Coeliac disease is often thought of as a gut condition, but its effects can go far beyond digestion. Many people experience digestive and non-digestive symptoms everyday, but don’t point to gluten or the gut. Sometimes, even if you are not realising it, the gluten is what is affecting your body, since the gluten has a big impact on the gut and brain in coeliac disease. This article explores lesser-known signs and how gluten-driven inflammation can affect both the gut and the brain.
What coeliac disease actually is
Some people have a misconception and think coeliac disease is a food intolerance or an allergy, but it is an autoimmune autoimmune reaction triggered by gluten. As Doctify-rated Consultant Gastroenterologist Dr Angad Dhillon explains, coeliac disease is an autoimmune condition where the immune system mistakenly attacks the lining of the small intestine when gluten, a protein found in wheat, barley, and rye, is consumed.
This immune response damages the villi, the small finger-like projections in the intestine that help absorb nutrients, leading to malabsorption and a range of symptoms. The exact cause is a combination of genetic factors and environmental triggers.
Why coeliac disease is often missed
Often, coeliac disease is missed, because not everyone has classic digestive symptoms. In some cases, people’s symptoms may develop slowly and feel “normal” over time. While in other cases, celiac disease symptoms can overlap with stress, IBS, anxiety, or low mood and be misdiagnosed.
The symptoms can vary widely between individuals because not every individual is the same and it depends on the interaction of the genetic, immunological, and environmental factors. Factors like viral infections, changes in the gut microbiome, and stress can trigger the disease in genetically predisposed individuals.
Hidden gut-related signs
There might be, as well, hidden gut-related signs, which people don’t identify as celiac disease, but then can be. One sign is ongoing bloating, wind, or mild abdominal discomfort. Another one can be alternating bowel habits rather than constant diarrhoea. Last but not least, nutrient malabsorption without obvious gut pain.
How gluten can affect the brain and mood
Scientists have found a close brain-gut connection, it is “a two-way communication network between the nervous system and the gut”. So the brain, as the gut, can also be affected by eating gluten when having coeliac disease. Some common non-digestive symptoms that might occur after consuming gluten are persistent fatigue or low energy, brain fog or difficulty concentrating, and a low mood, anxiety, or irritability.
Skin, joints, and other overlooked symptoms
Coeliac disease can, also, have overlooked symptoms in other regions of the body that can manifest as:
- Itchy or blistering rashes linked to gluten sensitivity.
- Mouth ulcers and dental enamel issues.
- Joint aches or unexplained bone pain.
- Iron deficiency anaemia without heavy periods or bleeding.
Who should consider testing
We recommend testing should be considered in:
- Adults with unexplained fatigue or brain fog.
- People with ongoing gut symptoms that don’t respond to dietary changes.
- Those with autoimmune conditions or a family history of coeliac disease.
It’s important to note that individuals should not start a gluten-free diet before being tested, as this can affect the accuracy of the results.
What testing involves
Coeliac disease is diagnosed through a combination of blood tests, an endoscopy, and sometimes genetic testing:
1. Blood tests:
The most used test is for anti-tissue transglutaminase (tTG) antibodies, which are elevated in most people with coeliac disease. A total serum IgA test is also used to rule out IgA deficiency.
2. Endoscopy and biopsy:
The gold standard for diagnosis. An endoscopy allows doctors to examine the small intestine and take a biopsy to check for villous atrophy, which is a hallmark of coeliac disease.
3. Genetic testing:
The genetic testing for HLA-DQ2 and HLA-DQ8 can help rule out coeliac disease, but it cannot definitively confirm the diagnosis.
There is no cure for coeliac disease, but it can be effectively managed with a strict, lifelong gluten-free diet.
Dr Angad Dhillon, Doctify-rated Consultant Gastroenterologist
Life after diagnosis
Having a lifelong gluten-free diet involves completely eliminating gluten from the diet, including hidden sources of gluten in processed foods, medications, and cosmetics. Most people will experience improvement in symptoms and healing of the intestine after following the diet.
Additionally, it is very important to have regular follow-ups and nutritional monitoring with healthcare providers to monitor any potential complications and ensure ongoing health management.
Conclusion
Coeliac disease can present in subtle, unexpected ways. The symptoms can vary widely between individuals because not every individual is the same and it depends on the interaction of the genetic, immunological, and environmental factors. But, recognising hidden signs can lead to earlier diagnosis and better quality of life. Speaking to a GP is the first step if symptoms don’t add up. Doctify offers excellent GPs that are willing to help you.
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Medically Reviewed
Last reviewed on 14/01/2025
