Celiac Disease and Associated Conditions
The immune system is a complex network of cells, tissues, and organs that protects the body from harmful germs and other substances that can cause illness. It can tell the difference between what belongs to the body and what comes from outside, such as bacteria or viruses. Autoimmune disorders occur when the immune system mistakenly attacks the body’s own cells, thinking they are foreign. This can lead to inflammation and damage in different parts of the body. The exact cause of autoimmune conditions is not known. They are thought to develop from a mix of factors, including genetics, changes in the gut microbiome (the trillions of bacteria, viruses, and fungi that live in the digestive tract), hormonal changes, and environmental triggers such as infections or pollutants.
Celiac disease is one of many autoimmune disorders. It is a genetic autoimmune condition that is triggered by eating gluten and leads to damage in the small intestine and can affect other organs in the body.
People with one autoimmune condition have a higher chance of developing another autoimmune disorder. This increased risk is thought to be linked to shared genetic traits, similar environmental triggers, and possibly factors related to the gut microbiome. The risk is higher when celiac disease is diagnosed later in life, or when it is diagnosed early in someone who has a family history of autoimmune disease.
Several autoimmune conditions are associated with celiac disease. These include type 1 diabetes, autoimmune thyroid disease (such as Hashimoto’s disease and Graves’ disease), autoimmune liver diseases (such as autoimmune hepatitis and primary biliary cirrhosis), inflammatory bowel disease (IBD), Sjögren’s syndrome, rheumatoid arthritis, multiple sclerosis, and Addison’s disease. Thyroid disease is the most common autoimmune condition linked to celiac disease.
Other conditions that can be associated with celiac disease include bone health issues, dental problems, iron-deficiency anemia, neurological issues, reproductive issues, mental health concerns, and more.
People who already have an autoimmune disorder are also at higher risk of developing celiac disease. About 5–6% of individuals with type 1 diabetes and 3–6% of those with thyroid disease develop celiac disease. Multiple autoimmune conditions can occur in both children and adults. Because of this, it is important to screen people with celiac disease for other autoimmune disorders, and to screen people with autoimmune disorders for celiac disease.
Celiac Disease and Type 1 Diabetes
Type 1 diabetes is an autoimmune disease in which the immune system attacks and destroys the cells in the pancreas that produce insulin. Insulin is a protein that helps control blood glucose levels. When the body cannot make enough insulin, blood sugar becomes too high, a condition called hyperglycemia. Over time, hyperglycemia can damage blood vessels and nerves.
Many people who have both type 1 diabetes and celiac disease do not have gastrointestinal symptoms, or their symptoms may be mistaken for effects of diabetes. Because of this, it is very important to screen people with type 1 diabetes for celiac disease. It is also important to monitor people with celiac disease for signs and symptoms of type 1 diabetes.
There is currently no known link between type 2 diabetes and celiac disease. Type 2 diabetes is different from type 1 diabetes because the pancreas can still make insulin. However, in type 2 diabetes the pancreas does not make enough insulin, or the body’s cells do not respond properly to insulin, a problem known as insulin resistance. Both situations lead to high blood sugar (hyperglycemia).
People are at higher risk of developing type 2 diabetes if they have a family history of the condition, belong to certain ethnic groups (including East Asian, South Asian, Hispanic, African American, and Indigenous populations), have overweight or obesity, live inactive lifestyles, or have other contributing factors. This means that individuals with celiac disease can still develop type 2 diabetes for the same reasons as the general population.
The strict gluten-free diet may help control blood glucose levels among people with diabetes. For management of celiac disease and diabetes, it is important to seek the guidance of a skilled and knowledgeable dietitian.
Celiac Disease and Thyroid Disease
The thyroid is a small, butterfly‑shaped gland located at the base of the neck. Thyroid disease occurs when the thyroid does not function properly. This includes hypothyroidism, when the thyroid does not make enough hormone, and hyperthyroidism, when it makes too much hormone.
In hypothyroidism, the body’s metabolism slows down. This can lead to an enlarged thyroid gland (goiter), tiredness, weight gain, constipation, dry skin, forgetfulness, depression, and other symptoms. Hashimoto’s thyroiditis is an autoimmune thyroid condition that can cause hypothyroidism.
On the other hand, hyperthyroidism speeds up the body’s metabolism, causing the body to use energy more quickly and increase the rate of cellular activity. Symptoms of hyperthyroidism can include irritability, weight loss, looser stools, sleep problems, nervousness, and vision changes. Graves’ disease is an autoimmune form of hyperthyroidism.
Thyroid disease can affect people of all ages and backgrounds. Women are five to eight times more likely than men to develop thyroid problems. About 5–10% of people with celiac disease also have thyroid disease. This connection is thought to be related to shared genetic factors, such as human leukocyte antigen (HLA) markers, as well as environmental influences. Because of this relationship, it is recommended that people with thyroid disease be screened for celiac disease, and that people with celiac disease be screened for thyroid disease.
Celiac Disease and Inflammatory Bowel Disease
Inflammatory bowel disease (IBD) includes Crohn’s disease and ulcerative colitis. IBD is an autoimmune inflammatory condition that affects the gastrointestinal tract, but it is different from celiac disease. IBD is a long‑term condition with periods of flare‑ups and periods of disease control. Unlike celiac disease, where gluten is the known trigger, the cause of IBD is still unknown.
Common symptoms of IBD include abdominal pain, diarrhea (with or without blood), weight loss, and fatigue. Canada has one of the highest rates of IBD in the world, and the number of people affected continues to rise. Treatment usually involves medication, and new research shows that diet may also play a supportive role in managing IBD. However, diet therapy—such as a gluten‑free diet—should not be started without medical advice and guidance from a trained nutrition professional. Individuals with IBD should consult a gastroenterologist or a specialized registered dietitian before making dietary changes.
Celiac Disease and Liver Disease
Individuals with celiac disease are at higher risk of developing autoimmune liver diseases such as autoimmune hepatitis, primary sclerosing cholangitis, and primary biliary cirrhosis. People with autoimmune liver disease also have a greater chance of developing celiac disease compared to the general population. Because of this two‑way relationship, it is recommended that all patients with autoimmune liver disorders be screened for celiac disease.
Liver enzymes are proteins made by the liver that normally enter the bloodstream in small amounts. Two liver enzymes commonly checked in liver disease are alanine transaminase (ALT) and aspartate transaminase (AST). Levels of ALT and AST rise in the blood when there is inflammation or damage in the liver. Some people with celiac disease have high liver enzyme levels without any symptoms. If this increase, called transaminitis, is not diagnosed or treated, it can lead to serious liver damage over time, including liver failure.
A timely diagnosis of celiac disease is important because following a strict gluten‑free diet can help reduce inflammation in the liver. People with both celiac disease and liver disease may also need medication to manage the liver condition and may be referred to a liver specialist (hepatologist) for further care.
Some people with celiac disease have mildly increased ALT levels at the time of diagnosis. This is called celiac hepatitis, which is the most common liver‑related effect of celiac disease. Celiac hepatitis is a mild and reversible form of liver inflammation. ALT levels usually return to normal within 6–9 months after starting a strict gluten‑free diet.
Celiac Disease and Joint Problems
Arthritis is a group of conditions that affect the joints and surrounding tissues. It is linked to pain, reduced mobility, and a lower quality of life. Rheumatoid arthritis (RA) and juvenile arthritis (JA) are autoimmune inflammatory conditions that affect the joints. Inflammation in the joints can cause pain, swelling, and long‑term damage. Some individuals with celiac disease may develop one of these arthritic conditions.
Joint and bone pain in celiac disease can also be linked to osteoporosis. In osteoporosis, pain is often caused by fractures or tiny cracks in the bone (microfractures) that develop because the body has not absorbed enough nutrients. Nutrient malabsorption can occur before celiac disease is diagnosed, which is why some people with bone disease are later found to have celiac disease. Bone problems can also develop if a person with celiac disease continues to be exposed to gluten over many years. Following a strict gluten‑free diet is important for protecting bone health in celiac disease.
Celiac Disease and Bone Health Issues
Calcium and vitamin D are important nutrients for building strong bones. In celiac disease, poor absorption of nutrients such as calcium, zinc, copper, phosphorus, magnesium, and vitamins A and D—either at diagnosis or from long‑term gluten exposure—can lead to weak bones. A strict gluten‑free diet that includes enough protein and micronutrients can help improve bone strength and overall bone health. Regular weight‑bearing exercise also supports bone health. Some individuals may need calcium and vitamin D supplements.
Bone health should be checked regularly in people with celiac disease. This is done using a special type of X‑ray called a dual‑energy X‑ray absorptiometry (DXA) scan. A DXA scan measures how much mineral is stored in the bones and compares it to healthy bone in people of the same sex and age. DXA results are used to diagnose osteopenia (low bone density) and osteoporosis (significant bone loss that makes bones fragile and more likely to break). Some individuals with celiac disease who have bone health concerns may be referred to a specialist, such as an endocrinologist, for further assessment and treatment.
Celiac Disease and Dental Problems
Dental enamel defects can occur in celiac disease. Dental enamel is the hard outer layer of the teeth. Enamel defects in celiac disease, and the number of teeth affected, are strongly linked to the age when symptoms first appear. These defects most often develop in permanent teeth, usually before age 7, when the permanent teeth are forming. The defects tend to appear in a similar pattern across all four sections of the mouth. Different types of enamel defects may be seen, including pitting, grooving, or even complete loss of enamel. Some children with celiac disease may also have delayed tooth eruption and slower tooth development. Both children and adults can have dental enamel defects.
Celiac Disease and Iron-Deficiency Anemia
Anemia is a blood disorder in which the number of healthy red blood cells or the amount of hemoglobin is lower than normal. Iron-deficiency anemia occurs when the bone marrow does not have enough iron to make hemoglobin. Hemoglobin is the protein inside red blood cells that gives blood its red colour and carries oxygen from the lungs to the rest of the body.
Iron‑deficiency anemia is the most common type of anemia in celiac disease, but anemia can also be caused by low levels of vitamin B9 (folate) or vitamin B12 (cobalamin). These nutrient deficiencies may happen because of poor dietary intake, damage to the small intestine that reduces absorption, or nutrient loss, such as iron loss during menstrual periods.
Symptoms of iron‑deficiency anemia and other anemias can include fatigue, shortness of breath, dizziness, pale skin, low mood, and headaches.
Iron‑deficiency anemia and other nutrient‑related anemias can occur at the time of celiac disease diagnosis or continue even while following a strict gluten‑free diet. A person with celiac disease may have more than one nutrient deficiency, so bloodwork is important at diagnosis and during follow‑up. Support from a skilled dietitian can help with the strict gluten‑free diet and determine whether nutrient supplements are needed.
Treatment for iron‑deficiency anemia may sometimes require intravenous iron infusions prescribed by a doctor or other health‑care professional. Anemia can also occur for reasons not related to nutrient deficiencies. In these cases, a person with celiac disease may be referred to a blood specialist (hematologist) for further assessment.
Celiac Disease and Neurological Issues
People with celiac disease may have neurological symptoms when they are diagnosed, or they may develop neurological problems later on. Common issues include neuropathy, migraine headaches and epilepsy. Many people who have neurological symptoms related to celiac disease do not have any gastrointestinal symptoms.
Click this link for more information about neurological health.
Neuropathy is inflammation of the nerves in the body. It can cause numbness, tingling, muscle weakness, and “pins and needles.” It most often affects the arms, legs, hands, and feet, but it can also affect internal organs. Neuropathy is more common in older adults and is rare in children with celiac disease. In celiac disease, neuropathy may be linked to inflammation or to low levels of vitamin B9 (folate), vitamin B12 (cobalamin), or vitamin E. A strict gluten‑free diet and nutrient supplements may help improve symptoms. In some cases, neuropathy may be autoimmune‑related and require medication for treatment.
A migraine is a severe headache that causes throbbing or pulsing pain. Migraine symptoms vary from person to person and are reported in people with celiac disease. Following a strict gluten‑free diet can greatly improve migraine symptoms. The exact reason is not fully understood, but it may be related to reduced inflammation and the effects of inflammatory proteins on the brain. Click this link for more information about migraines.
Epilepsy is a long‑term neurological disorder that causes repeated seizures. Some studies show that people with celiac disease may have a higher risk of developing epilepsy than the general population. Some individuals with epilepsy may also have undiagnosed celiac disease. In certain cases, following a strict gluten‑free diet can help reduce seizures, suggesting a possible link between the two conditions. However, most people with epilepsy still need medical treatment from a specialist (neurologist). Click here for more information about epilepsy.
Celiac Disease and Reproductive Disorders
Celiac disease is linked to several reproductive disorders in both men and women, including infertility and delayed puberty. In women, recurrent miscarriages and early menopause can occur. Women with celiac disease also have a higher risk of polycystic ovary syndrome (PCOS) and endometriosis. In men, celiac disease is associated with reduced sperm quality and hypogonadism. These reproductive issues are thought to be related to chronic inflammation or nutrient deficiencies, and they may improve with a strict gluten‑free diet as part of celiac disease treatment.
Screening for celiac disease is recommended for individuals with unexplained reproductive problems, as early diagnosis and management can help reduce complications. For more information about reproductive disorders, please speak with a primary care provider.
Celiac Disease, Mental Health and Well-Being
Celiac disease is closely linked to poor mental health, with higher rates of anxiety, depression, and other conditions. These issues may be related to disruption of the gut–brain axis and chronic inflammation caused by the immune response to gluten. Mental health symptoms such as brain fog and fatigue are also common, especially when celiac disease is untreated, but they can continue even after diagnosis.
Adjusting to life with a chronic condition can be challenging, especially with celiac disease, where the only treatment—a strict gluten‑free diet—can be difficult to follow. Barriers such as cost, limited food availability, and concerns about gluten exposure can affect daily life. Activities like eating out, dating, and travel may require extra planning and can increase stress or hypervigilance. A strict gluten‑free diet may improve some mental health symptoms, but ongoing psychosocial support is important for overall well‑being and quality of life.
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