Coeliac disease complications and health issues.

In addition to your nutrition, you may also be concerned about other health implications and complications of your diagnosis of gluten sensitive enteropathy, of which there may be several.

Other autoimmune diseases

Having an autoimmune disease such as coeliac disease (CD) increases the likelihood of having others. Some are quite rare, but a few of the more common ones are considered below. Symptoms should be referred to your doctor.

Dermatitis herpetiformis

As dermatitis herpetiformis (DH) is a part of the coeliac spectrum, a gluten-free diet (GFD) is the key treatment, but the rash will not clear up quickly with diet alone. A drug called dapsone can help to get the itchiness of the rash under rapid control, but you may need to take it for up to two years. The side effect of anaemia is fairly common, so this will need to be monitored. Dose reduction can be considered after six months once treatment and the GFD are established.

Type 1 diabetes mellitus

Diabetes mellitus type 1 is an autoimmune disease in which the insulin-producing pancreas is damaged. Insulin promotes the body’s uptake of sugar from the blood. In its absence, the sugar remains in the blood and does not get used for energy. Symptoms of increased thirst, frequent urination and tiredness result.

Type 1 diabetes is typically diagnosed in childhood, and almost always before a coeliac disease diagnosis when they co-occur. Around 4–5 per cent of people with type 1 diabetes have coeliac disease.

Blood glucose (sugar) control is the cornerstone of treatment, and this will include a diet high in low or moderate GI foods.

One concern to those with diabetes is the level of sugar in some ‘free-from’ products, but it’s a myth that people with type 1 diabetes have to give up sugar or sugary foods, although they should be only occasional treats in the context of a healthy diet.

Many people with type 1 diabetes find their glucose levels rising when they move to a gluten-free diet, but this is likely to be because their healing gut is absorbing more food. This may mean that you need to adjust insulin replacement quantities.

Epilepsy

This is a neurological condition characterized by recurrent seizures triggered by episodes of increased electrical activity in the brain disrupting normal ‘communication’ between cells.

Coeliac disease is slightly more common in people with epilepsy than in the general population, and a possible link between autoimmunity and epilepsy has been explored since the 1980s. There are anecdotal reports of people with epilepsy experiencing fewer, or even no, seizures once established on a gluten-free diet.

Thyroid disease

The thyroid is a gland in the neck, which produces hormones that regulate metabolism, thermoregulation, nervous system functions, cardiovascular functioning and more. There is a strong link between autoimmune thyroid conditions and coeliac disease, and it is worth being aware of possible symptoms and discussing these with your health-care providers should they arise. Stress or pregnancy may be a trigger in some cases.

Graves’ disease

This can cause overactivity of the thyroid gland – also known as hyperthyroidism. It is most common among women in their 30s and 40s. Its symptoms are varied and include:

• weight loss
• irritability, feeling emotional
• dislike of heat and warmth
• increased sweating
• swollen thyroid, presenting as a swelling in the neck called a goitre
• bulging eyes or swelling around eyes
• shaking, tremors and rapid heartbeat
• thinning hair. 

Hashimoto’s disease

This causes chronic thyroid inflammation and underactivity of the thyroid – also known as hypothyroidism. There may be only mild symptoms, if any at all. Others have more notable symptoms, including:

• tiredness
• weight gain
• dislike of cold temperatures
• muscular and joint pain
• slower heart rate
• goitre
• brittle hair and scaly skin
• constipation.

Rheumatoid arthritis

A weak association between rheumatoid arthritis and coeliac disease exists. Symptoms are:

• painful / swollen joints
• stiffness in the morning
• weak grip
• tiredness and feverishness.

Sjögren’s syndrome

In this relatively common autoimmune condition, the moisture-producing glands in the eyes and mouth are attacked. Other organs may also be affected. Symptoms include:

• dry mouth and sore tongue
• dry and itchy eyes
• vaginal dryness
• digestive problems
• joint and muscular pain.

Crohn’s disease and ulcerative colitis

These are serious inflammatory bowel disorders, whose symptoms are similar to those of coeliac disease and can be mistaken for a relapse in the condition. Severe diarrhoea or gastrointestinal malaise must always be referred to a gastroenterologist.

Multiple sclerosis

This is caused by autoimmune damage to the nerves of the central nervous system. It produces symptoms such as: tingling and numbness blurring of vision balance and movement problems muscular weakness tiredness.

Other autoimmune diseases

There are almost one hundred autoimmune conditions in total, some extremely rare, with a battery of diverse symptoms, from jaundice and enlarged liver (autoimmune hepatitis) to hazy vision (autoimmune uveitis). There are some symptoms that are common to several of them:

• joint or muscular pain or weakness
• feeling hot/sensitivity to cold or heat
• low fertility and sex drive
• digestive problems
• co-ordination problems and dizziness
• palpitations or an irregular heartbeat
• tingling in the hands and feet
• memory and concentration problems
• depression or mood swings
• dryness of the skin, mouth or hair.

Osteoporosis

One of the most serious and important long-term health considerations in those diagnosed with coeliac disease is osteoporosis – a condition in which the bone mass and density is reduced and bones are more liable to fracture. A huge risk factor is poor absorption of calcium, required for healthy bones, in years of undiagnosed coeliac disease.

It is diagnosed via a dual-energy X-ray absorptiometry (DEXA) scan at your local hospital, and this should be advised in those at risk, in order to measure bone mineral density. People at risk include post-menopausal women, men aged over 55 years, the underweight, anyone who has experienced previous fractures and those with a family history of the condition. You are more susceptible if you smoke, drink excessively, take little exercise or have a low-calcium diet.

There are a number of recommendations by which you can reduce your risk:

• Stick rigidly to a healthy, calcium-rich, gluten-free diet.
• Take regular exercise – including weight-bearing exercise.
• Keep to a healthy body weight.
• Keep to within safe alcohol consumption limits.
• Quit smoking.
• Take supplements of calcium or vitamin D, or both – but only if recommended by your doctor or dietitian.

Hyposplenism

This is a reduction in the functioning of the spleen – a small organ on the left side of the abdomen that helps protect against bacterial infections. Hyposplenism is more common in those with coeliac disaese. Hyposplenism is usually picked up via blood tests, and your health practitioner may advise you to be immunized against certain infections to which you may be more vulnerable because of it.

The injections may include the flu jab, the pneumococcal vaccine, and the Haemophilus influenzae type B (Hib) vaccine.

Medical treatment

It’s likely at some point that you will need to receive medical care unrelated to your coeliac disease.

If you or your child have to be admitted to hospital for any reason, be aware that your medical team may have very little awareness of coeliac disease. Coeliac UK advises you to plan ahead, as some hospitals can find it difficult to cater for those on a gluten-free diet. Speak to the charge nurse of your ward or the hospital’s dietitian to find out what the hospital can do and whether you need to bring in your own foods. If you don’t call ahead, it may take the hospital some time to obtain gluten-free (GF) supplies. Be vigilant about any food served to you or your child, and always check it is safe. Anaesthesia has no gluten, and most medicine should be safe too, but always let medics know, just in case. Take some back-up food supplies, and your Food and Drink Directory, which may be useful to staff.

By all means let your dentist know you are a coeliac, but there is unlikely to be any product your dentist uses in your mouth that contains gluten. However, owing to the association between dental enamel defects and coeliac disease, especially in children, it is worth letting your child’s dentist know about a coeliac disease diagnosis.

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