Could Your Extreme Fatigue Actually Be Celiac Disease?

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What are the symptoms of celiac disease?

First, it’s important to understand that there are two main groups of initial symptoms: intestinal and extraintestinal, Vahe Badalyan, MD, director of the Celiac Disease Program and gastroenterologist at Children’s National Hospital, tells SELF. Intestinal symptoms—like diarrhea and abdominal pain— are the result of inflammation and damage to the bowel. Extraintestinal symptoms arise from the poor absorption of nutrients and the inflammation that occurs in the body due to an overactive immune response.

Here’s a rundown of celiac disease symptoms to look out for:

Abdominal pain

When you have celiac disease, general abdominal discomfort is common. The exact mechanism of why celiac causes abdominal pain isn’t clearly understood and often the severity of symptoms does not correlate with the amount of internal damage from celiac.

Bloating

Eating even the smallest amount of gluten can cause bloating if you have celiac disease. One of the reasons is that untreated celiac disease may lead to changes in the way food travels through the digestive tract, according to a 2021 study published in the journal Clinical Gastroenterology and Hepatology.¹ This can cause food to become backed up in the stomach, which leads to bloating.

Diarrhea

This can be a big problem for people with celiac disease. Diarrhea happens when the bowels have trouble absorbing liquids or excrete too much liquid.² Malabsorption is what happens when the lining of the intestine is damaged preventing proper absorption of nutrients (cue all the diarrhea). You might notice a few other poop changes too, like appearing pale in color, fattier, or even more foul-smelling than usual—all of which are the result of damage to the gastrointestinal tract.

Unintentional weight loss

Unintentional weight loss is a common symptom of health conditions that cause malnutrition (when your small intestine can’t absorb enough nutrients)—and this is especially true with celiac disease. When gluten damages the lining of the intestinal tract, your body has trouble absorbing nutrients from carbohydrates, fats, and proteins, according to the Mayo Clinic. Without enough calories, it can be difficult for people with celiac disease to gain or maintain weight.

Iron-deficiency anemia

Iron-deficiency anemia can develop in people with celiac disease because the body is unable to adequately absorb iron (along with other nutrients), says Dr. Jossen. If you have iron-deficiency anemia, you may experience symptoms, such as pale skin, fatigue, shortness of breath, and heart palpitations, according to the American Society of Hematology. You might also notice other strange symptoms, such as ringing in the ears, itchy skin, hair loss, and an intense desire to chew on ice.

A super itchy, blistering rash

Known as dermatitis herpetiformis (DH or Duhring’s disease, this rash occurs when celiac disease manifests on your skin). It’s caused by the antibodies associated with celiac disease triggering an immune response in the skin, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The resulting inflammation leads to lesions, which commonly appear on the limbs and torso. Thankfully, only about 10% of people with celiac disease will get this rash, and you’ll know if you’ve had it. “It’s a pretty memorable, itchy, blistering rash,” notes Dr. Boland.

Chronic fatigue

Chronic fatigue with celiac disease often manifests as a feeling of tiredness and exhaustion that you just can’t seem to shake, says Dr. Badalyan. Although the exact cause for this symptom is still not known, according to a 2019 study published in the Journal of Human Genetics, it’s possible that inflammation from the autoimmune response is largely to blame.³

Weakness, numbness, and pain in your hands and feet

The result of something called peripheral neuropathy, this happens when the nerves of your peripheral nervous system (think the nerves outside your brain and spinal cord) become damaged. In people with celiac disease, nutritional deficiencies (especially vitamins B12, B6, and E, and metals like copper), antibodies, and even other underlying autoimmune disorders can impact the nervous system and lead to neuropathy. You’ll most likely notice uncomfortable sensations such as pain, tingling, or numbness in the feet (or on the face, in some cases).⁴

Osteoporosis

This one goes back to the pesky malabsorption issue that occurs with untreated celiac disease. The reason: Osteoporosis may occur if your small intestine can’t absorb vitamin D and calcium the way it’s supposed to, which leads to bones becoming weak, brittle, and more susceptible to breaking, per the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Symptoms of osteoporosis can include changes in your height and posture, unexplained back pain, and bone fractures.

Mood changes

Celiac disease can cause irritability, anxiety, and depression, according to a 2015 study published in the United European Gastroenterology Journal. The reason may be that celiac disease makes it hard for the body to absorb the nutrients necessary for brain health.⁵ On top of this, living with a chronic illness can impact your mental health in general. According to the National Institute of Mental Health (NIMH), people with chronic illnesses are at a higher risk of developing mental health conditions like depression.

Reproductive issues

When you have untreated celiac disease, nutritional deficiencies and an overactive immune system may lead to issues with your reproductive health. An older study published in the World Journal of Gastroenterology found that changes in menstruation are common in people with celiac, such as delayed, missed, or irregular periods, as well as decreased libido and changes in sperm health. The study also found that pregnant people with untreated celiac disease may also be at greater risk for premature delivery, low birth weight babies, and miscarriages, though more research is needed.⁶