New research from Sweden suggests that people who are gluten intolerant have a greatly increased risk of developing active tuberculosis (TB) infection.

Reporting online in the journal Thorax, researchers from the Orebro University Hospital in Sweden compared 14,335 people with gluten intolerance with 70,000 people without the condition. They concluded that people diagnosed with coeliac disease in adulthood had nearly four times the risk of active TB infection in both sexes, while those diagnosed as children had triple the risk.

The link between TB and gluten intolerance was not influenced by the levels of poverty or deprivation with which TB is normally associated. Instead, it is suggested that the findings may be explained by poor intake of vitamin D and calcium in people with gluten intolerance, as a result of both intestinal malabsorption and the nutritional deficiencies associated with a gluten-free diet.

This demonstrates the importance for anyone diagnosed with coeliac disease of ensuring that, whilst avoiding gluten, they maintain optimal levels of all essential nutrients, especially vitamin D, which is essential for an effective immune response against the TB infection.

Conversely, anyone who has TB should be investigated for coeliac disease, because it is possible that gluten intolerance may complicate existing TB or even increase the severity of the disease, and this study found that a prior diagnosis of TB more than doubled the risk of later developing coeliac disease.

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