Celiac disease is a chronic autoimmune disorder that primarily affects the small intestine.
It is triggered by the ingestion of gluten, a protein found in wheat, barley, and rye. When individuals with celiac disease consume gluten-containing foods, their immune system mistakenly targets the small intestine, causing inflammation and damage. The main site of damage is the villi—tiny, finger-like projections in the intestinal lining that are crucial for nutrient absorption.
In celiac disease, this immune response leads to villous atrophy, meaning the villi become flattened or destroyed. This damage significantly reduces the surface area available for nutrient absorption, resulting in malabsorption of essential nutrients. Furthermore, the damaged intestinal lining can impair the production and effectiveness of digestive enzymes, further hindering the breakdown and absorption of food and exacerbating inflammation.
Celiac disease affects approximately 1% of the global population and can develop at any age. However, the risk increases significantly for individuals with a first-degree relative who has the condition—rising to 1 in 10. Celiac disease can present at two primary peaks: early childhood and adulthood, typically around the second and third decade of life.
Common Symptoms
While classic symptoms like diarrhea and weight loss are common, celiac disease can also present with more systemic symptoms related to autoimmunity, inflammation, and malabsorption.
Gastrointestinal Symptoms:
- Chronic diarrhea
- Weight loss
- Malabsorption (leading to deficiencies in vital nutrients)
- Abdominal pain
- Bloating
Dermatological Symptoms:
- Dermatitis herpetiformis, a blistering, itchy skin rash that often appears on the elbows, knees, and buttocks.
Bone Health:
Untreated celiac disease can significantly impact bone health due to malabsorption of calcium and vitamin D, leading to:
- Osteopenia (low bone mineral density)
- Osteoporosis
- Increased fracture risk
These bone issues are often exacerbated by the chronic inflammation and autoimmunity seen in celiac disease. A strict gluten-free diet can help improve bone health by allowing for better nutrient absorption.
In Children:
In pediatric cases, celiac disease may manifest as:
- Failure to thrive (poor growth or weight gain)
- Pale, foul-smelling stools
- Short stature relative to peers
Reproductive Health in Women:
In women, untreated celiac disease can disrupt hormonal balance, leading to:
- Delayed puberty
- Higher age of menarche (first menstrual cycle)
- Increased risk of miscarriage
- Unexplained infertility
Hematological (Blood-Related) Issues:
Celiac disease can lead to chronic iron deficiency and unexplained anemia, often due to impaired absorption of iron and other essential nutrients.
Neurological Symptoms:
Some individuals may experience neurological symptoms, including:
- Peripheral neuropathy (tingling, numbness, or pain in the hands or feet)
- Gluten ataxia (loss of coordination and balance)
- Brain fog (difficulty concentrating, memory problems)
- Joint pain
- Fatigue
- Headaches
Other:
- Elevated liver enzymes (which may indicate liver involvement)
Diagnosis
Diagnosing celiac disease can be complex, with many individuals experiencing a delay of 6 to 10 years before receiving a correct diagnosis. The process of diagnosis begins with a blood draw, and requires a biopsy to confirm the diagnosis.
It’s important to note that false negatives can occur, particularly if gluten has been removed from the diet or in individuals on medications such as corticosteroids or immunosuppressants. In the case that gluten has been removed from the diet, genetic testing can help to guide a diagnosis.
Treatment: Lifelong Management with a Gluten-Free Diet
Currently, there is no cure for celiac disease, but the most effective treatment is a lifelong gluten-free diet. This means completely eliminating all sources of gluten from the diet, including wheat, barley, rye, and any foods or products containing these grains.
By adhering strictly to a gluten-free diet, most people experience symptom relief and significant improvement in gut health. However, it is essential to consult with a dietitian to ensure that your diet is balanced and nutritionally complete, as malabsorption can lead to deficiencies in vitamins and minerals that need to be corrected.
Clinical Insights: Supporting the Celiac Patient
- Identify other comorbidities: Approximately 30% of adults with celiac disease also have other autoimmune disorders. These should be screened and managed accordingly.
- Identify and address nutritional deficiencies: Individuals with celiac disease may require additional support to address deficiencies in vital nutrients such as iron, calcium, vitamin D, vitamin B12, and folate. Monitoring and supplementation can help prevent long-term complications.
- Support fiber intake and gut health: The exclusion of gluten-containing foods can lead to reduced fiber intake, especially when gluten-free alternatives are heavily processed and low in fiber. It is important to increase fiber intake through gluten-free whole grains, fruits, vegetables, and legumes. Fiber supplements can also be beneficial in promoting healthy digestion and regulating bowel movements. Probiotics may further benefit gut health. A gluten-free diet can reduce beneficial bacteria like Lactobacillus and Bifidobacterium, while adding probiotics may help restore microbial balance and reduce symptoms like diarrhea in celiac patients.
- Support other affected systems: Celiac disease can impact various body systems, including the skin, joints, and digestive system. Addressing symptoms in these areas with appropriate interventions can help improve overall well-being.
- Regular monitoring: Ongoing follow-up with a healthcare provider is essential for assessing the effectiveness of the gluten-free diet and detecting any potential complications early. Regular check-ups allow for timely adjustments and ensure optimal health outcomes.
Silent Celiac Disease
Some individuals with celiac disease may not experience any overt symptoms, despite having significant damage to the small intestine. This is known as silent celiac disease, and it highlights the importance of regular screening for those at risk, even in the absence of symptoms.
Supplement Considerations for Individuals with Celiac Disease
Because celiac disease often results in nutrient malabsorption, especially before a diagnosis or during early stages of treatment, many individuals may benefit from targeted supplementation to support healing and restore nutritional balance. Supplement needs should always be individualized and guided by laboratory testing and clinical assessment, but here are some commonly recommended nutrients to consider:
- Iron: Iron deficiency anemia is common due to impaired absorption in the damaged small intestine. Iron supplementation, especially in the form of ferrous bisglycinate (a gentler form on the digestive tract), may be needed to correct deficiencies.
- Vitamin D and Calcium:
Bone health is frequently compromised in celiac disease. Supplementing with vitamin D3 and calcium can support bone mineralization and reduce the risk of osteopenia or osteoporosis, particularly during the healing phase. - B Vitamins (especially B12, Folate, and B6):
Malabsorption can lead to deficiencies in key B vitamins, impacting energy levels, nerve health, and red blood cell production. A high-quality B-complex or individual supplementation may be recommended, especially for those experiencing fatigue, anemia, or neurological symptoms. - Magnesium and Zinc:
These minerals play a crucial role in immune function, healing, and enzyme activity. Because they are absorbed in the small intestine, levels can be low in individuals with active celiac disease. - Probiotics:
The gut microbiome is often disrupted in celiac disease, contributing to ongoing inflammation and digestive symptoms. Probiotics such as Lactobacilli and Bifidobacterium species may help restore a healthier balance of gut flora, support immune health, and improve nutrient absorption. - Fiber Supplements:
Gluten-free diets may be lower in fiber, especially when relying on processed gluten-free foods. Soluble fiber supplements, such as psyllium husk or partially hydrolyzed guar gum, can support digestion and bowel regularity. - Digestive Support and Enzymes:
For some individuals, the damage to the intestinal lining may require further soothing and support to reduce the availability of digestive enzymes. Temporary enzyme support may help reduce bloating and improve nutrient absorption while the gut heals. In addition, some individuals may benefit from ingredients that nourish and repair the gut lining such as L-glutamine, zinc carnosine, and soothing demulcents like slippery elm, licorice or aloe vera, to promote tissue regeneration and reduce inflammation.
Conclusion
Celiac disease is a lifelong condition that requires careful management to prevent significant health complications. Although there is no cure, a strict, gluten-free diet remains the cornerstone of treatment, leading to symptom relief and improved intestinal health. It is essential for individuals with celiac disease to be proactive in managing their condition by working with healthcare professionals, including dietitians, to ensure proper nutritional intake and address any deficiencies that may arise from malabsorption.
The wide range of symptoms—ranging from gastrointestinal distress to neurological and dermatological issues—demonstrates the complex and systemic nature of the disease. Additionally, the presence of comorbidities, such as other autoimmune disorders and nutritional deficiencies, underscores the importance of comprehensive care and regular monitoring.
References
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Sahin Y. Celiac disease in children: A review of the literature. World Journal of Clinical Pediatrics. 2021;10(4):53.
Laurikka P, Kivelä L, Kurppa K, Kaukinen K. Review article: Systemic consequences of coeliac disease. Alimentary Pharmacology & Therapeutics. 2022;56(Suppl 1):S64.
Celiac Disease. Canadian Digestive Health Foundation. June 24, 2022. Accessed April 2, 2025. https://cdhf.ca/en/digestive-conditions/celiac-disease/
Ali B, Khan AR. Efficacy of Probiotics in Management of Celiac Disease. Cureus. 2022;14(2):e22031.
