When celiac disease is not the only condition

by Alex Reis PhD, GFT science writer

There’s a lot more going on in our digestive tract than just digesting food. A deep and extensive network of nervous cells, called neurons, have earned it the nickname “second brain”. This “brain” may not be involved in any conscious thoughts we have throughout the day, but researchers are increasingly aware of how our gut plays key roles in many different diseases.

It shouldn’t come as a surprise then that patients with celiac disease are much more likely to experience a number of other conditions. These include not just obvious gastrointestinal manifestations, such as anemia and malabsorption, but also a variety of other seemingly non-gut related conditions. The list is long, and it includes osteoporosis, various autoimmune diseases, dermatitis herpitiformis, neurological disorders, decreased fertility, cardiovascular problems, type 1 diabetes and multiple sclerosis to name just a few.

What is becoming increasingly worrying is that many patients have already developed other conditions, such as diabetes or thyroid disorder, prior to the time of diagnosis for celiac disease. For instance a patient with MS may have a secondary diagnosis of celiac disease. It’s not uncommon for these patients suffering from multiple conditions to feel lost and unsure where to go for help. Or need help in knowing what treatment plan to focus on. The main problem is often a lack of communication between different health providers, and the patient’s medical information remains scattered. If it comes down to choosing which condition to treat first, often a closely controlled gluten-free diet is low on the pecking order. Although eliminating gluten could improve overall health that could be of benefit while treating other conditions.

These patients suffering from more than one chronic disorder need and deserve special consideration from their physician. In an ideal world, instead of looking at each individual condition, the patient should be offered a more holistic approach by a physician and dietitian aware of the “whole picture”. As the scientific evidence to support this approach mounts up, patients need to start demanding the support they need from their health care supporters.

Explaining risks

In addition, all patients with celiac disease should be informed about the risk of potentially developing another condition in the future. What these patients really need is information not only about each separate condition and how it could affect their life, but more importantly about possible complications and associated risks due to their celiac disease. Once more, health care personnel play a vital role in quantifying these risks.

Typically, the most difficult and important point to explain is the difference between relative risks versus absolute risks for different complications. It’s easy for doctors and patients to focus on higher risks for celiac patients – unnecessarily increasing the patient’s worry and stress levels – but it doesn’t have to be like that.

Taking cancer as an example, recent research has shown that the overall risk is identical to the rest of the population, with lymphoproliferative cancer being the only exception. It can be scary when doctors explain that celiac patients are two- to three-times more likely to develop this condition, but this only means 3 non-celiacs vs 7 celiacs developing the condition out of 10,000 people. A simpler way for doctors to explain would be to say that 99.97% of healthy individuals will not develop this type of cancer, compared to 99.93% of patients with celiac disease, which sounds rather more positive. In this case, the relative risk of developing cancer may be higher for celiac patients, but the absolute risk is minimal. Doctors can apply the same principle to explain about the risks of developing any condition.

Overall, what’s becoming increasing clear is that celiac patients need special consideration from their physicians, especially if they already suffer from other chronic conditions. If you have diabetes, for example, you may need to visit different specialists but your medical information is always reported back to your primary doctor, overseeing all of your treatments. The same model could work well for celiac patients with multiple conditions. Total oversight by a primary health provider to assist patients who are dealing with several specialists would be ideal and should be common practice.

This original article is made possible by Gluten Free Therapeutics. Our mission is to educate, inform, and provide the most effective nutritional products possible to allow those with celiac disease and serious gluten intolerances to heal their bodies. CeliVites complete line of superior gluten free supplements includes multivitamin/multimineral supplements, iron supplements, and calcium supplements for people living with celiac disease. All CeliVites products are designed to help you heal, restore and rebuild your body, because going gluten free isn’t enough! 


  • Akirov A, Pinhas-Hamiel O. Co-occurrence of type 1 diabetes mellitus and celiac disease. World J Diabetes. 2015 Jun 10;6(5):707-14.
  • Caio G, De Giorgio R, Venturi A et al. Clinical and immunological relevance of anti-neuronal antibodies in celiac disease with neurological manifestations. Gastroenterol Hepatol Bed Bench. 2015 Spring;8(2):146-52.
  • Fortune MD, Guo H, Burren O et al. Statistical colocalization of genetic risk variants for related autoimmune diseases in the context of common controls. Nat Genet. 2015 Jun 8. doi: 10.1038/ng.3330.
  • Grainge MJ, West J, Solaymani-Dodaran M, et al. The long-term risk of malignancy following a diagnosis of coeliac disease or dermatitis herpetiformis: A cohort study. Aliment Pharmacol Ther 2012; 35: 730–739.
  • Jansen H, Willenborg C, Schlesinger S et al. Genetic variants associated with celiac disease and the risk for coronary artery disease. Mol Genet Genomics. 2015 Apr 18
  • Najafi M, Sadjadei N, Eftekhari K et al. Prevalence of Celiac Disease in Children with Autoimmune Hepatitis and vice versa. Iran J Pediatr. 2014 Dec;24(6):723-8.
  • Pantaleoni S, Luchino M, Adriani A et al. Bone mineral density at diagnosis of celiac disease and after 1 year of gluten-free diet. Scientific World Journal. 2014;2014:173082.
  • Pinto-Sánchez MI, Bercik P, Verdu EF, Bai JC. Extraintestinal manifestations of celiac disease. Dig Dis. 2015;33(2):147-54
  • Salmi TT, Hervonen K, Kurppa K et al. Celiac disease evolving into dermatitis herpetiformis in patients adhering to normal or gluten-free diet. Scand J Gastroenterol. 2015 Apr;50(4):387-92.
  • Santonicola A, Iovino P, Cappello C, et al. From menarche to menopause: The fertile life span of celiac women. Menopause 2011; 18: 1125–1130

Comments ()

  1. Teresa Barron says:

    I discovered that I had celiac disease after three years of misdiagnosed Dermatitis Hepataformis. I am very much alone in dealing with this disease. I need some help.

Leave a Comment

We do not share your information with anyone else or publish your email. *Required fields.