Research has uncovered several seemingly unrelated conditions linked to celiac. Just a few years ago, doctors may have only looked for gastrointestinal symptoms to indicate potential celiac, but it’s now widely accepted that many other health conditions are related. Some are well known, such as osteoporosis and anemia. Others, such as liver disease and oral inflammation, are less likely to be connected to celiac. This review will describe some less-frequently recognized conditions, highlight recent research and discuss benefits of the gluten-free diet.
1. Nonalcoholic fatty liver disease
Nonalcoholic fatty liver disease (NAFLD) is a common form of liver disease. It is most frequently found in people who are overweight or obese and those with diabetes or high cholesterol. The liver performs many vital functions in the body, including detoxification and energy storage. It also stores fat, which, in the right amounts, isn’t a problem. When patients have too much accumulation of fat in the liver, however, NAFLD can develop. In most people, NAFLD does not present with any symptoms. But in some it can progress to more severe conditions, including fibrosis and cirrhosis.
NAFLD is also seen more frequently in patients with celiac, according to a study published in 2015. Researchers from the U.S. and Sweden found that of 26,816 celiac patients, 53 were eventually also diagnosed with NAFLD. This risk was highest in the first year after diagnosis. According to lead researcher Dr. Norelle Reilly, assistant professor of pediatrics and director of pediatric celiac disease at Columbia University Medical Center, “The rationale for exploring the risks of NAFLD in individuals with celiac disease may demonstrate unexpected or undesirable weight gain following the initiation of the gluten-free diet.” This weight gain, cautions Reilly, may increase the risk of developing NAFLD for patients with newly diagnosed celiac. Also, Reilly states that processed gluten-free food, which is often higher in fat and calories, may play a role.
Celiac link theory
Why some with celiac disease go onto develop NAFLD remains a bit of a mystery. But there is one theory, Reilly explains. “One possible route, proposed by Ludovico Abenavoli and colleagues, is that increased gut permeability, sometimes referred to as ‘leakiness,’ may be triggered by conditions associated with celiac disease, such as small intestinal bacterial overgrowth (SIBO). This can lead to exposing the liver to bacterial toxins, which can lead to injury and stress that can trigger the development of the condition.”
Most people with NAFLD are unaware they have the condition, and this is no different for those who have celiac. “NAFLD may have no symptoms, but at this point, screening is not recommended for average adults, with or without celiac disease,” says Reilly. “However, in any patient with elevated liver transaminases, NAFLD should certainly be considered among many disorders, and an appropriate evaluation is then warranted.”
Can NAFLD be prevented or treated? Because the condition is very much related to lifestyle choices, healthy eating can go a long way. “Maintaining a healthy diet and body weight with plenty of (gluten-free) whole grains, fruits and vegetables is associated with many health benefits, not just related to NAFLD,” advises Reilly. “Following regularly with a registered dietitian is recommended for all with celiac disease to help in maintaining this balance. Even among those who have already developed NAFLD, the mainstay of treatment involves lifestyle modifications and weight loss in those patients who are overweight.”