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Asymptomatic or Silent Celiac Disease

You May Feel Better Gluten-Free Even If You Felt Pretty Good Before

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Updated January 19, 2012

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

If you have celiac disease, you probably know it means your body reacts to the gluten protein found in the grains wheat, barley and rye by attacking the lining of your small intestine.

In some people with the condition, this results in major gastrointestinal symptoms, including diarrhea, constipation and abdominal pain. But other people with celiac disease don't notice major digestive symptoms. They may have other symptoms of celiac disease, including fatigue and neurological issues... or they may have no symptoms at all.

If you have celiac disease without noticeable symptoms, your condition is called "silent celiac disease" or sometimes "asymptomatic celiac disease." You still have the villous atrophy that defines celiac disease, and you still risk serious complications from the condition if you fail to eat gluten-free. But you don't suffer from diarrhea, constipation, or other digestive-related symptoms related to your condition.

Celiac Disease Diagnosis May Come As Shock to Those Without Diarrhea, Constipation

These days, with awareness of celiac disease growing, many more people are being diagnosed as celiac simply because they're identified through screening. When someone in your family is diagnosed with celiac, medical recommendations call for screening all close relatives, and that can pick up cases of asymptomatic celiac disease.

Other people are diagnosed with celiac disease because they have a related condition, such as thyroid disease or anemia, and their physicians refer them for celiac screening.

In many of these folks, the diagnosis comes as a surprise (or even a shock); if you don't have gastrointestinal symptoms, you're probably pretty stunned to discover you actually have a gastrointestinal condition.

Why Go Gluten-Free If Your Celiac Is Silent?

It can be tough to go and stay gluten-free if you don't notice gastrointestinal symptoms from your condition. There's no doubt that eating gluten-free can be complicated and difficult, and cheating on the gluten-free diet is pretty tempting if you don't suffer from symptoms.

However, there are two reasons to stay gluten-free even if you don't notice major symptoms from gluten ingestion.

The first is to safeguard your long-term health. Cheating on the diet can cause some pretty significant health problems, including malnutrition, infertility, osteoporosis and potentially even certain cancers.

Even cheating once or twice a month can prevent your intestines from healing and perpetuate the immune system response, so eating gluten occasionally is almost as bad as eating it constantly.

In addition, many people with celiac disease, including silent or asymptomatic celiac disease, may develop other autoimmune diseases, such as rheumatoid arthritis and psoriasis, if they continue to consume gluten. While there's little research on this, some studies suggest that a gluten-free diet might avert or treat these conditions.

Diet Leads to Improved Health In People with Silent Celiac

The second reason to stay gluten-free, even if you don't notice major symptoms from gluten ingestion, is that you might actually feel better. Really.

As a so-called "silent celiac," you shouldn't assume that you won't notice improved health once you adopt a strict gluten-free diet. In fact, recent research indicates the opposite: People with silent celiac disease who follow the gluten-free diet actually do report improved health.

In a study reported at the 2011 Digestive Diseases Week conference, a Finnish research team looked at 40 subjects who had no gastrointestinal symptoms but who tested positive for celiac disease on the very specific EMA-IgA celiac disease blood test. All also had some intestinal damage.

The researchers split the group in two, assigning half of the patients to a gluten-free diet and the other half to a regular, gluten-containing diet. They then tracked them for a year through surveys designed to evaluate both gastrointestinal symptoms and health-related quality of life.

The study found that survey scores -- both in symptoms and quality of life -- improved in the group following the gluten-free diet, while scores stayed the same in the group on the regular diet. In addition, levels of folic acid and vitamin B12 improved in the gluten-free group, but stayed the same in the regular diet group.

Even though the group following the gluten-free diet hadn't noticed symptoms before, they reported seeing some minor symptoms -- including reflux, bloating, abdominal distention and flatulence -- clear up when eating gluten-free.

The researchers also performed repeat biopsies in both groups, and noted improvements in intestinal damage in the group eating gluten-free.

Most View Diagnosis Positively, Plan To Stay Gluten-Free

After one year of the study, the researchers switched the gluten-eating group to the gluten-free diet. Once everyone in the study had eaten gluten-free for a full year, they polled the study subjects.

The results? A full 85% said they'd continue eating gluten-free, and 58% viewed their celiac screening and subsequent diagnosis as "positive" or even "very positive."

So even if you're a true silent celiac and have no real symptoms, especially gastrointestinal symptoms, you may still notice health benefits, and maybe even see a few minor complaints clear up, after going gluten-free. In addition, you may possibly save yourself from additional health problems down the road by sticking to the gluten-free diet.

Sources:

K. Kaukinen et al. Should screen-detected and asymptomatic celiac disease patients be treated? A prospective and randomized trial. Digestive Diseases Week 2011, Abstract #620.

A. Tursi et al. Prevalence of celiac disease and symptoms in relatives of patients with celiac disease. European Review for Medical and Pharmacological Sciences. 2010 June; 14(6): 567-72.

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