Complications

❓ What Are the Complications of Coeliac Disease?

Complications of coeliac disease typically only affect people who continue to eat gluten after diagnosis, or those who remain undiagnosed, which can be a common problem in milder cases. That's why it's so important to stick to a gluten free diet once diagnosed.

👉🏽 Click here to read about how coeliac disease is diagnosed.

🩸 Malabsorption

Malabsorption occurs when your small intestine cannot absorb essential nutrients properly. Common deficiencies include:

• Iron - Can lead to iron-deficiency anaemia, causing fatigue and weakness
• Vitamin B12 & Folate - Low levels can cause megaloblastic anaemia, leading to dizziness, tiredness, and shortness of breath
• Calcium & Vitamin D - Increases the risk of osteoporosis

🦴 Osteoporosis

Osteoporosis (weakened bones) leads to around 300,000 fractures each year in the UK, and 9 million globally. Studies show that up to 75% of people with coeliac disease have low bone mineral density at diagnosis - but this often improves significantly after 1 year on a gluten free diet.

Risk factors include:

• Late or missed diagnosis
• Not sticking to a gluten free diet
• Ongoing gut damage (villous atrophy)
• Low body weight and lactose intolerance
• Ageing, menopause, smoking, inactivity
• Certain medications (e.g. steroids)

If you are concerned, speak to your GP or Consultant - they may refer you for a DEXA scan to check your bone health.

🥱 Malnutrition

In severe cases, coeliac disease can lead to malnutrition, where your body lacks the nutrients it needs to function or recover properly.

Symptoms include:

• Fatigue, confusion, and dizziness
• Muscle weakness and unintended weight loss
• In children: delayed development and stunted growth

Treatment may involve high-calorie diets and nutritional supplements under medical supervision.

🧠 Neurological Problems

Up to 60% of people with coeliac disease have neurological symptoms at diagnosis - yet these are often overlooked or misdiagnosed. Those with non-gut symptoms are typically diagnosed almost 10 years later on average.

Common neurological complications include:

• Peripheral neuropathy - Tingling, pain, numbness in hands and feet
• Ataxia - Poor coordination, clumsiness, slurred speech
• Cognitive issues - Brain fog, memory lapses, poor focus
• Mental health symptoms - Anxiety, depression, and mood swings

It's important to note that potential mental health impacts, such as anxiety and depression, can arise from both the condition itself and the stress of managing to a strict gluten free diet.

🥛 Lactose Intolerance

Untreated coeliac disease can lead to temporarily lactose intolerance. This happens when gut damage reduces the enzyme needed to digest lactose (the natural sugar in dairy).

Symptoms include: bloating, diarrhoea, and stomach discomfort after consuming milk or dairy.

The good news? Lactose intolerance often improves once your gut heals. Until then:

• Use lactose-free dairy alternatives
• Consider calcium supplements to meet your daily needs

🦠 Increased Cancer Risk

Cancer is a very rare but serious complication of untreated coeliac disease. Someone with untreated coeliac disease has a slightly increased risk of developing certain rare gut cancers, including: 

• Small bowel cancer
• Small bowel lymphoma
• Hodgkin lymphoma

However, recent research shows the risk is lower than previously thought and returns to normal (same as that of the general population) once a gluten free diet is followed.

🫄 Pregnancy and Coeliac Disease

If coeliac disease is undiagnosed or not well-managed during pregnancy, it may increase the risk of:

• Recurrent miscarriages
• Low birth weight
• Premature birth

Following a gluten free diet and getting the right nutrients is essential for both maternal health and baby's development.