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  • Wendy Cohan, RN
    Wendy Cohan, RN

    Celiac Disease Head to Toe

    Reviewed and edited by a celiac disease expert.

      Headaches are a very common symptom of wheat allergy, as well as gluten intolerance.  Migraines are common in those with celiac disease and gluten intolerance, as are sinus headaches. 


    Caption: Image: CC--WalkingGeek

    Celiac.com 04/05/2019 (Originally published on 10/19/2009) - Gluten intolerance caused by celiac disease, or non-celiac gluten sensitivity, may affect virtually any part of the body. A culprit in multiple health disorders, gluten intolerance is a major driver of health care delivery and associated costs.  While this may seem to be an outrageous claim, a review of the many ways in which gluten intolerance can adversely affect the body will illustrate this point. So, let’s work our way down from head to toe.

    Celiac Disease Can Cause Hair Loss

    Normal, healthy hair is usually glossy and thick.  An autoimmune disorder known as alopecia areata results in abnormal loss of hair, either in patches, or totally, and is one of many autoimmune disorders associated with celiac disease. Malabsorption severe enough to cause malnutrition can also result in thin, sparse, fragile hair. One of the outward signs of hypothyroidism is thinning hair and a loss of the outer third of the eyebrow; hypothyroidism is strongly associated with celiac disease.

    How Celiac Disease Affects the Brain

    Now let’s look at the brain.  There are, unfortunately, a large number of neurological disorders associated with gluten intolerance and celiac disease, including narcolepsy, depression, ADD/ADHD, Autism Spectrum Disorders, and schizophrenia. There are also movement and balance disorders associated with gluten intolerance, including ataxia - the inability to coordinate movements and balance (gluten ataxia, celiac ataxia, some cases of sporadic idiopathic ataxia). In some cases, when symptoms are severe, this disorder mimics other disorders such as Parkinson’s, Normal Pressure Hydrocephalus, and even Alzheimer’s disease.

    Headaches Common in Celiac Disease

    Headaches are a very common symptom of wheat allergy, as well as gluten intolerance.  Migraines are common in those with celiac disease and gluten intolerance, as are sinus headaches.  These symptoms often decline dramatically after excluding gluten grains from the diet. Sinus problems are common in those with celiac disease, gluten intolerance, and sensitivity to dairy products as well, and are often reversible by making dietary changes. Some people with celiac disease seem to have an altered, highly acute sense of smell – for unknown reasons.

    Night Blindness from Vitamin A Deficiency

    Night blindness associated with vitamin A deficiency is reversible when malabsorption is resolved and with the addition of a vitamin A supplement. Xeropthalmia, or chronic, often severe, dry eyes, is also related to severe vitamin A deficiency.  It is rare in developed countries, but can be found in some people with malnutrition due to celiac disease.

    Canker Sores Common in Celiac Disease

    Apthous stomatitis is the name for the mouth ulcers associated with food allergies and intolerances, and is strongly associated with celiac disease and gluten intolerance. Even people who do not have gluten sensitivity get these once in a while but in those with gluten intolerance they are more frequent and especially long-lasting.  

    Dental Enamel Defects Can Indicate Celiac Disease

    While they are usually identified in childhood, they can continue to cause problems throughout life, because they often lead to more frequent dental cavities.  Halitosis, or bad breath, is a reflection of our internal environment and gastrointestinal health, and is often present in those with untreated celiac disease, gluten sensitivity, or gut dysbiosis – an upset in the balance of our internal microorganisms caused by poor diet and other factors. And, one of the autoimmune disorders strongly associated with celiac disease, and one of the most prevalent is Sjogren’s syndrome, which impairs the normal production of body fluids like tears, saliva, and vaginal secretions.

    Strong Link Between Celiac Disease & Eosinophilic Esophagitis

    Following the path our food takes to the stomach, we can look for effects in the esophagus too.  Eosinophilic esophagitis is a rarely encountered inflammation in the tissue of the esophagus which makes swallowing painful and difficult and can result in bleeding ulcerations.  When doctors do see it, they sometimes test for celiac disease, since there is a strong correlation.  Fortunately, in cases where this condition is caused by gluten intolerance, this painful chronic disorder clears up on a gluten free diet, too.

    GI Complaints Common in Celiac Patients

    Now we’re getting to the area most people associate with gluten intolerance – the gastro-intestinal system. In the past, celiac disease was usually described as causing gas, diarrhea, bloating, discomfort, cramping, and malabsorption.  But as you’ve already seen above, there is a whole lot more to this disorder, and we’re only halfway to the toes.

    Celiac Can Be Misdiagnosed as IBS

    In addition to the above symptoms, the body’s reaction to gluten can cause inflammation anywhere, but a common location is in the illeo-cecal junction and the cecum. This can sometimes be confused with appendicitis, or ovarian pain or an ovarian cyst in women experiencing right-sided lower abdominal discomfort.  Irritable bowel syndrome is suspected to affect at least 10-15% of adults (estimates vary). It is differentiated from IBD, or inflammatory bowel disorders (which include Crohn’s disease and ulcerative colitis). But, taken together, there are an awful lot of people out there with uncomfortable gut issues.  One fact to consider is that many of those with celiac disease were previously, and wrongly, misdiagnosed with IBS before discovering they actually had celiac disease.

    Kidney & Urinary Problems

    Let’s take a look at the urological system.  Even though gluten from the food we eat isn’t directly processed here, can it still be affected?  The answer is yes. Kidney problems in association with celiac disease are well documented, including oxalate kidney stones. Bladder problems are increasingly shown to be responsive to a gluten-free diet. This is kind of my specialty and I would estimate that about a quarter of those with interstitial cystitis, and many people with recurrent urinary tract infections, have a sensitivity to gluten. Even prostate inflammation in some men can be triggered by eating gluten grains.

    Adrenal Fatigue in Celiac Disease

    Sitting just atop the kidneys are our adrenal glands.  They have a difficult job, helping to direct our stress response system, our immune system, and our hormone output, and controlling inflammation in the body. Every time we experience a reaction to gluten, and our adrenals respond by sending out a surge of cortisol to help control inflammation, we are depleting our adrenal reserve.  When this happens chronically, over time, our adrenal system cannot keep up and becomes fatigued.  Symptoms of adrenal fatigue have far-reaching consequences throughout the body, including, of course, feeling fatigued and run down. But, adrenal fatigue can also affect our hormones, our blood sugar regulation, our mental acuity, our temperature regulation, and our ability to cope with food allergies, environmental allergies, and infections.

    Celiac Disease Common in Hepatitis Patients

    Can the liver, the body’s largest internal organ, be affected by gluten intolerance too?  One example is autoimmune hepatitis, in which can be untreated celiac disease can be found in large numbers. Early screening testing for celiac disease is now strongly recommended for patients diagnosed with autoimmune hepatitis.

    Gluten Intolerance, Pancreas and Blood Sugar

    The pancreas, which is key in blood sugar regulation, is highly affected by gluten intolerance.  Autoimmune disease triggers the development of Type I Diabetes, and is becoming more closely associated with celiac disease.  Testing for celiac disease is now becoming a routine part of examination when a child develops Type I Diabetes, and now that physicians are looking for celiac disease in juvenile diabetes, they’re finding it with greater frequency. Blood sugar regulation problems are also associated with non-diabetic hypoglycemia in those with gluten intolerance, and appear to resolve with a low-glycemic gluten free diet.

    Celiac Disease Can Affects Limbs and Extremities

    So, we’ve covered most of the body’s major internal systems. Now, let’s look at the extremities, our upper and lower limbs, where gluten-associated problems are also found. Ehlers-Danlos Syndrome, a collagen disorder resulting in shoulder, elbow, and wrist joints that dislocate easily (and other characteristics) is a genetic disorder that may also be associated with celiac disease.  I had mild symptoms of this disorder as a child, but never knew it had a name until I ran across it recently.  With a child who has this disorder, a simple game of swinging a child by the arms, or swinging a child between two sets of their parent’s arms, can result in a trip to the emergency to put their joints back into proper alignment. This is not to say that a reaction to gluten causes this genetic disorder, but that if you have a personal or family history of Ehlers-Danlos Syndrome, and symptoms that may be related to celiac disease, you should consider being tested.

    Arthritis Associated with Celiac Disease

    Rheumatoid arthritis is another of the autoimmune disorders associated with celiac disease, and often affects the fingers with crippling joint deformation. Other joints in the body can also be affected. Scleroderma is another terribly disfiguring and sometimes fatal autoimmune disorder affecting every part of the body. It is often first identified in the extremities, particularly the fingers. In scleroderma, normal tissue loses it’s flexibility as the body’s autoimmune response produces inflammation and an overproduction of collagen.  Collagen is the tough fibrous protein that helps form connective tissues including tendons, bones, and ligaments. Excess collagen is deposited in the skin and body organs, eventually causing loss of function.  Scleroderma can be associated with celiac disease.

    Skin Conditions Common in Celiac Patients

    The arms and legs are also common spots for yet another autoimmune disorder, psoriasis, to develop.  Some patients with psoriasis are responsive to a gluten-free diet, but unfortunately, not everyone. Another skin condition that often shows up on the arms is dermatitis herpetiformis (DH), although this itchy blistering skin rash can occur in other places as well.  Common sites are the backs of the elbows and the backs of the knees, or on the lower legs.

    Peripheral Neuropathy Common in Celiac Disease

    Peripheral neuropathy is a disorder that results in numbness, tingling, and sometimes severe nerve pain in the extremities.  Finger, hands, toes, feet, and lower legs may all be affected. Although usually associated with diabetes, peripheral neuropathy shows up fairly frequently in those with celiac disease, and is fortunately reversible on a gluten free diet supplemented by B-vitamins and some specific amino acids.  Peripheral neuropathy is usually associated with older people, but some of the cases I’ve observed recently have been in very young children who had severe malabsorption issues.  Fortunately they healed quickly and their neuropathy symptoms resolved completely.

    Malabsorption and Vitamin Deficiency

    There a few last symptoms related to malabsorption that tend to show up in those with celiac disease or gluten intolerance.  Easy bruising and bleeding, either due to a deficiency of Vitamin K, or to an autoimmune platelet disorder, is one. Rickets, or osteomalacia – a softening of the bones in the legs related to vitamin D deficiency – is another. As we said before, inflammation goes along with celiac disease and gluten intolerance, and a common site for inflammation is the lower extremities.  Sometimes this can be profound, and trigger doctors to think heart disease, but it’s often unresponsive to Lasix and other diuretics. This condition, too, may also clear up on a gluten-free diet.

    As for me, I’ll be happy to be gluten-free, from head to toe.


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    Fantastic article. I am a Podiatrist and have a patient with enlarged big toe no pain and skin rash in arch. I wondered if her celiac disease was related to these conditions and hope to get some more research for future article. Any help appreciated.

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    Thank you! I've been experiencing weird inflammation issues for at least five years (longer really BC I was diagnosed with pernicious anemia fifteen years ago). My doctors tested me for everything under the sun except celiac, BC I have such slight gut symptoms. I finally demanded a test after a severe reaction to a steroid prescribed to boost my immune system. Celiac it was. I've been free for nearly a month and am gradually seeing a cessation in my symptoms. Thank you for this information!

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    Great article - thank you.

    Can you please comment on 'people of color' who have celiac disease. I am a women of color and I have found it very frustrating when doctors tell me that I can't have celiac disease because I am of African descent. I have now received a diagnosis through a biopsy, and I absolutely have celiac disease. But it is still a challenge explaining to doctors that I have a positive diagnosis of the disease.

     

    For years I was misdiagnosed for celiac disease because I didn't fit the typical profile. I am not fair skinned, with light eyes and light hair, and slim.

     

    I appreciate your response on this subject.

     

    Many thanks,

    Tasia

    Hi Ladies,

    I am also a woman of color and am in the process of being tested for celiac. Already know I have the genetic marker for celiac (blood was tested and is positive) and my igA levels are out of normal range.

     

    Upper Endoscopy came back with mixed results (some normal areas; some areas flattened villi) and the final call by pathologist was negative for celiac. So frustrating.

     

    Checking for DH next and Hashimoto's Thyroid.

     

    My symptoms were: bloated stomach, flatulence, rash on backs of hands, nasal infections (constantly), lost my sense of smell, profuse bleeding (menses), etc.

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    Great article! For commenters that have stated that they didn't see a change after removing gluten from their diet, I've read that sometimes becoming gluten-free is not enough. The damage to the intestine has to be repaired, and it won't be repaired just by becoming gluten free. I would suggest researching "leaky gut syndrome". Those articles offer various supplements that can be used, such as Quercetin, Glutamine, Licorice Root, Digestive Enzymes, and Probiotics. Hope this helps someone!

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    Hello,

    This article cleared up so many questions for my own gluten sensitivity, and the more severe allergic reaction in my elderly mother-in-law. My 92 year old mother-in-law has most of the gluten related side effects listed in your article. She tries to eat gluten free but doesn't really believe in it. My husband and I are so frustrated and exhausted. I need help managing her healthcare--anyone have any suggestions?

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    I was diagnosed with Celiac Disease 2/13/09. After researching the disease, I am wondering how long I have been misdiagnosed! I have had a good number of symptoms for the last 30 yrs. My sister found out 5 yrs ago, that she had Celiac Disease, and she told me for at least 4 of those years to go in and be tested. She knew from the research that she had done, and knowing me so well, that I had it. She just had the leaky gut syndrome, but I have had at least a dozen symptoms, for 30 yrs! I feel better, but still have a long way to go. Gluten free is the only way I can keep my terrible headaches away. but I have yet to build up my strength and am always tired yet, but I'm sure it will take some time. I also haven't had one canker sore in my mouth since quitting gluten. My bones and joints still ache and get numb and tingle yet, but time will tell.

    I'm glad I know what has been wrong with me and doing whatever I can to feel better. It's taken its toll on me. My teeth are bad and are always rotting or breaking off. But thank you for all the information you can give me. Cindy

    Make sure to check for night shades allergies. They have many of the same symptoms. I'm only advising this because you said you still feel tired. I'm am complete gluten free for 6 months now and it wasn't til I removed tomatoes, potatoes, peppers,etched that I reach my full recovery.

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    Guest Restless Legs

    Posted

    I read somewhere that 34% of Celiac sufferers have restless legs. Taking Magnesium and Folic acid supplements helps, but I really need to get shots for that and B-12. Too much intestinal damage to absorb those things well. I also need a RX and am miserable for hours if I forget to take  pill several hours before bed. 

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  • About Me

    An RN for 14 years, I have been following a strict gluten-free diet for six years of improving health! Now I help others as a Celiac Disease/Gluten Intolerance Educator. I work one on one with people on meal planning, shopping, cooking and dining out gluten-free. I will also work with children who have behavioral issues related to gluten or other food sensitivities.  My other websites are: www.WellBladder.com and www.neighborhoodnurse.net.

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