Symptoms of Coeliac disease
Coeliac disease can present itself in a variety of ways, depending on the person. Some people experience significant symptoms and others may report no apparent symptoms at all (i.e. asymptomatic disease). The variability in symptoms from one person to the next can make diagnosis challenging. Coeliac disease also shares considerable symptom overlap with other gastrointestinal conditions, such as irritable bowel syndrome (e.g. abdominal pain, diarrhoea). Many people with coeliac disease describe long periods before being diagnosed, with studies finding average diagnostic delays of six to ten years! It is important to note that the number and/or severity of symptoms does not closely match the severity of the underlying bowel damage. A person that is getting exposed to gluten may feel okay but may nonetheless be in a state of active disease, and at a heightened risk of long-term complications. Fortunately, good dietary management can reduce the likelihood of both symptoms re-emerging and long-term issues.
Symptoms may include
- Abdominal pain
- Bloating or distension (i.e. gas build-up causing expansion of one’s abdomen)
- Flatulence (i.e. gas)
- Steatorrhoea (i.e. pale, excessively fatty stool)
- Fatigue and lethargy
- Vitamin/mineral deficiencies (e.g. iron deficiency)
- Weight loss
- Joint pain
- Mount ulcers
- Skin rash (i.e. dermatitis herpetiformis)
As with other chronic conditions that require long-term health management, individuals with coeliac disease may experience feelings of anxiety, stress, or low mood. Recent research suggests that those with coeliac disease are up to six times as likely to have an anxiety disorder and up to twice as likely to have a depressive disorder compared to non-coeliac individuals.
Psychological distress may arise due to various reasons, including coeliac disease symptoms (e.g. abdominal pain, fatigue), disturbances in the gastrointestinal tract including coeliac-related inflammation and changes in the microbiome, the ongoing challenges of managing the gluten-free diet, or malabsorption-related nutritional deficiencies (e.g. thiamine, vitamins B6 & B12, iron, vitamin D).
The relationship between coeliac disease and psychological symptoms is complex and likely due to the interplay of many of the aforementioned factors. It is normal to experience feelings of worry or low mood from time-to-time, especially during stressful or uncertain times, such as during/immediately after your diagnosis.
Try to stay mindful of your overall psychological well-being. If you feel as if these feelings are becoming too frequent, or exceed your ability to cope, consider seeking additional support from a mental health professional.
Relationship between gastrointestinal and psychological symptoms
The human gastrointestinal tract and brain are inextricably linked, with the health of one affecting the other. States of psychological distress, such as anxiety, stress, and depression, can induce changes in the way the gastrointestinal tract functions. For example, anxiety can increase the contractions of the digestive tract, accelerating the passage of food/nutrients, and causing symptoms such a diarrhea and abdominal discomfort. Similarly, psychological distress is associated with changes in the microorganisms that inhabit in the gastrointestinal tract, which can result in symptoms (e.g. bloating, diarrhea). Just as the brain can modulate gut function, so too can the gut influence the brain. Factors such as gastrointestinal inflammation and changes in gut microbiota are associated with psychological conditions such as depression and anxiety. These psychological symptoms can have a powerful effect on our ability to manage the challenges of daily life. In coeliac disease, symptoms such as depression are linked to poorer management of the gluten-free diet, which in turn perpetuates a state of active disease in the gastrointestinal tract.
For more information, see the brain-gut axis and coeliac disease