Celiac disease is a complex autoimmune condition that occurs when the body responds abnormally to gluten, a protein found in wheat, rye, and barley. While some individuals may associate celiac disease with only digestive issues like diarrhea or bloating, the reality is that it can affect multiple systems in the body, leading to a wide array of symptoms. In some cases, individuals might not even exhibit obvious signs, making diagnosis challenging.

Common Symptoms in Adults and Children

Celiac disease presents differently depending on age, gender, and individual biology. In adults, symptoms are often subtle and non-digestive, while in children, signs may be more classically gastrointestinal. However, this is not always consistent.

In both groups, common symptoms can include abdominal pain, bloating, chronic diarrhea, constipation, weight loss, nausea, and vomiting. Fatigue is also a frequent complaint and may be severe enough to interfere with daily activities. Adults may also experience heartburn, gas, or acid reflux, while children often display mood changes, irritability, and slowed growth.

Infants and young children with undiagnosed celiac disease might experience poor weight gain, delayed development, and dental enamel defects. Adolescents may encounter delayed puberty, short stature, and problems with attention and focus, often misdiagnosed as ADHD.

Digestive Symptoms

Although not all individuals with celiac disease have digestive symptoms, many do. Diarrhea remains a hallmark symptom, often described as smelly, watery, and floating. Constipation, however, is also common, and many people report alternating patterns of both.

Additional gastrointestinal signs include abdominal bloating that can be visibly noticeable, severe stomach pain, excessive gas, nausea, vomiting, and lactose intolerance. These symptoms often lead to misdiagnoses, such as irritable bowel syndrome (IBS) or acid reflux disease.

In some cases, individuals with celiac disease gain weight or are unable to lose weight, contrary to the stereotypical image of weight loss associated with the condition. Pancreatitis or gallbladder issues may also develop due to long-term digestive inflammation.

Neurological and Cognitive Symptoms

Celiac disease frequently affects the nervous system. Chronic fatigue is a prominent symptom, sometimes misattributed to aging or lifestyle. Sleep disturbances, including insomnia, are also common.

One of the more specific neurological symptoms is "brain fog," which involves memory lapses, difficulty concentrating, and slow thinking. Some individuals also experience frequent headaches or migraines that may improve upon adopting a gluten-free diet.

Numbness, tingling, or weakness in the limbs—known as peripheral neuropathy—can develop, and in rare cases, a condition called gluten ataxia may occur, resulting in balance and coordination problems. Restless legs syndrome has also been associated with celiac disease.

Psychological and Emotional Symptoms

Mental health is often impacted by untreated celiac disease. Anxiety, depression, mood swings, and irritability are common. Some individuals may find that these symptoms worsen with gluten exposure, even before physical symptoms appear. In children, persistent irritability may be the only sign of the condition.

Other individuals may experience difficulty coping emotionally with the effects of chronic illness and the restrictive gluten-free diet, especially before diagnosis.

Skin Symptoms

Celiac disease can also present through skin conditions. Dermatitis herpetiformis is a blistering, intensely itchy rash that is strongly associated with celiac disease. This rash may appear on the elbows, knees, buttocks, and scalp.

Other skin-related problems seen in people with celiac disease include psoriasis, eczema, hives, alopecia areata (hair loss), and chronic dry skin. Although scientific evidence linking gluten to these conditions is still emerging, many people report improvement in skin issues once gluten is removed from their diet.

Bone and Joint Symptoms

Musculoskeletal symptoms are another hallmark of undiagnosed celiac disease. Joint pain, back pain, and muscle aches may be present. Conditions like osteoporosis or osteopenia (bone weakening due to low mineral density) are more common, often as a result of poor nutrient absorption.

Rheumatoid arthritis and fibromyalgia-like symptoms are also sometimes seen. In many cases, these pains may ease once gluten is eliminated and nutrient absorption improves.

Dental and Oral Symptoms

Oral health can provide clues to underlying celiac disease. Individuals may experience frequent canker sores (aphthous ulcers), gum inflammation, tooth discoloration, or enamel defects.

Children with undiagnosed celiac may have delayed tooth eruption and permanent discoloration of adult teeth. Adults may suffer from cavities and gum disease due to prolonged nutritional deficiency.

Rare and Atypical Symptoms

Celiac disease is known to manifest in hundreds of ways, some of which may seem unrelated to digestion. In children, symptoms like extreme fatigue, very low blood pressure, or severe electrolyte imbalances can be signs of advanced disease.

Though rare, some adults may first present with serious conditions such as non-Hodgkin lymphoma. While the cancer risk remains low, individuals with longstanding untreated celiac disease have a slightly higher chance of developing certain rare intestinal tumors.

Nutritional and Hormonal Complications

Malabsorption of nutrients is a primary complication of celiac disease, leading to anemia, weight loss, and general weakness. Children often fall behind growth charts and may fail to thrive. If diagnosed early enough, nutritional rehabilitation can reverse some of these effects.

Osteoporosis is another frequent consequence of long-term untreated celiac disease, driven by poor calcium and vitamin D absorption. Hormonal imbalances are also common and can affect the reproductive system, thyroid function, and adrenal glands.

Women may experience irregular menstrual cycles, infertility, repeated miscarriages, and early menopause. Men may also face fertility issues. Celiac disease is notably more prevalent in individuals with other autoimmune conditions, such as type 1 diabetes or thyroid disorders.

When to Consult a Healthcare Provider

You should consider speaking to a healthcare provider if you or your child has persistent digestive issues, especially if they last longer than two weeks. Symptoms like chronic diarrhea, weight loss, unexplained fatigue, and recurring skin rashes should prompt medical evaluation.

It's critical not to begin a gluten-free diet before testing, as eliminating gluten beforehand can lead to false-negative results. A proper diagnosis typically involves blood tests for celiac antibodies and may be followed by an endoscopic biopsy to examine intestinal damage.

Family members of those diagnosed with celiac disease should also be tested, even if they do not show symptoms, as the condition is hereditary. First-degree relatives have a significantly higher risk.

Conclusion

Celiac disease is a multi-system autoimmune condition that can present with a wide range of symptoms—some of which may not seem digestive at all. These symptoms can vary by age, sex, and individual response, making the disease particularly challenging to diagnose.

While the symptoms may differ widely, the solution remains consistent: strict lifelong adherence to a gluten-free diet. Early recognition and diagnosis not only help manage existing symptoms but also prevent serious long-term complications. If you suspect celiac disease, early consultation with a healthcare provider is the key to restoring health and improving quality of life.