Adults with undiagnosed celiac disease often have nutrient deficiencies as the only sign of the condition, say researchers from the Mayo Clinic in Rochester, Minnesota.
Doctors often look for typical signs like unexplained weight loss or diarrhea, but the hallmark signal of celiac disease may be low levels of vitamins and other micronutrients due to poor nutrient absorption in the small intestine.
The researchers stated that doctors need to be on the lookout for low levels of certain micronutrients, in particular iron, vitamin D and zinc. Since many people don’t get regular blood tests, they need to be attuned to the symptom of iron deficiency: fatigue.
The initial screen for celiac is a blood test. If that comes back positive then the individual needs to be referred to a gastroenterologist who will confirm the diagnosis of celiac disease by taking a small bowel biopsy.
The researchers suspect that as many as 50 percent of adults with celiac disease go undiagnosed either because they don’t have weight loss and other signs thought to be typical of the disease or because they’ve put themselves on a gluten-free diet, which can result in a false-negative blood test.
About the study
The research team looked at 309 adults newly diagnosed with celiac disease between 2000 and 2014. The patients were matched by age with participants from the National Health and Nutrition Examination Survey (NHANES), a nationally representative database.
When the researchers compared the just-diagnosed celiac patients to NHANES participants, they found some big differences in nutrient levels. Zinc was deficient in 59.4% of those with celiac versus 33.2% of controls; copper was low in 6.4% of celiac patients versus 2.1% of controls, folate was low in 3.6% of celiac patients versus 0.3% of controls and vitamin B12 was low in 5.3% of celiac patients versus 1.8% of controls.
Among celiac patients, iron was low in 30.8%, but there were no controls with iron measurements to compare to. And contrary to traditional assumptions about celiac and thinness, weight loss was seen in just 25.2% of patients diagnosed with the disease.
The team hopes the study findings will serve as a heads-up to primary care physicians who might notice nutrient deficiencies in their patients. If they see nutritional deficiencies, they should start thinking about celiac disease.
Source: Mayo Clinic Proceedings, online June 24, 2019.
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