Often mistakenly referred to as an allergy to wheat, celiac disease is an inherited autoimmune response in which a person's body reacts adversely to ingested gluten—a mixture of proteins found in wheat, rye and barley. Celiac disease leads to destruction of the villi that line the walls of the small intestine. The destruction of these villi affects a person's ability to absorb critical vitamin and nutrients—particularly the fat-soluble vitamins A, D, E and K. People of all ages may experience symptoms that can linger for years without diagnosis because the signs of celiac disease vary greatly in their manifestations and severity.
No single gastrointestinal symptom clearly points to celiac disease. Presence of any of the following symptoms could suggest gluten intolerance, but they may also point to other gastrointestinal problems—including Crohn's disease, ulcerative colitis or irritable bowel syndrome. Ask your doctor about getting a test for celiac disease if you experience chronic diarrhea or constipation; floating, oily-appearing stools; regular indigestion or acid reflux; constant bloating and flatulence; regular abdominal cramping, pain and distention; lactose intolerance; nausea and vomiting; or noticeable weight loss or gain.
Many symptoms of celiac disease manifest in places other than the digestive tract. Because the disease often leads to the lowered absorption of vitamins and other nutrients in food, symptoms of malnutrition can result.
Non-gastrointestinal symptoms can include iron-deficient anemia (resulting in fatigue and weakness); joint and bone pain; vitamin deficiencies; headaches or migraines; mood swings or depression; irritability and inertia; "brain fog" or an inability to concentrate; abnormal menstrual cycles and infertility; dental-enamel erosion and irregularities; seizures; poor balance; nerve damage and muscle tremors; respiratory problems; canker sores; skin conditions such as eczema, psoriasis and rosacia; hair loss; easy bruising; hypoglycemia; nosebleeds; night blindness and symptoms similar to other autoimmune syndromes, such as lupus, Hashimoto's disease and Sjogren's syndrome.
People with celiac disease may experience an extremely unpleasant, itchy, blistering skin rash called dermatitis herpetiformis. And while everyone with celiac disease may not have this complication, everyone with dermatitis herpetiformis has celiac disease. These rashes tend to arise on the elbows, knees, back of the neck, buttocks and scalp, but can appear anywhere on the body. The rash begins as small blisters, and as the patient scratches them, they burst and crust over while more appear. Doctors use a simple skin biopsy to diagnose dermatitis herpetiformis, and a strict gluten-free diet can completely alleviate this ailment.
Some adults with celiac disease have no symptoms at all. However, gluten intolerance is damaging their small intestine and can result in future complications. A rare complication of long-term, untreated celiac disease is adenocarcinoma and lymphoma of the small intestine. Usually, asymptomatic celiacs find out they have the disease because it runs in their family. These people may not feel the effects of their disease, but should follow a gluten-free lifestyle in order to stay healthy. Symptoms may appear at any time, or often might be so subtle that the patient is unaware they are even experiencing them until they disappear with faithful adherence to a gluten-free diet.
You may wonder why you suddenly experience symptoms as an adult, when you've enjoyed gluten all your life with no side effects. No one knows conclusively what "triggers" the immune response in people who carry the genetic predisposition to celiac disease, but certain events can make symptoms appear suddenly and unexpectedly. Pregnancy, surgery, physical injury (through a car accident or other trauma), severe emotional stress (including divorce or death) or a significant illness are all associated with the onset of adult celiac disease.
- Living Gluten Free for Dummies; Danna Korn; 2006