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Q. Does overweight rule out the possibility of celiac?

Answered by
Dr. Muhammad M. Hanif Md.
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on May 18, 2016 and last reviewed on: Mar 04, 2020

Hello doctor,

I have a concern about my cholesterol levels and the possibility of an underlying condition. I am a 37 year old female with uncharacteristically low cholesterol. I donate blood regularly which gives me the opportunity to have my total cholesterol level tested. About a year ago, I created an online account with my area's local blood bank, where I found they keep a record of your past health screenings. It was at that time that I realized how low my cholesterol was. The lowest being 118 mg which was several years ago when I was in my 20's but, most recently and over the past year, my levels have averaged in the 134-137 mg range. For my age, I have been overweight for close to 10 years. I had never dieted or limited my cholesterol intake. I began researching online for any information that might explain levels this low. While there is an abundance of information regarding high cholesterol, regarding its causes and risks; there is practically no information available regarding low cholesterol levels or causes outside of the obvious low cholesterol intake (vegetarian or vegan diet) or use of cholesterol reducing mediations such as statins. With one exception celiac. As I began to read through the signs and symptoms of this disease, I could not believe how many I had been experiencing. In fact, some of these were things I never even realized were symptoms of anything. One specific symptom however that each and every article I read seemed to use to define a celiac was weight loss or being severely under weight. Months later, I stumbled across an article about celiac disease going undiagnosed because of the misconception that with celiac you cannot be overweight. So, I decided to raise the question with my GP. Unfortunately, after giving the doctor a rundown of my symptoms and explaining my concerns, as soon as the word celiac came out of my mouth, he quickly dismissed this as a possibility stressing that because I am not underweight and it was absolutely out of the question that I could have the condition. He then dismissed all of my symptoms saying, they were nothing to worry about and added that the lower my cholesterol was, the better. In his words, I should be thrilled at how low my cholesterol was and I must have good genes and with that he sent me on my way. For close to a year after that appointment, I too dismissed all of these symptoms.

Then, six months back, I was admitted into the hospital for an emergency cholecystectomy due to gallstones that caused me to have a severe gallbladder attack. At the time, I knew nothing about the gallbladder's function or its purpose so, there was no argument from me when the doctor explained that some people just get gallstones and the only way to treat gallbladder disease is to remove the gallbladder. Needless to say, my week at home following my surgery, I spent a lot of time learning about the gallbladder and almost immediately I found information describing the correlation between gallstones, gallbladder disease, low cholesterol, and yes, celiac. This past weekend I attempted to donate blood and for the first time in my life, I was turned away because my iron was too low. I went online thinking my iron counts for previous donations would be noted in my wellness chart and although they were not. My cholesterol result from my previous donation, just 2-3 weeks after my surgery, was down to 128 mg.

Would the fact that I am overweight truly rule out any possibility of celiac? If it would, what other conditions might explain all of my symptoms? Are there any others conditions with the same or similar symptoms also present with weight loss or being underweight? If celiac should be ruled out due to being overweight, what can I do to convince a doctor to test me for it?

Dr. Muhammad M. Hanif Md.

Cardiology Critical Care Physician General Medicine Internal Medicine
#

Hi,

Welcome to icliniq.com.

I welcome you and want to assure you need not worry as everything is going to be fine if proper care and treatment is opted in for. I have thoroughly gone through your case and can well understand your genuine health concerns.


The Probable causes:

There are a lot of reasons for this to not being celiac disease.
1. Diarrhea in celiac is very prolonged and there are watery stool. Not only pale they are greasy and floating on the pan, they are foul smelling too.

2. Steatorrhea is the feature of celiac in which large amount of dietary fats pass undigested.

3. Yes, weight loss is a feature of celiac. I have made my patients get to the same weight or so while having celiac but with a lot of efforts and special diet charts to follow and giving them extra calories in diet and special high caloric diet. If a patient keeps the same diet all the time, she definitely will get a decrease in weight.

4. No chances of weight gain with celiac unless extra efforts put in for that. I do not think you took some more than 3000 kilocalories of diet to observe and that is too for years.

5. You had a gallbladder issue from long ago. Firstly there is only a smudge before the stones appearance. Before getting symptomatic (painful) stones remain silent may be for months to years and during that time the bladder function deranges without getting attention of the patient. Your cholesterol levels were also sue to this fact.

6. Cholesterol is good if it is low. Genes also play a role in maintaining a set range of blood lipid profile. So, do not just worry.

7. No one can remain unnoticed for so long if she has had celiac. Severe flatulence is also a feature related specifically to celiac.

8. Excessive blood donation leads to low lipid profile ranges; iron deficiency and even anemia sometimes. You also had the same and it is due to the same reason.

9. Bleeding diathesis occurs due to the vitamin K deficiency in celiac patients.

10. Other celiac symptoms may be dysmenorrhea, calcium and potassium levels in serum dramatically low, muscle weakness, nerve issues, skin disorders, tongue and gum diseases, peripheral nerve issues, etc.

You may ask your PCP (primary care physician) to refer you to a gastroenterologist and you will not need to convince him. He himself will get you tested for any possibilities if needed.

Investigations to be done:

1. You need a latest fasting lipid profile.
2. Check your fasting blood glucose levels, CBC (complete blood count) with ESR (erythrocyte sedimentation rate) and differentials.
3. Thyroid profile.
4. Get complete stool analysis.

Regarding follow up:

Revert back with the investigation reports to an internal medicine physician online.---> https://www.icliniq.com/ask-a-doctor-online/internal-medicine-physician


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