Celiac Disease Symptoms

2. Signs and symptoms of malnutrition and vitamin or mineral deficiencies

Symptoms of malnutrition and vitamin or mineral deficiencies include: weight loss, fluid retention, anemia, osteoporosis, bruising easily, peripheral neuropathy (nerve damage), infertility, and muscle weakness.

• Weight loss and fluid retention: Weight loss is the direct result of inadequate absorption of carbohydrates, proteins and fat. However, weight loss may not always occur because patients with celiac disease often have enormous appetites that compensate for the reduced absorption of nutrients. Moreover, weight loss can be masked by fluid retention. Fluid retention occurs in advanced malnutrition because the reduced absorption of protein results in low protein levels in the blood. High protein levels in the blood are necessary to keep fluid from leaking out of blood vessels and into the body's tissues. When blood protein levels fall as in celiac disease, fluid leaks into many tissues (edema) but particularly the ankles and feet, which swell due to the edema.
• Anemia: Lack of absorption of vitamin B12 and iron can lead to anemia.
• Osteoporosis: Lack of absorption of vitamin D and calcium can lead to osteoporosis and bone fractures.
• Easy bruising: Lack of absorption of vitamin K can lead to diminished ability of blood to clot and hence to easy bruising or excessive bleeding.
• Peripheral neuropathy (nerve damage): Vitamin deficiencies of B12 and thiamine may contribute to nerve damage with symptoms of poor balance, muscle weakness, and numbness and tingling in the arms and legs.
• Infertility: Untreated celiac disease can lead to infertility in women, lack of menses (menstruation), spontaneous abortions and low birth weight infants.
• Muscle weakness: Lack of absorption and low levels of potassium and magnesium can lead to severe muscle weakness, muscle cramps, and numbness or tingling sensations in the arms and legs.

How do symptoms of celiac disease differ with age of onset?

In the past, celiac disease was considered to be a disease primarily of infants and children. It is now clear that initial signs and symptoms of celiac disease can occur in adults and even in the elderly.

Infants with celiac disease typically have diarrhea, steatorrhea, abdominal cramps, abdominal distension, irritability, muscle wasting, and failure to thrive and grow. These symptoms typically occur after introduction of gluten-containing cereals into their diets.

Children with celiac disease typically have diarrhea, increased amounts of fat in the stool (steatorrhea), flatulence (passing gas), short stature and weight loss. Proper treatment with a gluten-free diet can lead to accelerated (catch-up) growth in height; however, if untreated, childhood celiac disease can result in short stature as an adult. As children with celiac disease enter adolescence, many will experience spontaneous remissions (reduced symptoms) and remain free of the signs and symptoms of celiac disease until later in adulthood. This later reactivation can be precipitated by stress such as pregnancy or surgery.