Title: Why does celiac disease not only end in heartache and diarrhea?

Celiac disease is a chronic autoimmune disorder that occurs due to gluten consumption in genetically predisposed people. Although most people recognize celiac disease with digestive symptoms such as diarrhea, bloating, and abdominal pain, in fact, this disease can have a wide range of non-digestive symptoms, which are sometimes the only clues to diagnose the disease.

Non-digestive symptoms of celiac disease and their scientific reasons:

1. Malabsorption of micronutrients

In celiac disease, the intestinal villi (villi) that play a major role in food absorption are destroyed. This process leads to the malabsorption of iron, folate, vitamin B12, and vitamin D and symptoms such as:

resistant iron deficiency anemia

osteoporosis (even in children)

chronic fatigue

short stature and growth delay does.

2. Autoimmune mechanisms beyond the gut

Celiac is a systemic autoimmune disease. Antibodies against tTG and EMA attack other tissues in some patients:

Skin: dermatitis herpetiformis (itchy rashes)

Peripheral nerves: neuropathy (pins and needles in hands and feet)

Cerebellum: gluten ataxia (impaired balance and walking)

Thyroid: autoimmune thyroiditis (Hashimoto)

3. Systemic inflammation and mood disorder

Continuous activation of the immune system leads to the release of inflammatory cytokines such as IL-6 and TNF-alpha, which can cause:

depression and anxiety

excessive sleepiness

boredom and impaired concentration (similar to ADHD).

4. Disruption of the HPA (hypothalamus-pituitary-adrenal) axis

Chronic inflammatory stress caused by the disease can affect the function of the endocrine glands:

Delay in sexual maturity

Menstrual irregularity or amenorrhea

Infertility in adults

5. Genetic background and non-local responses

More than 95% of celiac patients have HLA-DQ2 or DQ8 genes. These genes, in addition to the intestine, can also facilitate autoimmune responses in other tissues.

Conclusion:

If symptoms such as resistant anemia, short stature, chronic fatigue, menstrual disorders, or neurological symptoms without a clear cause are observed, celiac disease should be suspected even in the absence of digestive symptoms.

Celiac diagnosis with blood tests. (Anti-tTG, EMA) and in some cases endoscopy and biopsy are possible.

For expert examination, online appointment and consultation with Dr. Panthea Tajik (specialist in gastroenterology, liver and children's nutrition) through the website or WhatsApp.