

There’s no cure for MS, but there are many treatment options, which vary from person to person depending on the severity and stage of their condition.

Treatments for MS attacks include corticosteroids to reduce nerve inflammation and plasma exchange for new and severe symptoms.

Treatments to slow the progression of MS include injectable and oral disease-modifying therapies. Because they do not contain gluten, MS treatments don’t affect or increase the risk of celiac disease.

Celiac disease is treated with a gluten-free diet. Some people with MS find that a gluten-free diet, including the Wahls Protocol Diet, also improves their MS symptoms. The reason for this effect is not fully understood. There are no current guidelines for dietary treatment of MS, including a gluten-free diet.

Some MyMSTeam members have found a gluten-free diet helpful in managing their symptoms. “I feel that gluten is the problem with neurologic disorders. I tested negative for a gluten allergy, but I have avoided gluten for two months so far with my husband and we feel great,” shared one member.

Another said, “I have been on an anti-inflammatory diet for about three years — no red meat, no processed foods, no dairy, and no gluten.”

It’s important to focus on what you can control when treating and managing these conditions. Making healthy lifestyle changes, like quitting smoking tobacco and reducing stress, may help manage both MS and celiac disease.

Talk With Others Who Understand

When managing MS and celiac disease, joining a support group and talking about your experiences may be helpful. MyMSTeam is the social network for people with MS and their loved ones. More than 197,000 members come together to ask questions, give advice, and share their stories with others who understand life with multiple sclerosis.

Do you have multiple sclerosis and celiac disease? What has helped you manage these conditions? Share your experience in the comments below, or start a conversation by posting on your Activities page.