But I'm Not Really Sick!

Often patients arrive at my office puzzled as to why they have Celiac Disease when they are "not sick".They are confused because they are not sick in the classic way folks view Celiac - a gut disease with severe gastrointestinal issues. They have the "extra-intestinal" symptoms of Celiac. When health professionals discuss CD they often use the analogy of an iceberg. A quick google search will bring up the "Celiac Iceberg". At the very top of the iceberg are those with the classic gastrointestinal symptoms - bloating, abdominal pain, diarrhea. Just below that small group, are those with the "extra-intestinal" symptoms - headaches, anemia, premature osteoporosis etc. Incidentally, below the water line are two more groups neither one of which have symptoms. They are individuals with "Silent Celiac" and "Latent Celiac". The "Silent" group shows Celiac antibodies and damage to the small intestine but no symptoms. This begs the question of how these are identified since they have no symptoms.They are usually picked up by screening relatives of those with diagnosed CD.  Most puzzling is the group at the very bottom of the iceberg - "Latent Celiac". These have positive blood tests but no damage - yet. They may progress into Celiac at a later date. That is the big unknown. According to a study done at the Univ. of Chicago Celiac Disease Center, the bulk of patients (i.e. 60%) are in the second group.

Their symptoms include a laundry list of symptoms that are, at first glance, hard to associate with a gut disease like CD. In addition to the symptoms mentioned above, they may experience failure to conceive, muscle aches, joint pain, poor balance and poor concentration. These symptoms have in common that most are the result of malabsorption of nutrients. Celiac is, of course, a disease of malabsorption. There may be other neurological symptoms whose cause is uknown. No matter what class they find themselves in, adherance to a gluten-free diet will make all well again.