What is Celiac Disease?
Celiac disease is a common autoimmune disease in which the inner wall of the small intestine becomes severely inflamed and thus cannot properly absorb nutrients. People with the disorder experience an adverse immune reaction when they take eat gluten, a dietary protein found in wheat, rye, or barley. Hybrid cereals like triticale, durum and spelt also contain gluten.
Once thought to be a childhood disorder, celiac disease can affect anyone regardless of their age, gender or race. Still, it is not completely understood by scientists why some children develop the condition early in life while some people become ill much later in life.
Celiac disease in children (better known as juvenile gluten-sensitive enteropathy or pediatric celiac disease) may develop any time once gluten is introduced into the child’s diet, usually after between 6 months and 2 years of age. Signs of pediatric celiac disease may show up after a few minutes or hours after eating gluten. In some children, these symptoms may go away after only a few hours. In others, they may last up to 2 weeks. It is worth noting that juvenile celiac disease may cause many different symptoms which typically vary from child to child, depending on their age. For example, in toddlers and infants, typical gastrointestinal irritations are the main symptoms and may include malnutrition, foul-smelling diarrhea, distended abdomen (protruding potbelly), nausea, bloating, and excessive vomiting. Children at this age may also develop celiac disease complications such as brain development disorder and failure to thrive.
In school-age children (6- to 12-year-olds), on the other hand, vomiting becomes less prominent than in toddlers or infants. However, they may experience other symptoms such as constipation, diarrhea, abdominal, stomach aches or pain, and weight loss.
Teens and older children with undiagnosed or untreated celiac disease may experience some non-gastrointestinal symptoms in addition to digestive conditions like bloating, constipation, diarrhea, and excess gas. Also called extra-intestinal symptoms, they may include dermatitis herpetiformis (itchy skin rash), chronic migraines or headaches, recurrent fatigue, stunted growth, aphthous ulcers (ulcerative mouth sores), delayed puberty, joint pain, and even achy pain in bones. Some teenagers may experience increased episodes of mood disorders like ASD, depression or anxiety.
Celiac disease affects about 1 percent of adults in the United States. In adults, gastrointestinal symptoms such as bloating, gas, diarrhea, abdominal pain, and vomiting tend to be less severe as well as less common. Instead, most adults with celiac disease experience extra-intestinal symptoms that may be linked to prolonged effects of malabsorption of nutrients. These may include:
- Inability to maintain a healthy weight or sudden, unexplained weight loss
- Osteoporosis (loss of bone density leading to weak, porous or brittle bones)
- Iron-deficiency, folate or vitamin B12 anemia
- Lactose intolerance
- Chronic fatigue
- Bowel cancers and lymphomas
- Depression and general irritability
- Dental problems
The severity of these symptoms varies from one person to another, which makes it easy to overlook or misdiagnose celiac disease for another condition, such as type 1 diabetes, gluten intolerance or irritable bowel syndrome (IBS).
That said, celiac disease is typically treated by simply going on a lifelong, strict gluten-free diet. It’s a major lifestyle change, which means you must completely give up foods, medications, drinks, supplements, and anything else that may contain gluten. The consequences of not treating the condition with a zero-gluten diet are dire and far-reaching. If left untreated, it can lead to severe celiac disease complications, such as miscarriage, loss of fertility, vision loss, preterm pregnancy, anemia, and may even increase the risk of other autoimmune disorders. These are consequences that hit pregnant women, not persons in general.
Risk factors for celiac disease may include family history, genetics, environmental factors, and having health conditions like thyroid diseases, type 1 diabetes, down’s syndrome, ulcerative colitis, and neurodegenerative disorders, to name a few. For instance, if your first-degree relative (child, sibling or parent) has celiac disease, your probability of developing the condition may be as high as 20 percent, according to a 2010 study.
For this reason, it is crucial to get tested or screened for celiac disease at the very first signs if it runs in your family. In this comprehensive article, we cover at length the symptoms, signs, and risks of celiac disease in adults, and how to get tested.
Celiac disease is a lifelong condition, meaning you carry the symptoms for the duration of your life. Interestingly, most people develop celiac disease early in life, and yet others may not show symptoms until they are in their 60s or even older. This is called elderly onset celiac disease.
Since it renders the small intestine unable to absorb enough nutrients, malnutrition, anemia, and digestive issues are common in people of all ages with undiagnosed or untreated celiac. However, certain symptoms of celiac disease in older adults may be somewhat different from those experienced by younger celiac adults. For instance, obesity and constipation are more common in older patients but seldom in younger adults. Also, celiac-related cardiovascular conditions are more frequent in elderly patients.
More often than not, symptoms of celiac disease are milder for older adults than for their younger counterparts, which is why they might mistake them for common aging signs, making it hard to get an early diagnosis and timely treatment.
Common Celiac Disease Complications, Risks, and Long-term Effects
No matter your age, if you have celiac disease, it’s critical that you consume no gluten. If you have undiagnosed or untreated celiac disease, and you continue consuming gluten, several different health problems and complications may occur. It is a common misconception that consuming a small amount of gluten may be harmless to you. That’s anything but true — consuming even a little gluten can trigger adverse symptoms and increase your risk of developing the following celiac disease complications and long-term effects.
Complications: Gastrointestinal Issues
In celiac disease, the gastrointestinal (GI) tract is the primary target of an unusual immune attack when the person eats gluten. More specifically, villi (small hairlike projections on the lining of the small bowel) are gradually destroyed by the inflammatory response to gluten.
This may have a domino effect across the entire digestive system. No wonder GI symptoms like bloating, diarrhea, gas, and constipation are often the first signs to show up.
If left untreated for a long time, celiac inflammation may have adverse effects on your digestive system, causing numerous gastrointestinal issues. Common celiac disease complications related to your GI may include:
Diarrhea is one of the earliest and the most common symptoms, reported by between 45 and 85 percent of people with untreated celiac disease. Diarrhea related to celiac disease may result in a frothy or oily, gray or light tan, and watery stool.
It’s caused primarily by the small intestine’s inability to digest food and absorb nutrients (malabsorption). That’s why diarrhea may be accompanied by the feeling of being backed up (constipation), bloating, and general abdominal discomfort.
When the celiac patient is treated with a gluten-free diet, diarrhea usually goes away within a few days, but it may take up 4 weeks before the symptoms become completely resolved.
If it’s undiagnosed or remains untreated, however, celiac disease may cause chronic diarrhea which usually lasts for at least 4 weeks.
If left unchecked, chronic diarrhea may lead to more serious symptoms like abdominal cramping, bloody stool, severe dehydration, fatigue, headaches, fever, and nausea. Going on a gluten-free diet is the best way to treat chronic diarrhea caused by celiac disease. The sooner, the better.
Note, however, that there are several other potential causes of chronic diarrhea, including severe food allergies, bacterial/viral/parasitic infection, adverse response to medications, and other chronic intestinal disorders like Crohn’s disease.
Crohn’s disease is a chronic digestive condition in which some parts of the gastrointestinal tract become severely inflamed. It’s one type of a group of conditions collectively called irritable bowel disease (IBD).
Like celiac disease, Crohn’s disease is an immune condition with possible genetic causes. It’s estimated that 3 million people in the U.S. are affected by Crohn’s disease, according to the Crohn’s and Colitis Foundation.
The inflammation mostly occurs in the colon and small intestine, but the disease can affect just about any part of the digestive system, from mouth to the rectum.
Symptoms often vary from person to person depending on the affected area of the GI and may start showing at any time between the ages of 13 and 30.
The most common symptoms of Crohn’s disease may include rectal hemorrhage (bleeding from the anus), diarrhea, bloody stool, vomiting, nausea, appetite loss, significant weight loss, fatigue, abdominal cramps, and frequent urge to move bowels.
Some studies seem to suggest that untreated celiac disease may be linked to an increased risk of developing Crohn’s disease. The other way around may also be true.
For instance, in one study published in the journal IBD, scientists concluded that the prevalence of Crohn’s disease in patients with celiac disease is higher than in the general population.
Ulcerative Colitis is another type of irritable bowel disease (IBD). Unlike Crohn’s disease which affects all parts of the gastrointestinal tract, ulcerative colitis is characterized by the inflammation of only the rectum or the large intestine (also known as the colon), or both.
When either the rectum or the colon becomes inflamed, this leads to the development of ulcers (small sores) on the inner walls of the intestines. This IBD condition may affect anyone regardless of age, gender or race, but it’s usually diagnosed between the ages of 15 and 35.
Ulcers on the lining of the colon and rectum are typically sensitive and painful, forcing your bowel to discharge its content (fecal matter) more frequently and quickly.
Chronic ulcerative colitis is often typified by pus, mucus, and blood in the stool. This may be accompanied by rectal bleeding, as well as other symptoms like fever, diarrhea, stomach pain, reduced appetite, nausea, weight loss, grumbling sounds, malnutrition, and pain in the rectum. In severe cases, the patient may experience inflamed eyes, mouth sores, joint pain and swelling, anemia, and skin issues.
Research has shown that there may be a connection between celiac disease and Ulcerative Colitis. In a 2015 Hungarian study, for instance, researchers found that 0.8 percent of celiac subjects had ulcerative colitis, which is a higher rate than in the general population.
Furthermore, ulcerative colitis and celiac disease are both immune-related conditions with a possible shared genetic background. There’s also an overlap seen in certain symptoms, including diarrhea, abdominal aches, pain, and anemia.
Constipation is another early symptom of celiac disease, characterized by moving a dry, hardened stool. If you are constipated, you may experience symptoms that include:
- Painful bowel movements
- Passing stool fewer than 3 times a week
- Straining when passing stool
- Feeling bloated or unusually full even after moving bowels
- Rectal blockage, fissures or tearing
As mentioned earlier, celiac disease destroys the villi lining the inner wall of the small bowel. These finger-like projections are tasked with absorbing nutrients from digested food matter.
When you have untreated celiac disease, the affected villi cannot effectively absorb nutrients, and instead, wick away additional water from the food. This results in a dry, thickened stool that is hard to move, leading to constipation.
Surprisingly, people with celiac disease may find it tricky to avoid constipation altogether even after going on a gluten-free diet. And there’s a good reason behind this.
A diet devoid of gluten locks out several different foods that are rich in fiber, notably cereals and grains. Low fiber intake has been linked to reduced bowel movements which eventually leads to constipation. As such, celiac patients may have to use laxatives, probiotics, and other constipation medications, as well.
Besides celiac disease, chronic constipation may also be caused by heavy dehydration, poor diet, and prolonged physical inactivity.
The pancreas is a digestive organ sits behind the abdomen, and it is responsible for producing digestive enzymes. When it becomes inflamed, this results in a condition called pancreatitis.
As the name suggests, chronic pancreatitis is a form that is characterized by long-term inflammation of the pancreas, meaning it doesn’t get better over time.
If not treated, chronic pancreatitis can cause permanent damage and scarring to the pancreas. Cysts and calcium stones (similar to gallstones) may also grow and cause blockage to the duct that transports digestive juices and enzymes to the stomach.
Eventually, chronic pancreatitis may lead to severe health complications, including diabetes, malnutrition, and thyroid conditions. Other symptoms may include fatigue, jaundice, internal bleeding, vomiting, nausea, abdominal pain, shortness of breath, sudden weight loss, and diarrhea.
Several studies have shown that there is a significant connection between undiagnosed or untreated celiac disease and chronic pancreatitis, according to a 2007 study involving 14,000 celiac patients.
Researchers concluded that people with celiac sprue are at an elevated risk of developing chronic pancreatitis. This seems to be corroborated by another 2012 analytic study that showed that celiac patients in Sweden may have a threefold higher risk of pancreatitis.
Other possible causes of chronic pancreatitis include hypercalcemia (high levels of calcium in the blood), cyst fibrosis, hypertriglyceridemia, and blockage of the pancreatic duct.
These are only five of the most common celiac disease complications related to the gastrointestinal tract. Read more about gastrointestinal complications.
If not treated early enough, celiac disease continues to cause inflammation and gradually destroys your digestive system, particularly the small intestine.
This causes your small bowel to absorb nutrients less effectively, leading to a condition called malnutrition. This is characterized by a severe lack of vitamins, minerals, and other nutrients in the body.
Individuals who are malnourished usually have deficiencies in key nutrients such as iodine, vitamin A, zinc, and iron.
Because of critical nutritional deficiency, your brain may not work properly, and your body is unable to fight off infections, recover from injury, and maintain other biological processes.
For celiac patients with serious malnutrition, muscles may start to degenerate and they find it challenging to keep warm. Generally, they feel confused, weary, dizzy, irritable, unable to concentrate, and severely fatigued. Wounds may take an unusually long time to heal, and the thyroid gland may start to swell (goiter).
Severe malnutrition may also cause anxiety, depression, drastic weight loss, potbelly, dry skin and hair, and sunken eyes. In children with celiac disease, malnutrition may cause delayed development and stunted or poor growth.
However, keep in mind that celiac disease is not the only known cause of malnutrition. Other potential causes may include Crohn’s disease, digestive problems, excessive alcohol intake, mental health issues, and anorexia.
Complication: Skin Rash (Dermatitis Herpetiformis)
Untreated celiac disease may also cause an autoimmune skin condition called Dermatitis Herpetiformis (DH), gluten rash or Duhring’s disease.
DH is characterized by a burning, blistering, and itchy rash that may affect the quality of your life. Both the itching and rash occur on the back, scalp, buttocks, knees, and elbows.
Duhring’s disease occurs predominantly in people with celiac disease, and the rash is usually an indication of immune reaction to gluten. In fact, between 15 and 25 percent of celiac patients experience this itchy skin rash, according to the NIH.
Although people with Dermatitis Herpetiformis also have damaged small intestines, more than 80 percent don’t show any gastrointestinal symptoms such as bloating, diarrhea, constipation, gas, and vomiting.
The rash and itchiness results from the reaction of immune system antibodies called immunoglobulin A (IgA) and gluten proteins, especially gliadin.
DH tends to affect men more than women, and it’s rarely diagnosed in children with pediatric celiac disease. Read more about celiac disease and DH.
Complication: Lactose Intolerance
Lactose intolerance is a condition where the person is unable to digest, absorb or tolerate lactose, a simple type of natural sugar most commonly found in dairy. As such, lactose-intolerant people are recommended not to consume yogurt, milk, and other dairy products.
A person becomes lactose intolerant when their small intestine is unable to make an adequate amount of lactase, an enzyme that is responsible for digesting and breaking down lactose.
Undigested lactose will eventually move to the colon where it interacts with gut bacteria in the large intestine. This leads to digestive issues like diarrhea, excess gas, bloating, nausea, and abdominal discomfort.
Given that celiac disease causes insurmountable damage to the small intestine, it’s not hard to see how it leads to lactose intolerance. The inflammatory reaction to gluten not only destroys villi but also damages cells that produce lactase, rendering your small intestines unable to produce enough enzymes to break down lactose.
It’s worth mentioning that lactose doesn’t actually damage your digestive system, unlike gluten. But consuming it when you’re lactose intolerant may lead to unpleasant symptoms because your intestines can’t break it down.
Besides being one of celiac disease complications, genetics, small intestine injury, surgery, Crohn’s disease, ulcerative colitis, and other types of irritable bowel disease may also cause lactose intolerance.
In medical terms, infertility is defined as the inability to develop pregnancy after 1 year of trying without protection. There are two kinds. Primary infertility is where a person hasn’t been able to get pregnant despite a year of having unprotected sex. On the other hand, people who can get pregnant but can’t carry the pregnancy to full term may be diagnosed with secondary infertility.
Some medical researchers and clinicians now believe that untreated celiac disease may be responsible for certain unexplained cases of infertility in both men and women.
In a 2014 study published in the journal Arquivos de Gastroenterologia, scientists discovered that the prevalence of otherwise unexplained infertility in women with celiac disease was significant at around 4 percent.
This seems to concur with another Danish study published in Human Reproduction. After analyzing medical records of 6,319 celiac women and comparing with those of 63,166 non-celiac women, researchers concluded that untreated celiac disease may increase the risk of infertility and pregnancy complications like miscarriage and stillbirths.
More in-depth research is needed to look into the long-term effects of celiac disease on men. Nonetheless, an earlier Italian study noticed that men with celiac diseases may have an increased risk of infertility than the general population.
Complication: Mineral and Vitamin Deficiencies
When the intestinal villi are destroyed because of celiac disease, the patient’s small bowel is unable to absorb enough vitamins and minerals. Individuals with undiagnosed or untreated celiac disease may suffer from the following mineral and vitamin deficiencies:
Iron deficiency: The body requires plenty of iron to produce hemoglobin and red blood cells that ship oxygen to where it’s needed. When the small intestine is damaged, it cannot absorb enough iron, leading to iron-deficiency anemia.
Vitamin A deficiency: Severe lack of vitamin A may increase risk of infection, as well as cause night blindness, loss of vision, and dry eyes.
Zinc deficiency: Zinc is needed for a strong immune system and proper functioning of enzymes. Its deficiency leads to diarrhea, hair loss, appetite loss, wounds that take long to heal, stunted growth, and more.
Vitamin B-12 deficiency: This vitamin is crucial for production of red blood cells. Its deficiency will likely cause difficulty concentrating, chronic fatigue, and nerve issues.
Niacin deficiency: This may lead to pellagra, a condition that is typified by dementia, dermatitis, and diarrhea.
Other deficiencies that have been linked to undiagnosed celiac disease include folate, calcium, riboflavin, vitamin D, magnesium, and fiber.
Although once thought to be a disorder restricted to children, research has shown that celiac disease is a fairly common disease affecting about one percent of the US population.
In children, the symptoms are most commonly related to the digestive system and may include bloating, vomiting, constipation, gas, and diarrhea. It may also cause stunted growth, delayed puberty, and slowed development.
In adults, however, the gastrointestinal symptoms may be less common, and signs of the condition are likely associated with prolonged malabsorption. These long-term effects are usually manifested as celiac disease complications, including:
Constipation, one of the most obvious complications from a damaged GI. Although it is one of the first symptoms, undiagnosed celiac disease can result in chronic constipation.
Chronic diarrhea is another gastrointestinal complication linked to untreated celiac disease. It manifests as an oily, frothy and watery stool that persists more than 4 weeks. If it’s not treated, it can result in chronic fatigue, and dehydration.
Irritable bowel disease is one of the most common celiac disease complications. It comes in two forms: ulcerative colitis, in which the colon and rectum are inflamed, and Crohn’s disease that’s characterized by an inflammation that can affect any part of the gastrointestinal tract.
Chronic pancreatitis is caused by an inflamed pancreas, making it unable to produce digestive enzymes and juices. Celiac disease may also cause blockage of the pancreatic duct, a tube that carries digestive juices to the stomach.
As celiac disease damages your small intestine, serious and prolonged inflammation may cause severe malabsorption of nutrients. This, in turn, causes critical nutritional deficiency and malnutrition. This makes the patient weary, fatigued, dizzy, unable to think clearly, and confused. It may also cause delayed wound recovery.
Nutritional deficiency can also cause a dangerous lack of vitamins such as vitamin A, vitamin B12, vitamin D, niacin, and riboflavin, all of which are needed for the proper functioning of the immune system and other biological processes.
Malabsorption may also lead to a severe lack of minerals like iron, folate, calcium, zinc, magnesium, and much more. This causes osteoporosis, iron-deficiency anemia, and osteopenia, just to mention a few.
As celiac disease damages the small intestine, it also renders it unable to produce enough lactase enzyme. This results in lactose intolerance. Scientists have also noted that undiagnosed celiac disease may be a cause of unexplained miscarriages and infertilities in both men and women.