Autoimmune Diseases Linked to Celiac Disease

Autoimmune diseases linked to celiac disease include Type 1 Diabetes, multiple sclerosis, Hashimoto’s, autoimmune hepatitis, Addison’s disease, arthritis, Sjögren’s syndrome, and more.

With so many clients coming to me battling other autoimmune diseases or concerned about developting another autoimmune disease, I thought it fitting to talk about them. Below we will talk about the risks of these autoimmune diseases, their symptoms, testing, and how to prevent them.

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Autoimmune Diseases are Associated With Celiac Disease

Can celiac lead to other diseases? Yes. If untreated celiac can lead to liver problems, nutrient deficiencies, malnutrition, and more. That being said, just having celiac also puts you at risk for another autoimmune disease.

Not only is celiac disease considered to be an autoimmune disease but many other autoimmune diseases are associated with celiac. In fact, the risk of developing another autoimmune disease is greater if you already have one.

Additionally, research has shown that depending on when you’re diagnosed with celiac, you have a higher risk of developing another autoimmune disease. The risk increases with age with the highest chances of 34% being if you’re diagnosed over the age of 20.

With there being a lot of overlap between autoimmune diseases, it’s important to be aware of the risks so you can be empowered to get help if you notice warning signs of other autoimmune diseases developing.

Autoimmune Diseases Linked to Celiac Disease​ - Tayler Silfverduk, celiac dietitian - list of high risk autoimmune disease in celiac disease

List of Autoimmune Diseases Linked to Celiac Disease

As mentioned earlier, there are a lot of autoimmune diseases associated with celiac disease. Autoimmune diseases like Type 1 Diabetes, multiple sclerosis, Hashimoto’s, arthritis, autoimmune hepatitis, EoE, and more. Let’s dive into each autoimmune disease celiacs are at greater risk for below.

Celiac Disease is Associated With Type 1 Diabetes

The autoimmune disease with the highest prevalence in people with celiac disease is Type 1 Diabetes. Documented to be at an increased risk ~3 to 16%, people with celiac should be aware of the overlap between the two diseases.

However, this is one of the autoimmune diseases linked to celiac that is more likely to develop in younger celiacs. More specifically the risk is associated with people with Type 1 developing celiac not the other way around.

With type 1 diabetes, the body starts attacking the pancreas until it stops functioning altogether. This means hormones to regulate blood sugar are not being released making the body unable to access a necessary form of energy. Because of this, people with Type 1 Diabetes need to act as their own pancreas by monitoring their blood sugars and eating or dosing themselves with insulin as needed.

Signs you have Type 1 Diabetes per the Mayo Clinic Include:

  • Increased thirst
  • Frequent urination
  • Bed-wetting in children who previously didn’t wet the bed during the night
  • Extreme hunger
  • Unintended weight loss
  • Irritability and other mood changes
  • Fatigue and weakness
  • Blurred vision

Diagnostic tests include:

  • A1C (to test your average blood sugar in the past 2-3 months, 6.5 or higher on two different tests indicates diabetes)
  • Fasting blood sugar tests (test your blood sugar regulation without food – you want this to be less than 100mg/dL)
  • Autoantibody blood tests to check for antibodies associated with type 1 diabetes (can be Islet or GADA, IA-2A, and IAA)
The Link Between Autoimmune Hepatitis​ and Celiac Disease + Symptoms - Tayler Silfverduk, celiac dietitian

The Link Between Celiac Disease and Autoimmune Hepatitis

Autoimmune hepatitis is increasingly prevalent in people with celiac. With some studies saying the increased risk is as high as 15%, others say it’s only around 6%.

Autoimmune hepatitis is when your body’s immune system starts attacking your liver. This attack leads to inflammation in your liver which if untreated, can lead to serious liver diseases like cirrhosis and liver failure.

The treatment for Autoimmune Hepatitis is immune system suppressing drugs. In some cases, a liver transplant is needed.

Signs of Autoimmune Hepatitis include:

  • Fatigue
  • Abdominal discomfort
  • Yellowing of the skin and whites of the eyes (jaundice)
  • An enlarged liver
  • Abnormal blood vessels on the skin (spider angiomas)
  • Skin rashes
  • Joint pains
  • Loss of menstrual periods

Diagnostic Tests for AH Per NIDDK:

  • Liver enzyme panel (to check for elevated ALT and AST
  • Exclusionary blood tests to eliminate other liver diseases
  • Associated antibody blood tests (ANA and SMA)
  • Imaging to assess how much damage has occurred

 

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Risk for Sjogren’s Syndrome With Celiac

With the risk increased risk between 2 and 15% in celiacs, Sjogren’s syndrome should not be ignored. With this syndrome, the body’s immune system attacks cells producing saliva and tears. The main symptoms thus are dry mouth and eyes.

Symptoms include:

  • Neurological problems
  • Dry eyes
  • Dry nose
  • Dry mouth
  • Change in taste or smell
  • Dry or peeling lips
  • Dry throat
  • Swollen/painful salivary glands
  • Difficulty swallowing, heartburn, reflux, esophagitis
  • Abnormal liver function tests
  • Arthritis, joint/muscle pain

Diagnostic Testing:

  • Rheumatologists are primarily responsible for diagnosis and management.
  • Diagnosis is done through a series of tests and symptom questionnaires.
  • For more on Sjogren’s testing visit this website.

Treatment involves a drug regimen prescribed by your doctor. For info check out this website.

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Celiac is Linked to Multiple Sclerosis

One of the other autoimmune diseases linked to celiac is Multiple Sclerosis (MS). If you have celiac you could be at higher risk for multiple sclerosis. And this is proven by research which shows a whopping 11% increased risk.

Multiple sclerosis (MS) is an autoimmune disease featuring injury to the central nervous system. This injury causes nerves to send misinformation to your brain triggering a variety of symptoms.

Signs of MS per John Hopkins Medicine include:

  • Bladder problems (frequent urination, urgency)
  • Depression
  • Dizziness or vertigo
  • Fatigue
  • Impaired coordination (ataxia)
  • Sensory symptoms (numbness, pain)
  • Spasticity (muscle stiffness or spasms)
  • Temperature sensitivity – worsening of MS symptoms by heat
  • Tremors
  • Trouble with short-term memory and concentration
  • Visual symptoms (optic neuritis, association with pain and eye movement, double vision)
  • Weakness

Diagnosis of MS per John Hopkins Medicine includes:

  • MRI of the brain and/or spinal cord – The MRI often shows plaques or scars typical of MS.
  • Cerebrospinal fluid (CSF) evaluation – Using a lumbar puncture or spinal tap, the CSF evaluation may show immunological abnormalities that help in the diagnosis.
  • Evoked potential studies – Measuring conduction of electrical impulses along the optic nerve (in patients suspected of having optic neuritis) and along nerve pathways in the brain and spinal cord.
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The Link Between Chron’s and Celiac Disease

Additionally, Chron’s disease is one of the other autoimmune diseases linked to celiac. It’s an irritable bowel disease with some sources citing an increased risk of 10% in celiacs. This disease should remain on the radar in case symptoms don’t improve.

Chron’s can impact any part of the digestive system from the mouth to the anus. Symptoms depend on what part of the digestive system is experiencing an autoimmune flare.

This leads us to the symptoms of chron’s disease of which many overlap with celiac. Symptoms include:

  • Diarrhea
  • Fatigue
  • Abdominal pain and cramping
  • Blood in your stool
  • Mouth sores
  • Reduced appetite and weight loss
  • Pain or drainage near or around the anus due to a fistula

Overlapping symptoms of Chron’s and Celiac per the Celiac Disease Foundation include:

  • Abdominal pain
  • Diarrhea
  • Anemia
  • Short stature

Diagnostic Testing includes:

  • Red Blood Cell testing to check for red blood cell counts to see if they are indicative of anemia (as a result of bleeding in the GI tract)
  • White Blood Cell count to see if you have inflammation or infection in your body.
  • A stool test is the analysis of a sample of poop. This will be used to rule out other digestive causes.
  • Colonoscopy and endoscopy to assess for damage and autoimmune reactions along the digestive system that correlates with Chron’s and to rule out other conditions.

And other tests. You can learn more on the NIDDK website.

Arthritis Autoimmune Diseases Linked to Celiac

Arthritis is not one single disease but a way to refer to stiffness, inflammation, and pain in the joints. Unfortunately, joint pain is one of the many 300+ reported symptoms of celiac disease. On top of that, Beyond Celiac reports that celiacs are 4 times more likely to have signs of certain types of arthritis.

Symptoms of arthritis primarily include inflammation, stiffness, and pain in joints. In celiacs, arthritis has been most commonly reported in the knees and the Achilles tendon (between the calf and heel).

Depending on the type of arthritis suspected, imaging or lab tests may be used to diagnose it. Rheumatologists are typically the doctors who diagnose it. Thus, if you are worried about having arthritis along with celiac, you may want to ask your doctor for a referral.

Celiac Disease and Addison's Disease - Tayler Silfverduk, celiac dietitian

Celiac Disease and Addison's Disease

Another one of the high risk autoimmune diseases linked to celiac is Addison’s disease. Per the Celiac Disease Foundation, people with celiac are at a 6% higher risk for Addison’s disease. Addison’s disease is an endocrine disease which means it impacts hormones in your body. More specifically, the adrenal glands don’t make enough cortisol and often aldosterone.

Both hormones are essential to the stress response (think responding to sickness) and blood pressure. This can be a particularly nasty combination to have. As both have a risk for malabsorption and gastrointestinal symptoms, and steroid absorption used to treat Addison’s can be altered due to intestinal damage from celiac.

Symptoms of Addison’s disease per the Mayo Clinic include:

  • Extreme fatigue
  • Weight loss and decreased appetite
  • Darkening of your skin (hyperpigmentation)
  • Low blood pressure, even fainting
  • Salt craving
  • Low blood sugar (hypoglycemia)
  • Nausea, diarrhea or vomiting (gastrointestinal symptoms)
  • Abdominal pain
  • Muscle or joint pains
  • Irritability
  • Depression or other behavioral symptoms
  • Body hair loss or sexual dysfunction in women

Testing for Addison’s disease includes blood tests, ACTH stimulation tests (measures how much ACTH is released before and after stimulation), and imaging. The blood tests are to measure sodium, potassium, cortisol, and ACTH (a hormone that stimulates your adrenal glands to make hormones). They can also measure antibodies associated with Addison’s. Imaging can be done to assess for abnormalities in your adrenal glands and pituitary glands. Read more about testing here.

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Celiac and Hashimoto’s

There is a connection between Hashimoto’s and celiac disease. In fact, Beyond Celiac reports that there is a 4x greater chance that someone with celiac will have a thyroid disease like Hashimoto’s. In fact, one study, albeit from 2003, found that half of the newly diagnosed celiacs also had a thyroid condition.

Hashimoto’s is an autoimmune disease where the body attacks and destroys the thyroid. The main problem is that the treatment for Hashimoto’s typically involves medications where absorption can be impaired if you have celiac, requiring a higher dose.

Symptoms of Hashimoto’s per the Mayo Clinic include:

  • Fatigue and sluggishness
  • Increased sensitivity to cold
  • Constipation
  • Pale, dry skin
  • A puffy face
  • Brittle nails
  • Hair loss
  • Enlargement of the tongue
  • Weight gain
  • Muscle aches, tenderness, and stiffness
  • Joint pain and stiffness
  • Muscle weakness
  • Excessive or prolonged menstrual bleeding
  • Depression
  • Memory lapses

Diagnosis of Hashimoto’s involves hormone tests to assess the activity of your thyroid. Additionally, it includes tests of antibodies associated with Hashimoto’s (TPO antibodies) – however this antibody test isn’t always accurate for everyone.

Celiac and Eosinophilic Esophagitis (EoE) - Autoimmune Diseases Associated with Celiac Disease​ - Tayler Silfverduk, celiac dietitian​

Celiac and Eosinophilic Esophagitis (EoE)

The risk of Celiac and Eosinophilic Esophagitis is high, with some studies reporting at least a 26% higher risk than non-celiacs. A relatively newly recognized disease, EoE was first identified in the 90s. Symptoms of EoE per the Mayo Clinic include:

  • Trouble swallowing
  • Issues with food getting stuck in the esophagus after swallowing 
  • Chest pain that is often centrally located and does not respond to antacids
  • Backflow of undigested food 

Causes include:

  • An allergic reaction to food in your esophagus
  • An overproduction of inflammatory proteins released by eosinophils in your esophagus
  • Damaged or scarred esophagus
  • And more

Diagnosis involves an endoscopy that goes all the way down to your duodenum to evaluate the esophagus, biopsy it, and consider other causes for symptoms. If you’re being tested for EoE make sure they biopsy your esophagus, 10-20% of EoE patients can have normal endoscopes but clinically relevant biopsy results.

Does Having Celiac Make you Immunocompromised?

If you are healed and recovered, no, celiac disease does not make you immunocompromised. If you are still recovering from or struggling with malnutrition, weight loss, or refractory celiac, you may be immunocompromised. The same goes for if you have recently been exposed to gluten.

The logic is that your immune system is likely not functioning at its prime if it’s busy overreacting to gluten. In addition, if you’re malnourished, undereating, or underweight, your body likely doesn’t have the energy to fight off a serious infection.

So short answer: if your celiac disease is well-managed then no, you are not immunocompromised. If you are still healing or exposed to gluten, then you may be immunocompromised.

If you’re concerned about the status of your immune system, be sure to consult with your doctor.

How to Prevent Autoimmune Diseases Linked to Celiac

If you have celiac disease, preventing getting another autoimmune disease might be at the top of your mind. The statistic that you are 34% more likely to get another autoimmune disease if you’re diagnosed over the age of 20 is scary. Let me leave you with a few thoughts on autoimmune disease prevention.

First, you can do everything “right” to prevent another autoimmune disease and still end up with one. So if there’s anything I want you to get from this, it’s that you did not cause your celiac disease, and you did not cause any other autoimmune disease you have or may develop.

Autoimmune diseases involve many factors beyond our control. Factors like: genetics, chance life-events, hormonal activity, unknown environmental factors, and more. The point is, even if we control what we can, an autoimmune disease can still develop. 

Second, for celiac, the best thing to keep your immune system away from the overreactive path of autoimmune diseases is to do your best to stay gluten-free. And no, one accident is not going to be the deciding factor on developing an autoimmune disease. However, purposely putting your body in an inflammatory state by eating gluten is not going to help.

Third, the best way to support your health is by doing things from a place of compassion, not fear. So instead of “what can I do to prevent autoimmune disease”, try “what can I do to feel good in my body?”. Typically these things are often associated with disease prevention in general. Notice I said associated – because you can still do all the “right” things and again, end up with an autoimmune disease.

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Steps to Prevent Other Autoimmune Diseases with Celiac Disease

The above reminders in mind, there are some things you can do to prevent associated autoimmune disease with celiac disease. In my clients, for example, there are some overarching themes I find in their habits that result in them feeling better. These themes include:

  • Daily enjoyable exercise – whether it’s for 15 minutes or 60, most of my clients find they feel better when making space for exercise in their day. And it’s not just them that notices it, the research notices the benefits of routine movement too.
  • Finding ways to routinely and enjoyably add fruits and/or vegetables to every meal. I emphasize ways to enjoyably add produce because I find when clients suffer through foods they don’t like, the habits don’t last and they aren’t actually feeling good about their food choices. Regardless, fruits and vegetables are packed full of antioxidants and anti-inflammatory properties. Not to mention, they have fiber to help boost gut health.
  • Incorporating more whole grains into your diet to keep your digestive system regular and moving. Not to mention they offer a source of vitamins V, E, zinc, and selenium which can be helpful in reducing inflammation. In fact, a 2018 study showed that a diet rich in whole grains can reduce body-wide inflammation. Anecdotally, many of my clients report improved satiety and digestive symptoms when they eat more whole grains. 
  • Find ways to destress and recover from celiac burnout and other forms of burnout. Pushing your mind and body to their absolute limit is good for no one. Many of my clients see huge improvements when they start to make time for stress recovery and self-care.
  • Eating enough and routinely so that your body has enough energy to do everything it’s supposed to do and your hormone operate smoothly.
  • Body image work so that taking care of yourself and treating yourself with compassion is easier. It’s hard to take care of a body that you don’t feel deserves it. Reframing your work around your body and approaching it from a place of respect is paramount to any healthy lifestyle change. Learn more about celiac and body image here.

Want help with these things? I am trained to help people with celiac disease address their relationship with food, nourish themselves appropriately, address body image and more. I’d love to help you! Click the button below to work with me!

Disclaimer: like every other post on my website, this post is not to take the place of individualized care from your healthcare team. If you are concerned about you health, be sure to consult your doctor to get your concerns addressed.