Silent Celiac Disease

You were screened because a family member has celiac. Or your doctor ran tests for another reason. The blood tests came back positive. The biopsy showed intestinal damage.

But you feel fine. You don’t have symptoms.

Welcome to silent celiac disease.

What Silent Celiac Means

Silent (or asymptomatic) celiac disease is:

• Positive celiac serology (blood tests)
• Positive intestinal biopsy showing villous atrophy
• Absence of obvious symptoms

The disease is there. The damage is happening. You just don’t feel it, or don’t recognize what you’re feeling.

How Common Is It?

Estimates vary, but:

• 20-40% of celiacs may be “silent” at diagnosis
• Some studies suggest even higher rates
• Many “silent” patients do have subtle symptoms they didn’t recognize

Silent celiac is not rare. It’s a significant portion of the celiac population.

Why You Don’t Feel Symptoms

Gradual Adaptation

If you’ve had celiac for years without knowing:

• Your body adapted slowly
• Your “normal” includes symptoms you don’t register as symptoms
• You don’t know what feeling good actually feels like

Symptoms You’re Missing

Silent celiacs often discover symptoms after going GF:

• “I didn’t realize how tired I was until I had energy”
• “I thought everyone felt bloated after eating”
• “I assumed brain fog was just aging”

What feels normal isn’t always healthy.

Variable Disease Expression

Celiac affects people differently:

• Some have severe GI symptoms
• Some have non-GI symptoms only
• Some have minimal obvious symptoms
• The intestinal damage is present regardless

Why the Diet Still Matters

The Damage Is Real

Even without symptoms:

• Your intestines are damaged
• You’re not absorbing nutrients properly
• Inflammation is present
• Long-term complications can develop

Silent Doesn’t Mean Harmless

Untreated silent celiac can lead to:

• Osteoporosis (from calcium malabsorption)
• Anemia
• Increased risk of other autoimmune diseases
• Potential increased cancer risk
• Fertility issues
• Neurological complications

You can feel fine and still be accumulating damage.

Symptoms May Develop Later

Many “silent” celiacs eventually develop symptoms:

• As they age
• After a trigger event
• When damage accumulates

Treatment now prevents future problems.

The Psychological Challenge

Motivation Is Harder

When you feel fine eating gluten:

• Why bother with a restrictive diet?
• What’s the payoff?
• The immediate sacrifice is obvious; the benefit is invisible

This makes compliance challenging.

”Maybe It’s Not Real”

Without symptoms, doubt creeps in:

• “Maybe the diagnosis was wrong”
• “Maybe I don’t really have it”
• “If I feel fine, is it that serious?”

The blood tests and biopsy are objective. The disease is real regardless of how you feel.

Explaining to Others

Others may not understand:

• “But you seem healthy!”
• “You don’t look sick”
• “Why can’t you just eat it if it doesn’t bother you?”

Invisible illness is hard to explain and hard for others to accommodate.

Approach to the Diet

Same Diet, Different Motivation

The diet for silent celiac is the same:

• Complete gluten elimination
• Cross-contamination prevention
• Lifelong commitment

The motivation is different:

• Not symptom relief, but prevention
• Not feeling better, but staying well
• Not immediate feedback, but long-term investment

Finding Your “Why”

Without symptoms to motivate, find other reasons:

• Lab markers normalizing
• Preventing complications
• Family members who depend on you
• Long-term health goals
• Principle (knowing you’re doing the right thing)

Tracking Progress

When you can’t feel improvement, track measurably:

• Antibody levels decreasing
• Any subtle improvements (energy, focus, skin)
• Bone density improvement
• Overall health markers

These objective measures replace subjective feelings.

What to Watch For

New Symptoms

If you later develop symptoms:

• May indicate gluten exposure you’re not aware of
• May indicate complications
• Worth investigating with your doctor

The “Better Than Expected” Effect

Many silent celiacs discover they feel better GF:

• Improvements they didn’t expect
• “Normal” they didn’t know they were missing
• Subtle symptoms they’d adapted to

Pay attention in the first months.

Monitoring

Even without symptoms, regular monitoring matters:

• Antibody levels (are they normalizing?)
• Nutritional status (are deficiencies correcting?)
• Bone density (especially important)
• General health

Long-Term Compliance

Silent celiac makes compliance hardest. Strategies:

Focus on the Science

When feelings don’t guide you, knowledge does:

• Understand the pathophysiology
• Know what damage looks like
• Understand why treatment matters

Regular Monitoring

Seeing antibody levels normalize provides feedback that feelings don’t.

Community

Connect with other celiacs:

• They understand dietary vigilance
• They can help you stay committed
• You’re not alone

Medical Partnership

Regular doctor visits keep you accountable and remind you the diagnosis is real.

A Prayer for the Silent Celiac

Lord, I carry something I can’t feel.

Help me treat what I can’t sense. Help me prevent what I can’t predict. Help me stay committed when the reasons feel abstract.

Give me discipline born of wisdom, not just of suffering. Help me care for this body even when it doesn’t cry out.

And if symptoms come, or if they don’t, help me do what’s right regardless.

Amen.

The Bottom Line

Silent celiac is real celiac. The absence of symptoms doesn’t mean the absence of disease.

The diet is the treatment. The commitment is the same. The stakes are equally high.

Your body is being damaged even if it’s not telling you. Listen to the science instead. Treat what you know is there.

The silence doesn’t mean safety. It means you need to be your own advocate without your body’s warning system to guide you.