“Current medical science describes diarrhea as a classical symptom of celiac disease, while anemia is described as an atypical or silent manifestation,” this according to Jefferson Adams in an article recently published on celiac.com.
I found this statement particularly interesting, especially considering that it was 20 years of chronic unexplained anemia that eventually led to my celiac diagnosis.
The article goes on to say that very little information exists that “accurately compares the severity of celiac disease between patients who present with anemia against those who present with diarrhea”.
Consequently, a research team affiliated with the Celiac Disease Center, Department of Internal Medicine at the Columbia University College of Physicians and Surgeons in New York embarked on a study to determine whether celiac disease is worse in anemia sufferers than people with diarrhea.
“For their study,” the article continues, “the researchers selected a study group of 727 patients from a database of celiac disease patients evaluated at a tertiary referral center between 1990 and 2011. They used the degree of villous atrophy and clinical and serologic parameters to determine the severity of the celiac disease for each patient.
“The team compared patients according to mode of presentation and sex. They also conducted age and sex-adjusted multi-variable analyses to assess the association between the mode of celiac disease presentation and cholesterol level, bone density, severity of Villous atrophy, erythrocyte sedimentation rate (ESR), and level of anti-tissue transglutaminase (anti-tTG).
“They found that just over three-quarters of the patients presented with diarrhea, while just under one-quarter presented with anemia; 92% of which was iron deficient anemia.
“Multiple regression analysis showed that celiac disease with anemia was associated with lower levels of total cholesterol (P=.02) and high-density lipoprotein (P=.002), and a higher ESR (P=.001) and level of anti-tTG (P=.01). In women only, celiac disease with anemia was associated with a lower level of cholesterol.
“Anemic patients were more than twice as likely to have severe villous atrophy and a low bone mass density at time they were diagnosed with celiac disease than were patients who presented with diarrhea.
The research concluded that “celiac disease patients who present with anemia have more severe disease than those who present with diarrhea”. It stated further that there seems to be sex-specific differences with respect to the connection between anemia and the various features of celiac disease, such as cholesterol.
In the 20 years leading up to my diagnosis, diarrhea never featured as a symptom and I can’t help wondering whether, had I been a diarrhea sufferer, this would have led to a quicker diagnosis. Then again, so many celiac sufferers who present with diarrhea are incorrectly diagnosed with IBS or similar ailments, so perhaps I should consider myself fortunate to have be diagnosed at all.
By the time I was diagnosed, the damage to my small intestine was so bad that my body could no longer absorb iron at all and I was forced to undergo intravenous iron transfusions at least once every two years. Additionally, I had become an ice-aholic, chewing ice cubes at a rate that drove my family crazy.
Today, almost three years later, I continue to enjoy the incredible lightness of being Glutenoptic, and am still free of more than just gluten. The journey can be tough at times, but it is most certainly worthwhile.