The risks of gluten allergies have been underestimated, according to a study published Tuesday which found increased mortality rates among people with celiac disease.
Celiac disease is triggered by exposure to gluten, a protein found in wheat, rye and barley.
Found in about one percent of the Western population, it damages the small intestines and interferes with the absorption of nutrients from food.
People with celiac disease often also have other diseases which attack the immune system such as diabetes or arthritis.
However, celiac disease often goes undiagnosed until substantial damage has been done to the digestive system.
Using data taken from biopsies taken between July 1969 and February 2008 in Sweden, researchers were able to examine the overall risk of death in individuals with celiac disease and digestive inflammation and compare it to the general population.
They found the risk of death was "modestly increased."
Patients with inflammation had a 72 percent increased risk of death; patients with celiac disease had a 39 percent increased risk; and patients with latent celiac disease had a 35 percent increased risk of death.
Lead author Jonas Ludvigsson of the Orebro University Hospital concluded that there could be several explanations for the increased mortality risks.
"Malnutrition of energy and vitamins and chronic inflammation may increase the risk of death," he wrote, noting that even patients who maintain gluten-free diets have persisting lesions.
Those with inflammation who had not been diagnosed with celiac disease may have an overall worse prognosis because institution of a gluten-free diet often leads to normalization, the authors concluded.
"Until recently, gluten sensitivity has received little attention in the traditional medical literature, although there is increasing evidence for its presence in patients with various neurological disorders and psychiatric problems," Peter Green of Columbia University College of Physicians and Surgeons wrote in an accompanying editorial.
"The study by Ludvigsson and colleagues reinforces the importance of celiac disease as a diagnosis that should be sought by physicians. It also suggests that more attention should be given to the lesser degrees of intestinal inflammation and gluten sensitivity."
The risk of death was highest in the first year of follow-up but decreased with age at diagnosis, with risk being higher for those diagnosed before age 20.
The study was published in the Journal of the American Medical Association.