Gluten-Free Diet and Asymptomatic Celiac Disease

imagesIn the United States, an estimated three million Americans suffer from celiac disease. Due to lack of information about celiac disease manifestation, roughly 83% of Americans who experience symptoms go undiagnosed, and as a result, are not aware of the damage to their intestinal lining. There are also those who have the disease but show few or no symptoms, which makes diagnosis difficult. This is called asymptomatic or silent celiac disease[1]. A recent study published in Gastroenterology sought to determine whether asymptomatic individuals benefit from a gluten-free diet, the only current therapy to treat celiac disease[2].

imgresIn this particular study, 3,031 at-risk individuals volunteered to participate in screening for serum celiac antibodies. The EMA (endomysial antibody) IgA blood test was used to detect antibodies that attack one’s own tissue. When the EMA-IgA is positive, it is likely that the patient has celiac disease, and should undergo an endoscopy for confirmation of the disease. Out of the initial 3,031 individuals who volunteered, the authors found 40 individuals who were eligible for diet testing based on criteria met (age and no clinical symptoms) and a positive EMA-IgA. The potential benefit of a gluten-free diet in asymptomatic individuals was gauged by comparing the results of two test groups. One group was placed on a gluten-free diet while the other had a normal gluten-containing diet. Researchers observed intestinal villi height: crypt depth ratio, objective disease scores, bone mineral density (BMD), and body mass index (BMI) before and after the experiment to evaluate the effectiveness of a gluten-free diet.

imagesAt the culmination of the experiment, researchers recorded improved serology and
mucosal morphology in individuals placed on a gluten-free diet. Although no difference was observed with regard to BMD and BMI, improvement was also noted in objective disease symptoms and quality of life scores. This study confirms that patients believed to be asymptomatic for celiac disease experienced improvement in intestinal lining and silent symptoms they otherwise were unaware of having until placed on a gluten-free diet. In addition, another study completed in 2014 notes a considerable to complete histological recovery in newly diagnosed adult patients adhering to a gluten-free diet for one year[3]. In both studies, many who chose to go on the gluten-free diet continued, showing that the benefits obtained often outweigh social, financial, or emotional costs of adhering to a strict dietary plan. Although it is clear that adopting a gluten-free diet for affected individuals is beneficial for overall intestinal health and quality of life, there are noted downsides, including inhibited social functioning and economic burden[4]. The long-term benefits of treating this autoimmune disorder, however, far outweigh short-term inconveniences.

Works Cited

[1] Thalheimer, Judith. “Silent Celiac Disease.” Today’s Dietitian Vol, 16 No. 5. P. 22. http://www.todaysdietitian.com/newarchives/050114p22.shtml

[2] Kurppa, Kallee. Paavola, Aku. Pekka, Collin, et al. “Benefits of a Gluten-free Diet for Asymptomatic Patients with Serologic Markers of Celiac Disease.” Gastroenterology 2014;147(3):610-617. http://www.medscape.com/viewarticle/841051_4

[3] Galli, G. Esposito, G. Lanher, E. et al. “Histological Recovery and Gluten-free Diet Adherence.” Aliment Pharmacol Therp. 2014; 40(6): 639-647 http://www.medscape.com/viewarticle/831284_4

[4] Lee, AR. DL, Ng. Zivin, J. Green, PH. “Economic burden of a gluten-free diet.” J Hum Nutr Diet. 2007 Oct;20(5):423-30 http://www.ncbi.nlm.nih.gov/pubmed/17845376

Gluten-Free Diet and Asymptomatic Celiac Disease