Vitamin deficiencies may be only sign of celiac disease

Adults with undiagnosed celiac disease often have nutrient deficiencies as the only sign of the condition, researchers say. Doctors often look for typical signs like unexplained weight loss or extreme thinness, but the hallmark signal of celiac disease may be low levels of vitamins and other micronutrients, according to a report in Mayo Clinic Proceedings.
"People have preconceived ideas of what celiac disease looks like," said study coauthor Dr Joseph Murray, a professor of medicine at the Mayo Clinic in Rochester, Minnesota. "They expect to see patients who because of nutrient malabsorption and diarrhea will end up being skinny with lots of deficiencies. But now we have lots of patients who haven't lost weight - and many who are quite overweight - but still have micronutrient deficiencies.
While they are not losing calories, they are not absorbing some vital nutrients." Practically speaking, that means doctors need to be on the lookout for low levels of certain micronutrients, in particular iron, vitamin D and zinc, Murray said. Since many patients aren't getting regular blood tests, they may need to be attuned to the telltale symptom of iron deficiency: fatigue, he added.
"It's a very common symptom," Murray said. "People come in and say they don't have the energy they used to, whether it's during exercise or doing daily living activities. This illustrates they might be deficient in iron because of hidden celiac disease. They don't have diarrhea or belly pain, but they have no iron because of damaged intestines. And while a patient taking large quantities of iron might absorb enough to correct anemia, it's not going to fix the inflammation in the intestines and it's not going to prevent other complications that can occur later in life."
The initial screen for celiac is a blood test, Murray said. "If that comes back positive then the patient needs to be referred to a gastrointestinal specialist since you want to make sure it's really celiac before coming to a lifelong diagnosis that will require lifelong treatment." Murray suspects that as many as 50 percent of adults with celiac disease go undiagnosed either because they don't have weight loss and other signs and symptoms thought to be typical of the disease or because they've put themselves on a gluten-free diet, which can skew the results of the blood test.
Murray and his colleagues took a close look at 309 adults newly diagnosed with celiac disease between 2000 and 2014. The patients were matched by age with participants from the National Health and Nutrition Examination Survey (NHANES), a nationally representative database.