Celiac disease is an autoimmune condition where ingesting gluten, a protein found in wheat, barley, and rye, triggers an immune response. This response primarily affects the small intestine, leading to damage. While celiac disease is often associated with weight loss due to malabsorption, some individuals with untreated celiac disease can experience weight gain. Understanding its varied impact on body weight provides a complete picture.
How Celiac Disease Manifests
When a person with celiac disease consumes gluten, their immune system mistakenly attacks the lining of their small intestine. This immune reaction damages the villi, small, finger-like projections responsible for nutrient absorption. The destruction of these villi, known as villous atrophy, impairs the body’s ability to absorb nutrients, including fats, carbohydrates, proteins, vitamins, and minerals. The inflammatory process is mediated by T cells, which disrupt the small bowel’s mucosal lining.
Weight Changes in Celiac Disease
Weight loss is a commonly recognized symptom of celiac disease, stemming from the malabsorption of fats, carbohydrates, and proteins. When the damaged small intestine cannot properly absorb these macronutrients, the body enters a caloric deficit, even if adequate food is consumed. This persistent lack of nutrient absorption often leads to unintentional weight loss.
However, weight gain can also occur in individuals with untreated celiac disease. Chronic systemic inflammation, a hallmark of untreated celiac disease, can disrupt metabolic pathways. This inflammation may contribute to insulin resistance or alter fat storage mechanisms, potentially leading to increased body fat.
The damaged gut microbiome in untreated celiac disease, known as gut dysbiosis, can also influence body weight. Alterations in gut bacteria can affect how the body extracts energy or impact metabolic signaling. These changes might promote greater energy harvesting or alter satiety signals, contributing to weight gain in some individuals.
Some individuals may engage in compensatory eating behaviors prior to diagnosis, unknowingly contributing to weight gain. Faced with symptoms like fatigue or perceived hunger from malabsorption, they might consume excessive calories from processed, often high-sugar or high-fat, gluten-containing foods. This attempt to alleviate symptoms through increased food intake can result in a caloric surplus and subsequent weight gain.
Inflammation associated with celiac disease can also lead to fluid retention. Protein malabsorption, a consequence of intestinal damage, can lead to low protein levels in the blood, causing fluid retention and tissue swelling.
Health Risks of Untreated Celiac Disease
Beyond weight changes, untreated celiac disease poses numerous serious health risks. Chronic malabsorption can lead to significant nutrient deficiencies, impacting various bodily functions. Common deficiencies include iron, leading to iron-deficiency anemia, and calcium and vitamin D, which can result in osteopenia or osteoporosis, weakening bones and increasing fracture risk. Malabsorption of vitamin B12 can also cause nerve damage.
Untreated celiac disease increases the likelihood of developing other autoimmune disorders, such as Type 1 diabetes and autoimmune thyroid disease. The persistent immune system dysregulation can trigger reactions against other body tissues. Neurological issues are also documented complications, including peripheral neuropathy, which causes numbness and tingling in the extremities, and ataxia, affecting coordination and balance.
There is also an increased, though rare, risk of certain cancers, particularly intestinal lymphoma, including enteropathy-associated T-cell lymphoma (EATL), and small bowel adenocarcinoma. Untreated celiac disease can also contribute to fertility problems and adverse pregnancy outcomes.
Seeking Diagnosis and Management
If celiac disease is suspected, medical consultation is essential. The diagnostic process typically begins with specific blood tests, such as the tissue transglutaminase IgA antibody (tTG-IgA) and total IgA. These tests look for antibodies produced by the immune system in response to gluten. If blood tests indicate the possibility of celiac disease, an endoscopy with a small bowel biopsy is usually performed to confirm the diagnosis by examining villous damage in the small intestine. It is crucial to continue consuming gluten regularly before and during testing, as avoiding it can lead to inaccurate results and hinder proper diagnosis.
Currently, the only effective treatment for celiac disease is strict, lifelong adherence to a gluten-free diet. This involves completely avoiding foods and products containing wheat, rye, and barley. Following this diet allows the small intestine to heal, leading to symptom improvement and a reduced risk of long-term complications. Consulting with a healthcare professional, including a registered dietitian specializing in celiac disease, is highly recommended to ensure proper nutritional management and to navigate the complexities of maintaining a gluten-free lifestyle.