Cholesterol change in coeliac patients following gluten-free diet depends on baseline levels

Although untreated CD is usually associated with low TC levels, a subgroup of patients with non-classic presentations and without primary dyslipidemia, such as adults with hypochromic anaemia [5] or with minimal malabsorption, may display mild/moderate hypercholesterolemia at diagnosis, when a concomitant excess intake of dietary fat occurs. A strictly followed GFD implies close control of patient's eating habits with the unintentional result that, as well as reducing gut inflammation and malabsorption, a coexisting dietary imbalance may be corrected. Thus, it is likely that in newly diagnosed patients displaying overt hypocholesterolemia, the effect of GFD is to increase cholesterol level via enhanced intestinal uptake and reduced steatorrhea. However, in the subset of CD patients whose cholesterol level is increased due to unhealthy eating habits, GFD may lower it even before the effects of increased intestinal absorption become apparent. This hypothesis should be examined in a larger clinical study. We believe that the concern about increased cardiovascular risk in patients following GFD is currently overemphasized.