The digestive disease is being diagnosed more frequently in everyone – including the elderly, says Joseph Murray, MD, a gastroenterologist at the Mayo Clinic in Rochester, Minnesota, and author of the book Mayo Clinic Going Gluten Free: Essential Guide to Managing Celiac Disease and Other Gluten-Related Conditions. Celiac disease is an autoimmune condition that tends to run in families. People with celiac can’t tolerate gluten, a protein found in wheat, barley, and rye, according to the National Institutes of Health (NIH). In these people, gluten damages the part of the small intestine that helps absorb nutrients. Signs and symptoms may include pain, diarrhea, malnutrition, anemia, and osteoporosis, the NIH says. In older people, cognitive impairment can also be a symptom, Dr. Murray says.
Celiac Later in Life
Research published in the Annals of Medicine in 2010 found that celiac disease rates rose as people aged. Researchers analyzed stored blood samples from more than 3,500 people that had been taken in 1974 and then again in 1989. In 1974, one in 501 people showed blood markers for celiac disease. Fifteen years later, that number soared to one in 219. Alessio Fasano, MD, one of the researchers who led the study, says the sense among experts is that this trend continues today. “In doing these studies, we found that people can eat gluten for many, many years and not get sick. All of a sudden, they lose this capability,” says Dr. Fasano, director of the Center for Celiac Research at Massachusetts General Hospital in Boston and co-author of the book Gluten Freedom. So why would a person develop celiac disease after testing negative years earlier? Fasano believes a change in the composition of the intestinal bacteria in people who are genetically predisposed to celiac could trigger the autoimmune response, and “this is probably driving this epidemic.” Surgery, antibiotics, an infection, or stress – like the death of a spouse – can change the bacterial composition, he says. Murray believes simply getting older may play a role in developing celiac disease later in life. “Our immune system is aged when we turn 40, and autoimmune diseases seem to become more common as we get older,” he says. Few people with celiac disease are diagnosed correctly, Murray says. In seniors, he adds, celiac is often misdiagnosed as another gastrointestinal problem common in the elderly. But testing that can reliably diagnose celiac disease does exist. Doctors test the blood for certain antibodies, substances that appear if the immune system is reacting badly to gluten, according to the University of Chicago Celiac Disease Center. If the test is positive, doctors confirm the diagnosis by taking a small sample, or biopsy, of the small intestine to check for damage. If you suspect you have celiac, don’t cut out gluten from your diet before testing, Murray warns, or you’ll get inaccurate results.
Going Gluten-Free in Your Golden Years
Removing gluten from your diet is the only treatment for celiac right now, says Fasano. This prevents further damage to your intestine and gives it a chance to heal. Embracing a new diet in your golden years isn’t easy, though, so once you’re diagnosed, Fasano says that meeting with a registered dietitian knowledgeable about celiac is a must. Rachel Begun, MS, RD, a celiac patient and gluten-free-diet expert in Boulder, Colorado, says a dietitian can “help you learn how to read food labels on packaged foods, teach you how to avoid gluten while eating out, and help tailor a dietary plan that meets your specific nutritional needs." Her advice is to choose naturally gluten-free foods like fruits and vegetables; lean meats, poultry, and fish; plant-based proteins like beans, nuts, and seeds; and whole gluten-free grains like millet.
The Future of Celiac Treatment
Clinical trials now under way are looking at different treatments to make gluten less harmful to people with celiac. One drug involves two manmade enzymes that would digest gluten before the body could react to it. Another being developed in Europe, Murray says, would bind gluten in the gut so that the body would get rid of it in a bowel movement. Unfortunately these treatments are years from becoming available and would not “be a passport to eating gluten with impunity,” he cautions. Still, there may be a game-changer down the road. Scientists are working on a vaccine that could make a person fully resistant to the effects of gluten. If it works, Murray says, “that could be a home run."
