By Leigh Reynolds
Celiac disease may be described as a condition affecting the digestive tract, but its reach extends from head to toe.
Celiac disease is a remarkably difficult condition to diagnose. It may be tempting to blame the long list of symptoms – after all, there are more than 300 different signs and associated conditions – but this would be a massive understatement. The true challenge for diagnosis stems from the fact that this condition develops in a complex web of interlinked symptoms that is (almost) as unique to each patient as their own fingerprint.
When faced with seemingly unrelated symptoms, many not localized to the gastrointestinal tract and not exclusive to celiac disease, physicians need to work more like detectives “following clues” to get to the root of the problem: celiac disease.
The Immune response starts it all It all starts in the gastrointestinal tract. Whether individuals develop symptoms or not, for celiac disease patients, the condition always starts with gluten in the diet, resulting in an immune response and inevitably damage to the lining of the intestine.
1. Localized immune response symptoms include (but are not limited to):
Abdominal pain and discomfort
Gassiness (flatulence) with bloating
Diarrhea or constipation
Nausea and vomiting.
Next follows nutritional deficiencies Not surprisingly, this damage often leads to malabsorption, which in turn causes deficiencies in micronutrients, including vitamins and minerals. In fact, studies show that 9 out of 10 celiac disease patients have at least one nutritional deficiency at the time of diagnosis, and about half have more than one.
2. Symptoms due to malabsorption include (but are not limited to):
Failure to thrive
Short stature and growth retardation
Water-soluble vitamin deficiencies (Vitamin B1, B2, B6, B12, vitamin K, and folic acid)
Fat-soluble vitamin deficiencies (vitamin A, E, and D)
Mineral deficiencies (Iron, magnesium, zinc, manganese, calcium, potassium, copper, and iodine)
Followed by the all-body symptoms Finally, as a consequence of nutritional deficiencies, what started as a gastrointestinal condition soon manifests itself in a variety of unrelated symptoms spread throughout the body, from anemia to infertility. Celiac disease may be described as a condition affecting the digestive tract, but its reach extends from head to toe.
In some cases, these extra-intestinal manifestations overshadow the original symptoms and make for an even more complicated diagnosis. The symptoms of an immediate immune response caused by the presence of gluten are non-specific, therefore, doctors are more likely to diagnose celiac disease based on its nutritional deficiencies and subsequent symptoms.
Effects of deficiencies include, for example, iron, folic acid and vitamin K causing poor blood parameters and vitamin D and calcium depleting bone density, as well as selenium and iodine disturbing thyroid function and vitamin A, E, and D causing infertility and other reproductive issues. A list of symptoms related to nutritional deficiencies that can be a part of celiac disease is as follows.
3. Neurological and psychiatric symptoms
Ataxia * (Vitamin E, Vitamin B3, B12)
Sensory neuropathy * (Vitamin E)
Impaired cognitive function
Epilepsy * (Folic acid)
Dementia * (Vitamin B3)
Seizures * (Vitamin B3)
4. Musculoskeletal symptoms
Osteomalacia *(Vitamin D, Calcium)
Osteoporosis *(Vitamin D, Calcium)
Low bone mineral density * (Zinc)
Muscular myopathies * (vitamin E)
5. Hepatic and renal symptoms
Hypertransaminasemia (elevated transaminases)
Autoimmune liver disease
Primary biliary cirrhosis
IgA nephropathy (kidney disease)
6. Dermatological symptoms
Loss of hair or fragile hair
Dermatomyositis (inflammation of the skin)
Inflammation of mouth and lips *(iron, vitamin B3, B12, folic acid)
Recurrent aphthous ulcers
Inflammation of the tongue *(Vitamin B group)
Skin lesions * (Zinc)
7. Hematologic symptoms
Anemia * (Iron, folic acid, Vitamin B12, Copper)
Poor spleen function
Low white blood cells * (Vitamin B12, folic acid, Copper)
Low blood platelets * (Vitamin B12, folic acid, copper)
Blood clotting disorders * (Vitamin K)
8. Endocrine and autoimmune symptoms
Type 1 diabetes
Thyroid disease * (Selenium, iodine)
Overactive parathyroid glands *(vitamin D, calcium)
Sjogren’s syndrome (an autoimmune disease in which the body destroys salivary and lacrimal glands)
Addison’s disease (adrenal insufficiency)
Cardiomyopathy (heart disease)
9. Reproductive symptoms
Amenorrhea * (Zinc)
Infertility * (iron, folic acid, Vitamin B group)
Recurrent miscarriage * (iron, folic acid, vitamin B group)
Low pregnancy rate
Hypogonadism * (Zinc)
Immature secondary sex traits
Reduced semen quality * (Vitamin A, E, and D)
10. Oncological symptoms
Esophageal and oropharyngeal carcinoma
Conclusion From all these unrelated symptoms, there can only be an obvious conclusion: physicians should always bear in mind a possible celiac disease diagnosis and have a low threshold of suspicion for this condition. It may not explain every symptom associated with this condition, but the same way nutritional deficiencies may trigger a search for celiac disease, a diagnosis of celiac disease should prompt an immediate and extensive analysis assessing nutritional deficiencies. Typically, the best way to go forward in this situation is with adequate vitamin and mineral supplementation and close monitoring at follow-up appointments.
*may be caused by nutritional deficiencies as a consequence of malabsorption
This original article is made possible by Gluten Free Therapeutics. Their mission is to educate, inform, and provide the most effective nutritional products possible to allow those with celiac disease and serious gluten intolerances to heal their bodies. CeliVites complete line of superior gluten-free supplements includes multivitamin/ multimineral supplements, iron supplements, and calcium supplements for people living with celiac disease. All CeliVites products are designed to help you heal, restore and rebuild your body because going gluten-free isn’t enough!