Celiac disease is a digestive disorder in which the immune system attacks the lining of the small intestine due to an abnormal immune response to the protein gluten. Gluten is found in wheat, barley, rye, and products made from those grains, and it also used as a food additive. Damage to the intestinal lining causes digestive symptoms and poor nutrient absorption, which can lead to symptoms of malnutrition. The symptoms of celiac disease can vary from person to person, depending on factors such as the person’s age, the person’s diet and the extent of the damage to the lining of the small intestine.
The most common symptoms that occur due to celiac disease, especially in the early stages of development, are digestive symptoms such as abdominal pain, diarrhea, constipation, nausea and vomiting, bloating and gas. Stools of a person with celiac disease may be fatty and extremely foul-smelling due to poor absorption of dietary fats. A person with celiac disease may also experience changes in appetite, sudden weight loss and lactose intolerance, even though they had no problem digesting lactose before. A person suffering from celiac disease may have these symptoms in any combination and in different intensities. Some of the symptoms may be intermittent and go away for a while, even if a celiac disease sufferer is not yet on a gluten-free diet.
Aside from the digestive symptoms of celiac disease, many other symptoms can result from various vitamin, mineral and nutrient deficiencies. Poor nutrient absorption in the small intestine occurs because the immune system attacks the villi that line the small intestine. Villi are the small projections of the intestinal lining that serve to increase the surface area of the inside of the small intestine to make absorption more efficient. The small intestine is responsible for the majority of nutrient absorption in the body. A few substances can be absorbed through the stomach and large intestine, but for the most part the small intestine is the organ that absorbs the nutrients that we need to function.
Symptoms of poor nutrition and vitamin and mineral deficiencies that celiac disease sufferers might experience include anemia, or low red blood cells, severe fatigue, low bone density and osteoporosis, mouth ulcers, muscle cramps, bone pain, hair loss, peripheral neuropathy, or tingling and numbness in the nerves of the hands and feet, infertility and missed menstrual periods, decreased blood clotting due to a deficiency in vitamin K, mood problems like depression and anxiety and neurological problems such as seizures. Vitamin and mineral deficiencies can affect every part of the body. A person with celiac disease who has a stronger immune response to the presence of gluten, or someone who has been suffering from celiac disease without treatment for a long time, is more likely to show symptoms of malnutrition.
Because of the variety of symptoms that a person with celiac disease can present with, celiac disease may be a difficult diagnosis in some cases. In people with celiac disease who have a lot of digestive symptoms, diagnosis is easier because the symptoms will lead a doctor to examine the intestines for problems, and the damage from celiac disease can be seen on a biopsy of the small intestine. Blood tests for specific antibodies can also help screen for suspected cases of celiac disease. However, if a person presents with fewer digestive complaints and has symptoms of vitamin and mineral deficiencies, celiac disease may not be on the top of the diagnostic list. A single vitamin deficiency may be treated, or if multiple deficiencies are present, such a person may be suspected of having an eating disorder. In these cases, diagnosis of celiac disease may take longer.
It is also important to note that a doctor can not successfully diagnose celiac disease if a person starts on a gluten-free diet before going to the doctor, because there will be no antibodies to look for in the blood. The small intestine will still be in the process of healing after a few weeks, but the doctor will be far less likely to perform a biopsy in the first place if there no circulating antibodies that suggest celiac disease.
One other test that can be done in the process of diagnosing celiac disease is a genetic test. Celiac disease has two genetic markers, called DQ2 and DQ8. If these genes are found, it does not mean that a person has celiac disease. However, if neither of these genes are present, then a person cannot have celiac disease. Celiac disease is inherited, but the presence of the genes doesn’t mean that a person is guaranteed to develop the disease, and it gives no information about the age of onset of the disease.