9 Signs of Celiac Disease You Should Never Ignore

Celiac disease is an autoimmune condition that affects millions of Americans, yet many people remain undiagnosed for years. When someone with celiac disease consumes gluten—a protein found in wheat, barley, and rye—their immune system launches an attack on the small intestine, causing inflammation and damage to the intestinal lining.

The symptoms of celiac disease can vary significantly from person to person. While some individuals experience severe digestive problems, others may have subtle or even no noticeable symptoms at all. Understanding the warning signs is crucial for early detection and proper management of this condition.

Here are the 9 most common signs of celiac disease that should prompt you to consult with your healthcare provider.

1. Chronic Diarrhea

One of the most prevalent symptoms of celiac disease is persistent diarrhea. When gluten damages the small intestine’s lining, it impairs the body’s ability to absorb nutrients and water properly, leading to loose, watery stools.

Research indicates that approximately 43% of people with celiac disease experience diarrhea before diagnosis. The good news is that following a strict gluten-free diet typically resolves this symptom within weeks to months. Studies show that individuals who adhere to a gluten-free diet report significantly fewer episodes of diarrhea compared to those who continue consuming gluten.

However, it’s important to note that diarrhea can result from many conditions, including infections, food poisoning, irritable bowel syndrome (IBS), or other gastrointestinal disorders. If you’re experiencing chronic diarrhea lasting more than a few weeks, consult your doctor for proper evaluation.

2. Abdominal Bloating and Discomfort

Bloating is a frequent complaint among people with undiagnosed celiac disease. The inflammation triggered by gluten consumption can cause the digestive tract to become swollen and distended, leading to uncomfortable feelings of fullness and tightness in the abdomen.

Clinical studies have found that approximately 9% of newly diagnosed celiac patients report bloating as a primary symptom. Research also demonstrates that adopting a gluten-free diet significantly reduces bloating and improves overall quality of life for those with this condition.

Interestingly, some people without celiac disease may also experience bloating from gluten consumption, particularly those with non-celiac gluten sensitivity or IBS. Other common causes of bloating include constipation, bowel obstruction, excessive gas production, and various digestive disorders.

3. Excessive Gas and Flatulence

Increased gas production is a common digestive complaint in people with untreated celiac disease. The damage to the intestinal lining affects the normal digestive process, leading to fermentation of undigested food and subsequent gas buildup.

Studies involving children with celiac disease found that nearly 47% experienced excessive flatulence. In adults, the prevalence is slightly lower but still significant, with about 7% reporting this as a primary symptom.

While excessive gas can be embarrassing and uncomfortable, it’s worth noting that many conditions can cause this symptom. Constipation, indigestion, swallowing air while eating, lactose intolerance, and IBS are all common culprits. A proper medical evaluation can help determine the underlying cause.

4. Persistent Fatigue and Low Energy

Overwhelming tiredness and decreased energy levels are hallmark symptoms of celiac disease that often go unrecognized. Multiple factors contribute to this fatigue, including poor nutrient absorption, sleep disturbances, and the body’s ongoing immune response to gluten.

Large-scale studies have confirmed that people with celiac disease experience significantly higher levels of fatigue compared to the general population. Fortunately, this symptom typically improves after starting a gluten-free diet, though the recovery timeline varies among individuals.

The malabsorption caused by celiac disease can lead to deficiencies in essential vitamins and minerals—particularly iron, vitamin D, and B vitamins—which directly impact energy levels. Additionally, research shows that individuals with celiac disease are more prone to sleep disorders, which further contributes to daytime fatigue.

5. Unexplained Weight Loss

Sudden, unintentional weight loss is often an early warning sign of celiac disease, particularly in children. Because the damaged intestinal lining cannot properly absorb nutrients from food, the body essentially becomes malnourished despite adequate calorie intake.

Studies indicate that approximately 29% of children with celiac disease have below-normal body weight, and 26% have a low body mass index (BMI). In older adults, weight loss is frequently one of the most noticeable symptoms.

The encouraging news is that following a gluten-free diet typically reverses this trend. Research shows that after celiac disease treatment, patients often gain an average of 17 pounds within the first year. In children, a gluten-free diet significantly increases both body weight and BMI after just one year of adherence.

Keep in mind that unexplained weight loss can also indicate other serious conditions such as diabetes, thyroid disorders, cancer, or depression, so medical evaluation is essential.

6. Iron Deficiency Anemia

Iron deficiency anemia is one of the most common complications of celiac disease, affecting approximately 40% of patients. The damaged intestinal villi cannot properly absorb iron from food, leading to a shortage of healthy red blood cells needed to carry oxygen throughout the body.

Symptoms of iron deficiency anemia include:

• Extreme fatigue and weakness
• Pale skin and nail beds
• Chest pain or rapid heartbeat
• Frequent headaches
• Dizziness or lightheadedness
• Cold hands and feet

Research involving children with celiac disease found that 18% were anemic at diagnosis. Remarkably, 92% of these cases resolved after following a gluten-free diet for approximately one year.

It’s worth noting that iron deficiency anemia has many potential causes beyond celiac disease, including inadequate dietary iron intake, chronic blood loss from heavy menstruation or ulcers, and long-term use of certain pain medications. Your doctor can perform blood tests to determine the underlying cause.

7. Constipation

While many people associate celiac disease with diarrhea, constipation is actually a common symptom for some individuals. This may seem counterintuitive, but the mechanism is clear: damaged intestinal villi can absorb excess moisture from stool as it passes through the digestive tract, resulting in hard, difficult-to-pass stools.

Paradoxically, constipation can persist even after starting a gluten-free diet. This happens because eliminating gluten often means cutting out many high-fiber whole grains, which can reduce overall fiber intake and worsen constipation.

To combat constipation while maintaining a gluten-free diet, focus on consuming plenty of naturally gluten-free high-fiber foods such as fruits, vegetables, legumes, and gluten-free whole grains like quinoa, brown rice, and certified gluten-free oats.

Other factors that can contribute to constipation include physical inactivity, dehydration, certain medications, and various medical conditions.

8. Depression and Anxiety

The connection between celiac disease and mental health is increasingly recognized by medical professionals. Research consistently shows that people with celiac disease have higher rates of depression and anxiety compared to the general population.

A comprehensive analysis of 29 studies found that depression was significantly more common and more severe in adults with celiac disease. Another large review of 37 studies linked celiac disease to an increased risk of depression, anxiety, and eating disorders.

The reasons for this connection are multifaceted. The chronic inflammation caused by celiac disease may affect brain chemistry and neurotransmitter function. Additionally, the stress of managing a chronic condition, social limitations around food, and nutrient deficiencies (particularly B vitamins) can all contribute to mood disorders.

Mental health symptoms often improve after starting a gluten-free diet, though some individuals may benefit from additional support through counseling or therapy. If you’re experiencing symptoms of depression or anxiety, it’s important to discuss these concerns with your healthcare provider.

9. Dermatitis Herpetiformis (Itchy Skin Rash)

Dermatitis herpetiformis is a distinctive itchy, blistering skin rash that serves as a telltale sign of celiac disease. This rash typically appears on the elbows, knees, buttocks, back, or scalp and is characterized by clusters of small, intensely itchy bumps and blisters.

Approximately 17% of people with celiac disease develop dermatitis herpetiformis. Interestingly, those who experience this skin manifestation often don’t have the typical digestive symptoms associated with celiac disease, which can delay diagnosis.

The rash is caused by the same immune response that damages the intestinal lining, but in this case, antibodies are deposited in the skin. A skin biopsy can confirm the diagnosis through a specific type of testing called direct immunofluorescence.

Like other celiac symptoms, dermatitis herpetiformis typically improves with a strict gluten-free diet, though it may take several months to see significant improvement. If the rash reappears, it often indicates accidental gluten exposure.

Special Considerations: Celiac Disease in Children

Celiac disease symptoms in children can differ significantly from those in adults, and they often vary depending on the child’s age. Recognizing these age-specific symptoms is crucial for early diagnosis and prevention of complications.

Infants and Toddlers

Young children typically present with:

• Chronic diarrhea or constipation
• Vomiting
• Abdominal bloating or distended belly
• Failure to thrive or poor weight gain
• Delayed growth
• Irritability and fussiness
• Muscle wasting

School-Age Children

Older children often experience:

• Abdominal pain and bloating
• Diarrhea or constipation
• Difficulty gaining weight or unintentional weight loss
• Short stature compared to peers
• Chronic fatigue
• Behavioral issues or attention problems

Teenagers

Adolescents may present with:

• Delayed puberty
• Stunted growth or short stature
• Iron deficiency anemia
• Chronic fatigue
• Bone or joint pain
• Frequent headaches or migraines
• Dermatitis herpetiformis
• Mouth ulcers or dental enamel defects
• Depression or anxiety

If you suspect your child may have celiac disease, consult with their pediatrician about appropriate testing. Early diagnosis and treatment can prevent serious complications and support healthy growth and development.

Associated Health Conditions and Complications

When left untreated, celiac disease can lead to numerous serious health complications. The chronic inflammation and malabsorption caused by ongoing gluten exposure can affect virtually every system in the body.

Nutritional Deficiencies

Untreated celiac disease commonly leads to deficiencies in:

• Iron
• Calcium and vitamin D
• Vitamin B12 and folate
• Fat-soluble vitamins (A, D, E, K)
• Zinc and magnesium

Bone Health Issues

Poor calcium and vitamin D absorption can result in:

• Osteoporosis (brittle bones)
• Osteopenia (low bone density)
• Increased fracture risk
• Joint pain

Neurological Problems

Some individuals with celiac disease develop:

• Peripheral neuropathy (numbness, tingling, or pain in hands and feet)
• Ataxia (difficulty with balance and coordination)
• Seizures or epilepsy
• Migraines

Reproductive Issues

Untreated celiac disease may contribute to:

• Infertility in both men and women
• Recurrent miscarriages
• Irregular menstrual periods

Other Autoimmune Conditions

Because celiac disease is an autoimmune disorder, having this condition increases your risk of developing other autoimmune diseases by approximately 25%. Associated conditions include:

• Type 1 diabetes
• Autoimmune thyroid disease (Hashimoto’s or Graves’ disease)
• Autoimmune liver disease
• Rheumatoid arthritis
• Sjögren’s syndrome
• Addison’s disease

Regular medical monitoring and strict adherence to a gluten-free diet can help prevent or minimize these complications.

Diagnosis: When and How to Get Tested

If you’re experiencing several of the symptoms described above, it’s important to consult with your healthcare provider about celiac disease testing. Early diagnosis is crucial for preventing long-term complications.

Who Should Be Tested?

Testing for celiac disease is recommended if you:

• Have symptoms suggestive of celiac disease
• Have a first-degree relative with celiac disease
• Have type 1 diabetes or other autoimmune conditions
• Have certain genetic conditions like Down syndrome or Turner syndrome
• Have unexplained iron deficiency anemia
• Have chronic liver disease of unknown origin

Diagnostic Process

Celiac disease diagnosis typically involves:

• Blood tests: These check for specific antibodies (tissue transglutaminase antibodies and endomysial antibodies) that are elevated in people with celiac disease
• Genetic testing: Tests for HLA-DQ2 and HLA-DQ8 genes can help rule out celiac disease if negative
• Endoscopy with biopsy: If blood tests are positive, an upper endoscopy with small intestine biopsy is typically performed to confirm the diagnosis

Important: Do not start a gluten-free diet before testing, as this can cause false-negative results. You must be consuming gluten regularly for accurate test results.

Managing Celiac Disease: The Gluten-Free Diet

Currently, the only effective treatment for celiac disease is a strict, lifelong gluten-free diet. While there is no cure, adhering to this diet allows the intestinal lining to heal and prevents further damage.

Foods to Avoid

You must eliminate all sources of gluten, including:

• Wheat (all varieties, including spelt, kamut, farro, and durum)
• Barley
• Rye
• Triticale
• Malt (usually made from barley)
• Brewer’s yeast

Foods commonly containing gluten include:

• Bread, bagels, and baked goods
• Pasta and noodles (unless gluten-free)
• Cereals (unless certified gluten-free)
• Crackers and pretzels
• Beer and some alcoholic beverages
• Soy sauce (unless gluten-free tamari)
• Many processed foods, sauces, and condiments

Safe, Naturally Gluten-Free Foods

Focus on whole, unprocessed foods that are naturally gluten-free:

Proteins:

• Fresh meat, poultry, and fish
• Eggs
• Legumes (beans, lentils, chickpeas)
• Nuts and seeds

Grains and Starches:

• Rice (white, brown, wild)
• Quinoa
• Corn and polenta
• Buckwheat
• Millet
• Amaranth
• Certified gluten-free oats
• Potatoes and sweet potatoes

Fruits and Vegetables:

• All fresh fruits
• All fresh vegetables
• Frozen fruits and vegetables without sauces

Dairy:

• Milk
• Plain yogurt
• Natural cheeses
• Butter

Tips for Success on a Gluten-Free Diet

• Read labels carefully: Gluten can hide in unexpected products like medications, supplements, and processed foods
• Avoid cross-contamination: Use separate cooking utensils, cutting boards, and toasters for gluten-free foods
• Look for certification: Choose products with a “Certified Gluten-Free” label for added assurance
• Plan ahead: Research restaurant menus and prepare gluten-free snacks when traveling
• Work with a dietitian: A registered dietitian specializing in celiac disease can help ensure nutritional adequacy
• Join support groups: Connect with others managing celiac disease for tips, recipes, and encouragement

The Importance of Strict Adherence

Even small amounts of gluten can trigger intestinal damage in people with celiac disease, so strict adherence to a gluten-free diet is essential. Studies show that consuming as little as 1/8 teaspoon of flour can cause intestinal inflammation.

Research indicates that approximately 50 milligrams of gluten per day (equivalent to about 1/100th of a slice of bread) can cause intestinal damage in people with celiac disease. This is why vigilance about cross-contamination and hidden sources of gluten is so important.

The good news is that most people experience significant symptom improvement within weeks to months of starting a gluten-free diet. Complete intestinal healing typically takes longer—six months to two years in adults and three to six months in children.

When to See a Doctor

You should consult with a healthcare provider if you:

• Experience persistent digestive symptoms like diarrhea, bloating, or abdominal pain
• Have unexplained weight loss or difficulty gaining weight
• Feel constantly fatigued despite adequate rest
• Have chronic anemia that doesn’t improve with iron supplementation
• Develop an itchy, blistering rash
• Have a family member with celiac disease
• Experience symptoms of nutritional deficiencies

Remember, many people with celiac disease have minimal or no symptoms, particularly in the early stages. If you have risk factors for the condition, discuss screening with your doctor even if you feel well.

Living Well with Celiac Disease

While a celiac disease diagnosis requires significant dietary changes, most people adapt successfully and live full, healthy lives. The key is education, preparation, and support.

Many people report that after the initial adjustment period, they actually feel better than they have in years. The elimination of gluten allows their body to heal and function properly, often resolving symptoms they had learned to live with.

With the growing awareness of celiac disease and gluten sensitivity, gluten-free options are more widely available than ever before. Most grocery stores now have extensive gluten-free sections, and many restaurants offer gluten-free menus.

Regular follow-up with your healthcare team is important to monitor your condition, check for nutritional deficiencies, and ensure proper healing. Most doctors recommend follow-up blood tests at 3-6 months after diagnosis, then annually thereafter.

Conclusion

Celiac disease is a serious autoimmune condition that can affect multiple body systems and cause a wide range of symptoms. The nine most common signs—diarrhea, bloating, gas, fatigue, weight loss, iron deficiency anemia, constipation, depression, and itchy rash—should prompt evaluation by a healthcare provider.

Early diagnosis and treatment are crucial for preventing long-term complications and improving quality of life. If you suspect you may have celiac disease, don’t wait to seek medical attention. The diagnostic process is straightforward, and once diagnosed, a strict gluten-free diet can effectively manage the condition.

Remember that symptoms vary widely among individuals with celiac disease. Some people have severe symptoms while others have none at all. This is why screening is recommended for those with risk factors, even in the absence of symptoms.

With proper management, people with celiac disease can lead healthy, fulfilling lives. The key is education, vigilance about dietary choices, and regular medical follow-up. If you’ve been diagnosed with celiac disease, consider working with a registered dietitian who specializes in this condition to ensure you’re meeting your nutritional needs while maintaining a strict gluten-free diet.

Sources:

• National Center for Biotechnology Information – Celiac Disease
• Mayo Clinic – Celiac Disease
• National Institute of Diabetes and Digestive and Kidney Diseases – Celiac Disease
• Celiac Disease Foundation
• Beyond Celiac
• PubMed Central – Clinical Presentation of Celiac Disease
• Gastroenterology Journal – Celiac Disease Research