Uncovering the Hidden Symptoms of Celiac Disease: What You Need to Know

Written by: Selena Devries, RD

Updated: May 29th, 2026

Celiac disease is known in the medical community as a ‘medical chameleon’ as many of the symptoms overlap with other diseases and conditions making it difficult to diagnose. In fact, the average diagnosis time in Canada is 10 years (1).

However, there are many hidden symptoms of celiac disease individuals may experience prior to diagnosis. Keep reading to learn about the hidden symptoms of celiac disease, and if you should get tested.

What is Celiac Disease?

Celiac disease is an autoimmune condition that damages the small intestine when gluten is ingested. The small intestine is where nutrient absorption occurs and when it is damaged, nutrient malabsorption occurs and body wide symptoms and conditions can develop.

Regarding symptoms, well-known symptoms typically include:

weight loss
abdominal pain or cramps
diarrhea
abdominal bloating
gas

On the other hand, non-celiac wheat sensitivity does not damage the small intestine. As such, nutrient malabsorption doesn’t occur. However, the individual will still experience symptoms that often include:

abdominal cramping
constipation
diarrhea
bloating
headaches
low energy
brain fog
joint pain

Hidden Symptoms of Celiac Disease

Regarding celiac disease, symptoms can vary widely. Here is a list of possible hidden symptoms of celiac disease:

Iron Deficiency Anemia

Iron deficiency anemia is very common in celiac disease. This is because iron is absorbed in the small intestine, which is damaged in those with celiac disease, leading to iron malabsorption.

Symptoms of iron deficiency can include:

low energy
fatigue
feeling unusually cold in hands and feet
feeling weak
heart palpitations
dizziness
shortness of breath
brittle nails
hair loss
headaches

It is estimated that up to 50 percent of newly diagnosed celiacs present with iron deficiency anemia (2). If iron levels are low and supplements are not working, asking your doctor for a celiac blood test would be a logical, next step.

Liver Abnormalities

An annual checkup may reveal that you have elevated liver enzymes which may leave you and your doctor puzzled. Undiagnosed celiac disease is associated with a threefold increased risk of autoimmune conditions.

Further, autoimmune conditions may lead to liver dysfunction including autoimmune celiac hepatitis or mildly elevated liver enzymes (3). These conditions don’t typically cause any noticeable symptoms and may only be found in bloodwork.

Reproductive Disorders

Women with celiac disease may have a higher risk for numerous gynecologic conditions.

One 2023 study found that women with celiac disease were more likely to experience ovarian dysfunction, polycystic ovarian syndrome (PCOS), irregular menstruation and painful periods.

Additionally, individuals with celiac disease were found to have:

higher rates of endometriosis
menopausal and perimenopausal disorder
infertility
recurrent pregnancy losses
rare/absent periods

Finally, in adolescents, delayed puberty and delayed menarche may also be present in those with celiac disease (4).

Poor Growth in Children

Because celiac disease causes malabsorption in the small intestine, both micronutrients (vitamins and minerals) and macronutrients (fat, carbohydrates, protein) can be malabsorbed which can lead to poor weight gain and poor growth.

If a child falls off their typical height or growth curve, it should be investigated. For example, if your child is typically on the 25th percentile for growth and continues to slowly drop to lower percentiles on multiple readings and doesn’t recover, this is a red flag and should be followed up by the child’s doctor.

Dental Issues

Poor dental enamel is a common hidden symptom of celiac disease. Particularly, poor tooth enamel may also be associated with the malabsorption of calcium and vitamin D which plays an integral role in the normal mineralization of dental enamel.

Further, poor dental enamel may result in discoloration of teeth, giving them:

more yellowish tinge
the appearance of white spots or brown spots
horizontal lines, pitting or deep groves (5).

woman having dental examination for symptoms of Celiac Disease

Neurological Problems

Studies show that about 21-28 percent of individuals with celiac may present with migraines (6).

Along with an increased risk of migraines, individuals with celiac have been shown to have a 2.5-fold increased risk for developing neuropathy which can cause the feeling of pins and needles, numbing and burning sensations in the extremities (7).

Additionally, gluten ataxia, brain damage from gluten ingestion, may occur. This may lead to clumsiness, loss of balance and uncoordinated movements that can lead to falls or slurred speech (8).

Bone Health Problems

Low bone mineral density (osteopenia) and osteoporosis are common in undiagnosed celiac disease. It is estimated that up to 60 percent of newly diagnosed individuals have low bone density (9).

Additionally, individuals with celiac disease are more likely to experience fractures in the hip, spine, forearm, and humerus compared to those without celiac disease (10). Moreover, as nutrient malabsorption occurs in celiac disease, the lack of vitamin D and calcium may also play a role.

Dermatitis Herpetiformis (DH)

DH is known as the ‘celiac rash’ and is estimated to impact about ~10 percent of individuals with celiac disease (11). DH is an extremely itchy rash that occurs in clusters around the:

buttocks
knees
elbows
back
hairline and scalp

The rash typically causes raised, red and blistery bumps that may also cause a burning sensation.

Getting Tested for Celiac Disease

There are two steps required for celiac testing.

The first step for testing is a blood screen test. There are two main blood tests required that include total serum IgA and Anti-tTG IgA. Prior to the blood test, you must consume gluten daily, for at least 6-12 weeks for accuracy.

If the blood screen test is positive, the second step includes a referral to a gastroenterologist (GI) for an endoscopy procedure. The endoscopy procedure allows the doctor to look closely at what is going on in your small intestine and look for damage that would result from gluten ingestion. Again, you need to eat gluten daily, prior to this test being done.

Celiac disease-related damage can be tricky to find in the small intestine so at least 4-6 biopsies should be taken.

It’s important to note that there are alternatives to the endoscopy procedure for certain children. Children may receive additional blood tests, and potentially, genetic tests instead.

An endoscopy procedure is not usually needed for dermatitis herpetiformis and, rather, the second step would include a skin biopsy looking for evidence of the DH rash.

Celiac Disease Treatment

The only treatment for celiac disease is a strict, 100 percent gluten-free diet for life. This includes avoiding all sources of gluten including:

wheat
barley
rye
certain types of oats
triticale

With celiac disease, minimizing cross-contact in the diet is vital as tiny amounts of gluten can be harmful. Cross contact is when gluten accidentally gets into gluten-free food during food processing, preparation, and cooking.

If a celiac diagnosis has been confirmed, a referral to a dietitian with expertise in the gluten-free (GF) diet should be the next step as there is a steep learning curve with the transition to GF living. A celiac dietitian can help you follow the diet and help you overcome symptoms, read food labels, treat nutrient deficiencies, eat out safely in restaurants, learn about cross-contact and much more.

FAQs

What does celiac disease feel like?

Celiac may result in symptoms like diarrhea, abdominal pain, painful periods, itchy skin rash, fractures, or migraines. However, you may also experience symptoms that you can’t feel at all like dental enamel defects or abnormal liver enzymes.

How do you get celiac disease?

Celiac disease requires three things to develop: The celiac gene, gluten ingestion and an environmental ‘trigger’ that turns the celiac gene on. Once the celiac gene has been turned on, along with gluten ingestion, celiac disease can develop.

Is celiac disease an autoimmune condition?

Celiac disease is an autoimmune condition that damages the small intestine when gluten is ingested. In turn, this may lead to many wide symptoms and conditions.

Is celiac disease a disability?

Celiac disease is unlikely to qualify as a disability in Canada. This is because to qualify, celiac needs to continue to significantly impact your daily life post gluten-free diet treatment.

Although there are significant social challenges on the GF diet, this would not be sufficient. Thorough documentation from medical professionals would be needed to substantiate a disability claim for celiac disease. However, individuals with celiac disease can claim the extra cost of gluten-free food on their annual tax return.

Key Takeaways

Celiac disease is not just a disease that causes ‘stomach’ problems. There are many hidden symptoms of celiac disease, and if not caught early, celiac disease can lead to the development of additional conditions such as osteoporosis, infertility, autoimmune liver disease, migraines, or iron deficiency anemia.

Getting screened for celiac disease includes a simple blood test while being on a gluten- containing diet. The blood test includes total serum IgA and Anti- tTG IgA. In most cases, if the blood test is positive, a referral to the gastroenterologist for a diagnostic endoscopy procedure would be the next step.

If celiac disease is confirmed, the only treatment for celiac disease is a 100 percent strict, GF diet for life. Once the diagnosis has been confirmed, a referral to a celiac dietitian should be included to help with the transition to gluten-free living.

References

Celiac Canada. (2024). Report pages 24-02-13 BR v11. Retrieved from https://e.issuu.com/embed.html?d=ce6594-report-pag
Singh, P., Arora, A., Strand, T. A., Leffler, D. A., Catassi, C., Green, P. H., Kelly, C. P., Ahuja, V., & Makharia, G. K. (2018). Global Prevalence of Celiac Disease: Systematic Review and Meta-analysis. Clinical gastroenterology and hepatology 16(6), 823–836.e2. https://doi.org/10.1016/j.cgh.2017.06.037
Villavicencio Kim, J., & Wu, G. Y. (2021). Celiac Disease and Elevated Liver Enzymes: A Review. Journal of clinical and translational hepatology, 9(1), 116–124. https://doi.org/10.14218/JCTH.2020.00089 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7868701/
Nanah, Rama; Chatterjee, Arjun; Nanah, Robana; Almasri, Jehad,Hamid, Osama; Eltelbany, Ahmed; Jansson-Knodell, Claire; Rubio-Tapia, Alberto. Women’s Health Disorders in a Celiac Disease Population-A Nationwide Cohort Analysis. The American Journal of Gastroenterology 118(10S):p S1330-S1331, October 2023. | DOI: 10.14309/01.ajg.0000956808.85757.1e
Rashid, M., Zarkadas, M., Anca, A., & Limeback, H. (2011). Oral manifestations of celiac disease: a clinical guide for dentists. Journal (Canadian Dental Association), 77, b39.
Arzani, M., Jahromi, S. R., Ghorbani, Z., Vahabizad, F., Martelletti, P., Ghaemi, A., Sacco, S., Togha, M., & School of Advanced Studies of the European Headache Federation (EHF-SAS) (2020). Gut-brain Axis and migraine headache: a comprehensive review. The journal of headache and pain, 21(1), 15. https://doi.org/10.1186/s10194-020-1078-9
Thawani, S. P., Brannagan, T. H., 3rd, Lebwohl, B., Green, P. H., & Ludvigsson, J. F. (2015). Risk of Neuropathy Among 28,232 Patients With Biopsy-Verified Celiac Disease. JAMA neurology, 72(7), 806–811. https://doi.org/10.1001/jamaneurol.2015.0475
Coeliac UK. (n.d.). Neurological conditions linked to coeliac disease. Retrieved July 30, 2024, from https://www.coeliac.org.uk/information-and-support/coeliac-disease/conditions-linked-to-coeliac-disease/neurological-conditions/
Duerksen, D. R., Lix, L. M., Johansson, H., McCloskey, E. V., Harvey, N. C., Kanis, J. A., & Leslie, W. D. (2021). Fracture risk assessment in celiac disease: a registry-based cohort study. Osteoporosis international 32(1), 93–99. https://doi.org/10.1007/s00198-020-05579-7
Mosca, C., Thorsteinsdottir, F., Abrahamsen, B., Rumessen, J. J., & Händel, M. N. (2022). Newly Diagnosed Celiac Disease and Bone Health in Young Adults: A Systematic Literature Review. Calcified tissue international, 110(6), 641–648. https://doi.org/10.1007/s00223-021-00938-w
National Institute of Diabetes and Digestive and Kidney Diseases. (n.d.). Dermatitis herpetiformis. Retrieved July 30, 2024, from https://www.niddk.nih.gov/health-information/professionals/clinical-tools-patient-management/digestive-diseases/dermatitis-herpetiformis