Older than 65?
You should know about celiac disease in the aging population
In recent years, celiac disease has gone from a relatively unknown condition to a highly discussed topic with extensive media exposure, celiac-friendly recipes, and a designated gluten-free space on the menus of many popular restaurants. Celiac disease is an autoimmune condition of the gastrointestinal tract, affecting an estimated 1 in 133 Canadians.
In those who have celiac disease, the protein gliadin, which is a component of gluten found in wheat, barley, rye, triticale, and some processed foods, triggers an unusual immune response. It leads to damage in the microscopic finger-like projections (villi) that line the inner wall of the small intestine, which reduces its ability to absorb valuable nutrients from food. Common celiac disease symptoms include iron deficiency, diarrhea, changes in weight, fatigue, breathlessness, cramps, bloating, irritability, and skin conditions.
Typically, a physician will request a blood test and, if the test is indicative of celiac disease, will then conduct a scoping procedure to obtain a biopsy of tissue from the small intestine. This remains the gold standard procedure to confirm diagnosis.
Currently, the only treatment for those diagnosed with celiac disease is a completely gluten-free diet. It is also important that patients avoid gluten contamination in their food and personal items, as well as avoiding cross-contamination from others who consume or use products containing gluten.
It is typical for celiac disease to develop at a young age, so physicians sometimes overlook the possibility that celiac disease is causing symptoms in older adults and seniors, leading to delayed treatment and prolonged suffering.
Elderly Onset Celiac Disease
In children and young adults, celiac disease is more likely to present with symptoms of anemia, failure to thrive, diarrhea, and weight loss.
For those who develop celiac disease when they are older than 65-years-of age (elderly onset celiac disease), the symptoms can be different than they are in younger populations.1 Anemia and micronutrient deficiencies are common in individuals of all ages who have untreated celiac disease, since the small intestine is unable to absorb adequate amounts of nutrients from food. Certain other symptoms, such as constipation and obesity, are common in elderly celiac patients but rare in their younger counterparts.
Symptoms are often mild for elderly patients, who might mistake them for the common signs of aging, and could fail to bring up these symptoms with their physicians and delaying diagnosis and treatment.
Celiac Disease and Cardiovascular Health
Ideally, all individuals should make cardiovascular health a priority from an early age. Older celiac disease patients are at an increased risk of heart disease, possibly because the chronic inflammation they experience (while eating gluten) contributes to fatty buildup and stress on the blood vessels that support the heart.2 A diet rich in fruits and vegetables, legumes, lean proteins such as chicken and fish, and gluten-free grains and alternatives, such as brown rice and quinoa, can help to improve both heart health and celiac disease symptoms. In elderly patients, timely diagnosis is essential. Without avoiding gluten, the damage it causes means that patients might not get the nutrients they need to protect themselves against heart disease and other age-related conditions.
Due to improved knowledge about celiac disease and its symptoms, seniors are now more likely to bring up concerns with their physicians, which may lead to faster and more accurate diagnosis. The good news is that by avoiding gluten, all associated symptoms typically resolve.
First published in the Inside Tract® newsletter issue 202 – 2017
1. Cappello M et al. Elderly Onset Celiac Disease: A Narrative Review. Clinical Medicine Insights: Gastroenterology 2016;9:41-49.
2. Libby P et al; Leducq Transatlantic Network on Atherothrombosis. Inflammation in atherosclerosis: from pathophysiology to practice. J Am Coll Cardiol. 2009;54:2129-2138.