Introduction

This article will introduce coeliac disease and how the condition may lead to either weight loss or weight gain. 

Explanation of coeliac disease

Coeliac disease is an autoimmune condition whereby your body’s immune system attacks healthy cells to cause the symptoms of disease.¹ In coeliac disease, your immune system attacks and damages the cells in your gut (small intestine) when you eat a protein called gluten.¹ The damage caused to your small intestine results in you not being able to digest  nutrients from your food properly.² 

Importance of understanding its impact on weight

Coeliac disease causes damage to the cells in your small intestine so you are unable to take in nutrients from your food properly.² As a result, one common symptom of coeliac disease is a change in weight.² This change may be weight loss or weight gain.² 

Weight change is often one of the first presenting symptoms of the condition in adults, and children often fail to grow and develop normally (known as failure to thrive or faltering growth).^2,3

Understanding coeliac disease

This section will introduce coeliac disease. 

What is coeliac disease?

Coeliac disease is an autoimmune condition. This means your own body immune system attacks your the healthy cells in your small intestine to cause the symptoms of disease.¹ In coeliac disease, your immune system damages the cells in your small intestine when you eat the protein gluten.¹ Gluten is present in wheat, barley and rye.¹ 

Coeliac disease is treated by removing gluten from the diet and sticking to a gluten-free diet.¹ Further information on a gluten-free diet can be found on the NHS website. 

How does it affect the body?

In coeliac disease, your immune system drives inflammation and damage to the cells in your small intestine when you eat gluten.² This cellular damage results in your body being unable to take in nutrients properly.² The disease impacts your digestive system directly but also all other systems of your body indirectly.² Therefore, coeliac disease can present in individuals with a wide variety of different symptoms.⁴

Common symptoms

The common gut symptoms of coeliac disease include:⁵ 

• Diarrhoea and/or constipation 
• Bloating and feeling gassy (flatulence) 
• Stomach aches
• Indigestion 

Other symptoms of coeliac disease impacting the body more generally include:⁵ 

• Unintentional weight loss or gain
• Excessive tiredness which results from not receiving the right about of nutrients from your food
• Problems getting pregnant
• Damage to nerves
• Impact on coordination, speech and balance
• Itchy rash (known as dermatitis herpetiformis) 

Link between coeliac disease and weight

Coeliac disease can result in both weight loss or weight gain due to a failure to take up nutrients from your food properly. This section will explore the link between coeliac disease and changes in weight. 

Weight loss

Unintentional weight loss in coeliac disease can result from various factors. We will outline the most common below. 

Malabsorption of nutrients

The immune-mediated response caused by coeliac disease results in damage and inflammation to the cells in your small intestine.² Since the small intestine is a primary site of nutrient absorption, the cell damage can result in a failure to absorb nutrients properly.² This malabsorption of nutrients leads to unintentional weight loss.² 

Digestive issues

Digestive issues arising as a result of coeliac disease, for example, diarrhoea and constipation, can also result in unintentional weight loss.⁶ 

Loss of appetite

Individuals with coeliac disease may also experience a loss of appetite and, as a result eat less food and lose weight.⁷ 

Weight gain

Weight gain in coeliac disease may also arise via several factors. Here we will outline the most common reasons for weight gain in coeliac disease. 

Misinterpretation of gluten-free foods

Misinterpretation of gluten-free foods may lead to an individual with coeliac disease gaining weight.⁸ The affected individual’s gluten-free diet should be balanced in nutrients and healthy to avoid weight gain.⁸ 

Healing gut leads to weight restoration

When you start a gluten-free diet to treat coeliac disease, your body will start to absorb nutrients properly again.⁹ This may lead to weight restoration and gain.⁹ Importantly, this is healthy weight gain and shows your body is healing well. 

Improvement in appetite and nutrient absorption

As you start your gluten-free diet and nutrient absorption improves, it is likely your appetite will increase.⁷ This increase in appetite may also result in weight gain in individuals with coeliac disease.⁷ 

Managing weight with coeliac disease

In this section we will outline how you can help to manage your weight as an individual living with coeliac disease. 

Importance of proper diagnosis

It is important to get a proper diagnosis if you think you may be suffering with coeliac disease. A diagnosis of coeliac disease is made via a blood test and a biopsy of the small intestine to confirm the condition.⁵ Whilst you are being tested you should continue to eat gluten to make sure the tests are accurate.⁵ 

Since coeliac disease is partly a genetic condition, it is also important to get tested if you have a first-degree relative (parents, siblings or children) diagnosed with coeliac disease.⁵ 

Following a gluten-free diet

If your healthcare professional diagnoses you with coeliac disease, you will have to remove gluten from your diet and start a gluten-free diet. Properly following a gluten-free diet will help you avoid unintentional weight loss or excessive weight gain in coeliac disease. 

Understanding gluten

Gluten is a protein present in wheat, barley and rye.¹⁰ Gluten is the protein that triggers the autoimmune response in coeliac disease.¹⁰ To treat coeliac disease, you must follow a gluten-free diet. 

Identifying safe and unsafe foods

The NHS website and the Coeliac UK website provide comprehensive descriptions of foods containing gluten (unsafe foods) and food which do not contain gluten (safe foods). Here we will outline some examples. 

Unsafe foods, or those containing gluten, include: 

• Bread
• Pasta
• Cereals
• Biscuits or cakes
• Gravy and sauce
• Pastry 

Safe foods, or those which do not contain gluten, include: 

• Most dairy products
• Fruits and vegetables
• Fish and meat 
• Potatoes
• Rice and noodles
• Gluten-free labelled foods (including flours)

Working with healthcare professionals

After your diagnosis of coeliac disease, it is important to work with healthcare professionals to manage your gluten-free diet and any weight changes associated with your condition. 

Dietitians and nutritionists

You may be referred to a dietitian or nutritionist who will help you manage your gluten-free diet.¹¹ It is important you work closely with these healthcare professionals as they will make sure you understand and are able to follow your diet consistently.¹¹ 

Monitoring nutrient levels

Your healthcare professionals will also monitor your nutrient levels to ensure you do not become malnourished from your coeliac disease.¹¹ 

Incorporating exercise and lifestyle changes

As an individual with coeliac disease it is important you incorporate exercise and certain lifestyle changes to help you manage your condition and any weight changes. 

Maintaining overall health

To maintain overall health it is important you incorporate exercise into your daily routine. The Coeliac UK website provides further information on how much exercise and what exercise you should be doing. 

Supporting weight management goals

Incorporating exercise alongside the right diet can be useful to help reach weight management goals. Speak to your healthcare professionals on further advice on lifestyle changes to incorporate to manage your weight in coeliac disease. 

Summary 

Coeliac disease is an autoimmune condition that leads to damage to cells of your small intestine. The condition is triggered by eating a protein called gluten which is present in wheat, barley and rye. The damage to the cells in your small intestine means you do not properly take up nutrients which can result in a variety of symptoms and deficiencies. Coeliac disease and treatment with a gluten-free diet can lead to both weight loss and gain. To effectively manage your weight with coeliac disease it is important you get a proper diagnosis, follow a strict gluten-free diet, work closely with your healthcare professionals and incorporate exercise into your daily routine. 

FAQs

What are the hidden symptoms of coeliac disease? 

Coeliac disease does not just impact the gut. Individuals with coeliac disease may present with a wide variety of rarer symptoms, including anaemia, bone disease, high liver enzymes and neurological problems.²

What triggers coeliac disease later in life? 

Coeliac disease is caused by a combination of genetic and environmental factors.¹ Therefore, even if you have eaten gluten your whole life, certain environmental changes may trigger the onset of the disease.¹ 

Is living with coeliac disease hard? 

Living with coeliac disease can be challenging but it is manageable. The Coeliac UK website provides detailed information on how you can live well with coeliac disease.