Does Spain have a lot of celiacs? Unpacking celiac disease prevalence and diagnosis rates

October 29, 2025 •

3 min read

While the global prevalence of celiac disease is estimated at around 1% of the population, Spain shows comparable rates, though a significant portion of cases remain undiagnosed. This underdiagnosis is a critical issue that makes it difficult to definitively answer, 'Does Spain have a lot of celiacs?'. The increasing trend in diagnosed cases suggests growing awareness, but the full picture is more complex.

Quick Summary

Spain's celiac disease prevalence is similar to other European countries, but underdiagnosis is a major issue, particularly among adults, despite recent increases in awareness and diagnosis rates. The rise in diagnosed cases is more about improved screening than a sudden surge in the condition.

Key Points

Prevalence in Line with Europe: Spain has a celiac disease prevalence estimated around 1% of the population, comparable to the overall European average.
Significant Underdiagnosis: A large portion of celiac cases in Spain remain undiagnosed, particularly in the adult population, despite increasing diagnosis rates.
Increasing Diagnosis Rates: Incidence rates for celiac disease have been on the rise in Spain, primarily due to increased clinical suspicion and improved diagnostic testing.
Challenges of a Gluten-Free Diet: While awareness is growing, celiacs in Spain face difficulties with the higher cost of gluten-free products and potential cross-contamination when eating out.
Prevalence vs. Unnecessary Diets: Studies show a notable percentage of the Spanish population follows a gluten-free diet without a medical diagnosis, which can complicate social awareness and support efforts.
Reliable Information is Crucial: Due to the wide variability of symptoms and the prevalence of misinformation, consulting healthcare professionals and celiac societies is essential for a correct diagnosis and management.

Prevalence and incidence: Is celiac disease common in Spain?

The true number of individuals with celiac disease is often higher than the number of diagnosed cases. In Europe, the estimated prevalence is around 1% of the population, which aligns with estimates for Spain. However, studies indicate a significant number of celiacs remain undiagnosed. This is partly due to the wide range of symptoms, including both digestive and non-digestive issues like anemia and osteoporosis.

Studies in Spain have shown varying prevalence rates. A 2016 study found a prevalence of 1 in 204, noting this was likely an underestimate. Another study in Aragon in 2019 estimated prevalence at 0.35%, also acknowledging it was below the expected 1%. These differences highlight challenges in accurate data collection, partly because the condition lacks a specific code in primary care databases.

Diagnosis trends and challenges

Diagnosis rates are increasing in Spain. A study in Galicia noted a rise in annual incidence among adults and the elderly between 2012 and 2019, likely due to increased awareness and better testing methods. However, underdiagnosis remains a significant issue, with estimates suggesting many celiacs are undiagnosed.

Diagnosis typically involves:

Serological screening: Blood tests to detect antibodies like IgA anti-transglutaminase type 2 (TG2).
Genetic testing: Checking for HLA-DQ2 and HLA-DQ8 genes, which are common in celiac patients. A negative result makes the condition unlikely.
Intestinal biopsy: Considered the gold standard, though guidelines may allow skipping it in pediatric cases with very high antibody levels.

The reality of living gluten-free in Spain

Spain's adherence to EU allergen labeling laws assists in identifying packaged gluten-free products. Organizations like FACE also offer resources and lists of safe establishments. Nevertheless, challenges persist:

Eating out: Cross-contamination is a risk in some restaurants.
Cost: Gluten-free products can be expensive.
Social factors: Following a gluten-free diet can sometimes lead to social difficulties.

Celiac disease statistics: Spain vs. Europe

Comparing Spain's celiac statistics with other European countries reveals some similarities:


Characteristic	Spain (2012-2019)	European Trend
Incidence rate	Increasing, particularly in adults.	Overall increasing incidence.
Diagnosis ratio	Significant underdiagnosis (e.g., 1 diagnosed for every 7 undiagnosed).	Widespread underdiagnosis, with varying estimates.
Diagnostic approach	Combines serology, genetics, and biopsy, with improving standards.	Increasingly relies on serology first, with biopsy protocols varying.
High-risk groups	Children and females show higher incidence and prevalence.	Similar patterns.

Nutritional implications and diet adherence

A strict, lifelong gluten-free diet is essential for treating celiac disease. However, adhering to this diet can be challenging due to factors like cost, social situations, and lack of knowledge. Inconsistent adherence or accidental gluten exposure can impede intestinal healing. Celiac associations in Spain have been shown to help improve adherence through support and information.

The non-celiac gluten sensitivity dilemma

A growing trend in Spain is the adoption of gluten-free diets by individuals without a celiac diagnosis. A 2024 report indicated that 8% of the Spanish population followed a gluten-free diet, with 72% doing so unnecessarily. This trend can blur the lines between medically necessary diets and personal choices, potentially creating additional challenges for those with a genuine medical need. Accurate information and professional guidance are crucial in this context.

Conclusion

Spain has a notable population with celiac disease, but the true prevalence is obscured by a history of underdiagnosis, a pattern also seen in other parts of Europe. While recent trends show an increase in diagnoses due to better methods and awareness, the actual number of affected individuals is likely higher than diagnosed cases. Celiacs in Spain still face challenges related to the cost of gluten-free food, dining out safely, and social integration. Continued education for the public and healthcare providers is vital for timely diagnosis and proper management. The increasing popularity of unnecessary gluten-free diets also adds complexity to communicating the seriousness of celiac disease.

Authoritative resource

For more information on celiac disease in Spain, including resources and support groups, consult the Federación de Asociaciones de Celíacos de España (FACE) at celiacos.org.

Frequently Asked Questions

The prevalence of celiac disease in Spain is generally considered to be in line with the European average of approximately 1% of the population. However, regional studies show some variability, and like many countries, Spain has a significant number of undiagnosed cases.

Historically, classic gastrointestinal symptoms like diarrhea and abdominal distension were commonly noted, especially in children. However, recent trends show an increase in non-classical and extra-intestinal symptoms in adults, such as anemia, osteoporosis, and general weakness.

As an EU member, Spain has mandatory allergen labeling, which helps with identifying packaged gluten-free foods in supermarkets. Major cities have a growing number of restaurants with gluten-free options. However, smaller eateries may lack proper knowledge of cross-contamination, and finding a wide variety of affordable products can still be a challenge.

Underdiagnosis is attributed to several factors, including the wide variability of celiac disease symptoms, a lack of awareness among some healthcare professionals, and the historical lack of a specific coding for the condition in primary care records. Many adults present with less obvious symptoms, making diagnosis difficult without targeted screening.

Yes, Spain has established celiac societies, most notably the Federación de Asociaciones de Celíacos de España (FACE). These organizations provide support, resources, and information on safe gluten-free products and eating establishments across the country.

While it is a popular trend, adopting a gluten-free diet without medical necessity is not advised by nutritional experts. A 2024 report highlighted that a large number of Spaniards follow this diet without justification, which can result in unnecessary costs, social difficulties, and potential nutritional deficiencies if not properly managed.

Similar to other Caucasian populations, the presence of HLA-DQ2 and HLA-DQ8 genes is a necessary but not sufficient factor for developing celiac disease in Spain. A genetic test for these markers can help rule out the disease with high certainty.