Celiac disease is a chronic autoimmune disorder with one trigger: gluten. When someone with celiac disease consumes gluten, their immune system responds by damaging the small intestine. That can lead to a host of health problems, and the inflammation brought on by this immune response can contribute to a wide array of symptoms.
These symptoms differ from person to person and can affect every system of the body. Here are the common symptoms of celiac disease you should know about.
10-Symptoms-of-Celiac-Disease-You-Should-Know-According-to-Experts (GI) symptoms. "For a large portion of people-40% to 60%-their main manifestation of the disease is gastrointestinal," Salvatore Alesci, MD, PhD, chief scientist and strategy officer at the patient advocacy and research organization Beyond Celiac, tells Health. These symptoms can include constipation, diarrhea, cramps, bloating, and gas. Producing stool that floats or that is foul-smelling is another possible symptom of celiac disease, according to the American College of Gastroenterology.
It can be difficult to differentiate these symptoms from other common GI problems, like irritable bowel syndrome (IBS). "Before I diagnose someone with IBS, I rule out celiac," Amy Burkhart, MD, an integrative medicine physician and registered dietitian who specializes in gut health, tells Health. The first step is a simple antibody blood test. A biopsy of the small intestine can confirm the diagnosis. One thing to remember is that if you are getting a blood test for celiac disease, you need to continue to consume gluten before the test so that you get an accurate result.
While GI symptoms might be the most common way celiac disease shows up, 40-60% of people with the condition don't have any GI symptoms, according to Dr. Alesci. And an absence of the telltale GI symptoms is the number one reason why patients are misdiagnosed or stay undiagnosed, he says. Here are some common non-GI symptoms of celiac disease to be aware of.
"Most people don't think about celiac disease as a disease of the brain, but there is a group of researchers at the University of Sheffield in the UK that have shown that people with celiac have damage to their brains," Dr. Alesci says. One of the things that the study found was that those with celiac disease had slower reaction times. Short-term memory loss, inability to concentrate or find the right word, and attention difficulties are other neurological signs of celiac disease, Dr. Alesci adds.
Anxiety and depression
When your body is under constant threat from chronic inflammation, you may also experience anxiety, Dr. Alesci says. Malabsorption of nutrients from celiac disease may also impact brain function to predispose you to depression. Making things even more complicated is the fact that the challenges stemming from a diagnosis of a chronic condition itself is associated with mental health disorders, according to Beyond Celiac.
Coordination and balance problems
The same antibodies that attack your small intestine can also be found in a brain region called the cerebellum, which controls coordination and movement, Dr. Alesci says. "Patients may have poor coordination in their balance, gait, and eye movements," he says. Numbness, tingling, and weakness (neuropathy) are also symptoms of celiac disease.
Bone density loss
Osteopenia (early bone density loss) and osteoporosis (a disease where bones are weak and brittle) is a risk when you have celiac disease. It results from a malabsorption of calcium and vitamin D3, according to Dr. Alesci. A gluten-free diet will help with absorption of these nutrients from your diet, but you'll also likely have to take supplements, he says.
Another downstream effect of not absorbing calcium: thyroid dysfunction. Not getting enough calcium can trigger the parathyroid glands to produce more parathyroid hormone, Dr. Alesci explains. (The parathyroid glands are four pea-sized glands on the thyroid gland, which is located at the base of your neck.) The resulting condition, called hyperparathyroidism, can also lead to weakened bones, as well as kidney stones, according to the National Institute of Diabetes and Digestive and Kidney Diseases.
Enamel defects, like spots on teeth, and recurrent canker sores are possible signs of celiac disease, according to Dr. Burkhart. "If you're getting mouth sores on a regular basis or experiencing other dental issues like fractures and tooth decay, that should trigger a celiac screening," she says. Chronic stress or inflammation may play a role in the development of mouth sores. In addition, your tongue may burn and feel dry, which has to do with malabsorption of vitamin B12, folate, and iron, the Celiac Disease Foundation reports. Overtime, if you're not on a gluten-free diet, these symptoms may increase the odds of oral and esophageal cancers.
Anemia can result from not consuming or absorbing enough iron, the nutrient that helps your body make hemoglobin, a protein in the blood that ferries oxygen around your body and is necessary for energy. The go-to treatment is iron supplements. However, if anemia does not get better after supplementation, this is a potential sign of celiac disease, Dr. Burkhart explains.
Celiac disease can make it hard to get and stay pregnant. That's because the antibodies produced from eating gluten may attack the placenta, Dr. Alesci says. Research has suggested that between 1%-3% percent of women with unexplained infertility had undiagnosed celiac disease, according to Beyond Celiac. Some studies have even found the prevalence to be as high as 8%. Other studies show that undiagnosed celiac disease also causes lower fertility rates among men.
Unexplained fatigue and weight loss
With all the stress and demands of daily life, it's not unusual to feel tired or realize you've lost weight. While these are both extremely common, they can point to a host of diseases, including autoimmune disorders. So if you're feeling extra fatigued or are losing weight even though you are not trying to (which can happen if you're not absorbing nutrients properly), talk to your doctor about the potential explanation being celiac disease.
How do you know if your symptoms are being caused by celiac disease?
One of the tough things about diagnosing celiac disease is that there are so many symptoms that show up all over the body. There are more than 300 known symptoms of celiac disease, Beyond Celiac notes. And yet, "celiac is the most underdiagnosed or misdiagnosed disease among all of the chronic autoimmune disorders," Dr. Alesci says.
Diagnosis often requires connecting the dots between seemingly unrelated symptoms-and you might see different specialists for each problem. While one in 100 people have celiac disease, just 17% are aware of it. "Celiac has a reputation as a rare disease, but I do not consider 1 in 100 rare," Dr. Burkhart says.
While people who develop celiac disease have a genetic predisposition to the disease, there also needs to be an environmental trigger that sets the disease process in motion. Triggers can include things like viral illnesses, pregnancy, menopause, or dietary factors, according to Dr. Burkhart. Since celiac disease can run in families, it's important to tell your doctor if a first- or second-degree family member has the condition, which can help you get tested sooner.
How can you manage symptoms of celiac disease?
Once diagnosed, "the only treatment is a lifelong strict, gluten-free diet," Dr. Burkhart says. Because of that, some patients don't want to know if they have celiac-something that's understandable given the dietary changes-but it's critical to know.
Having celiac disease and not following a gluten-free diet increases your risk of cancer of the small intestine and esophagus; it can also lead to a narrowing of the small intestine due to inflammation, according to the American College of Gastroenterology (ACG). Your risk for osteoporosis, infertility, neuropathy, and several vitamin deficiencies are also increased if you don't manage your celiac disease, the ACG reports.
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