Celiac disease is an autoimmune gastrointestinal medical condition in which damage to the inner lining of the small intestine occurs. For those who have celiac disease, a substance called gliadin (a grain protein in gluten), which is found in wheat, barley, rye, and triticale, triggers an abnormal immune response that flattens and alters the millions of microscopic finger-like projections (villi) that line the inner wall of the small intestine, preventing them from working properly. Consequently, the body cannot obtain many essential proteins, fats, carbohydrates, vitamins, and minerals from food that are necessary for good health. Individuals who have celiac disease should never eat any product containing even the smallest amount of gluten that contains gliadin, as it takes only one molecule to trigger the destructive response.
Symptoms of celiac disease may include iron deficiency anemia, diarrhea, weight loss, fatigue, breathlessness, cramps, bloating, irritability, and skin problems. While celiac disease in itself does not cause many problems, as long as the patient adheres to a strict gluten-free diet, there are many disorders and risks associated with celiac disease. In this article, we are reviewing a few of these risks, namely weight variation, thyroid disease, type 1 diabetes, and tuberculosis.
A patient’s unintended weight loss is often one of the first indicators to a physician to consider a celiac diagnosis. Weight loss can result from improper absorption of nutrients due to a malfunctioning small intestine. However, a study conducted in Northern Ireland in 2006,1 which tracked the weight patterns of 188 celiac disease patients who switched to a strict gluten-free diet for two years, shows interesting results. At the end of the study, only 4% of participants had maintained their weight, 15% had lost weight, and an astounding 81% experienced sufficient weight gain to have become overweight, based on comparison to height-to-weight charts on standards of normality.
The reason for the weight gain is uncertain. It might be because, while previously eating gluten, subjects had adapted to ingesting a greater quantity of food but since the gluten damaged their small intestines, they were not receiving the full nutritional value from the foods they consumed. Once eliminating gluten from the diet allowed healing of the small intestine, digestion became more efficient, at which point the subjects could actually consume less food to receive adequate nutrition. If subjects kept consuming the previous quantity of food, then weight gain would be inevitable.
Another potential cause of weight gain is the type of foods consumed. Gluten is useful in food processing because it binds, stabilizes, and prevents crumbling. When omitting gluten, food product manufacturers might increase the fat and/or sugar content to compensate for the gluten effect. Excessive use of these modified products could also contribute to weight gain.
Adapting to the gluten-free diet by increasing consumption of fruits and vegetables and reducing the quantity of safe grain products, as well as ensuring regular exercise, may help combat unwanted weight gain.
A large study conducted in Sweden looking at data gathered from 1964-2003, published in October 2008,2 shows that people with celiac disease are more likely than the average population to have a thyroid disease, such as hypothyroidism, hyperthyroidism, or thyroiditis.
The butterfly-shaped thyroid gland is located toward the front of the body at the base of the neck. One of its functions is to produce hormones that regulate the body’s metabolism. Hypothyroidism occurs when the thyroid produces too little thyroid hormone, causing sensitivity to the cold, weight gain, dry skin, fatigue, tiredness, and a slower pulse, whereas hyperthyroidism occurs when the thyroid produces too much thyroid hormone, causing nervousness, a fast heartbeat, excessive sweating, and heat intolerance. Thyroiditis is inflammation of the thyroid gland.
The study followed 14,000 subjects diagnosed with celiac disease and 68,000 matched control subjects. Results showed that people with celiac disease were 4 times more likely than were the general population to develop hypothyroidism, 3 times more likely to develop hyperthyroidism, and 3.6 times more likely to develop thyroiditis. The highest risk identified was in children; however, males and females of all ages who had celiac disease were more likely than were the control subjects to develop a thyroid condition.
Thyroid disease and celiac disease are both autoimmune conditions and likely co-exist because of shared genetic traits.
Type 1 Diabetes
In diabetes mellitus type 1, which is most commonly diagnosed in otherwise healthy children or young adults, the individual’s immune system destroys insulin-producing cells within the pancreas. Insulin is the hormone that signals to the body’s cells to take up carbohydrates circulating in the blood. Without insulin, too much sugar remains in the blood because it isn’t being used for immediate energy nor stored for later use. Symptoms include blurred vision, extreme thirst and hunger, fatigue, frequent urination, slow wound-healing, decreased mental sharpness, and unintentional weight loss.3
A study from England, published in 2008,4 examined the relationship between Type 1 Diabetes and celiac disease, and found that the two autoimmune disorders shared four genetic mutations.
Tuberculosis is a disease caused by an infection with the bacterium, Mycobacterium tuberculosis, which usually affects the lungs but may attack any part of the body. Tuberculosis is contagious when the bacteria are airborne and pregnant women can pass it to their fetuses. Symptoms include a bad cough, fever, weight loss, and weakness.5 Mycobacterium tuberculosis infects approximately one third of the world’s population; however, only 5-10% of those infected actually develop active tuberculosis, and these individuals often have a compromised immune system. A large study conducted in Sweden,6 consisting of 14,335 individuals with celiac disease and 69,888 control subjects, examined whether tuberculosis is more likely to occur if the patient already has celiac disease. The study showed that individuals with celiac disease were three to four times more likely than were the control group to contract tuberculosis.
Once diagnosed with celiac disease, a person should immediately begin a nutritious diet that is 100% gluten-free, which quickly results in elimination of most disease symptoms. However, for individuals with celiac disease, some further risks do exist, especially on a genetic level. If you have one autoimmune disorder, then you may have others, such as thyroid disease or type 1 diabetes. If you have celiac disease and are concerned that you might have one of these other medical conditions, please talk to your healthcare provider.