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Celiac Disease In The Elderly

Why It's Worth The Trouble To Put Elderly Celiacs On Gluten-Free Diets

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Updated March 08, 2009

Until the mid-1990s, few people thought celiac disease could develop in older people. Celiac disease was considered a disease of childhood. Babies had celiac disease (or celiac sprue, as it was called), and they usually outgrew it – or so people thought. Now, we know better. Celiac disease is a life-long condition. It affects people of all ages and all body shapes. The symptoms can be obvious, or subtle. Fortunately, more and more doctors are learning to add celiac disease to their list of possible reasons for patients’ symptoms.

If it was startling years ago to find that middle-aged adults could have celiac disease, it's perhaps even more surprising to learn how many elderly people are walking around with undiagnosed celiac disease. As a group of researchers in Finland said when they analyzed the rate of celiac disease among older people, “We [thought] that they would over time have developed obvious symptoms.” But in fact, only 25% of the elderly people with celiac disease in the Finnish study had symptoms, and those were mostly mild (although a few of the subjects did have intestinal lymphoma or gastric cancer, which are complications of untreated celiac disease). Furthermore, the Finnish researchers found that the prevalence of celiac disease in their elderly population was more than twice as high as in the general population.

A group of Israeli researchers has also reported on celiac disease in elderly patients. Theirs was a smaller study, involving just 7 older individuals with celiac disease, but their findings are striking. In two female patients, the symptoms of celiac disease were subtle, namely, “cognitive decline that was attributed to Alzheimer dementia but [improved] after the initiation of gluten-free diet.” A third person had a condition called peripheral neuropathy (numbness, weakness, or burning pain in the arms or legs) that disappeared after the gluten-free diet was started.

The Israeli doctors’ other elderly patients had more typical symptoms, such as weight loss, iron deficiency anemia, diarrhea, and severe early osteoporosis. Sadly, it took a median of 8 years for these patients to be diagnosed with celiac disease, and in that time one patient developed an intestinal lymphoma that ultimately proved fatal. Even so, the researchers said, in most of their elderly patients, the gluten-free diet led to “complete resolution of symptoms… and a significant weight gain.” (Doctors at the Mayo Clinic in the U.S. also wrote about older adults with celiac disease and cognitive impairment, including confusion, memory loss, and personality changes. In this report, only 3 of the doctors’ 13 patients improved or stabilized on the gluten-free diet.)

Starting An Elderly Person On A Gluten-Free Diet: Is It Worth The Trouble?

In 1994, in a medical journal called Gut, a group of British doctors wrote the following about their experience in diagnosing and treating celiac disease in 40 elderly patients:
    The value of diagnosing a condition that presents late in life with often only trivial symptoms, may be questioned especially when this entails changing long established eating habits… [But] patients often only realize how unwell they were in retrospect after commencing a gluten free diet… [Our patients] had come to accept quite marked ill health as normal. The patients in our series who started on a gluten free diet, all benefited clinically and it was possible to show improvement objectively... The ability of the elderly to manage a gluten free diet has been shown in that 38 of 40 patients who started a gluten free diet complied well and benefited clinically. In addition they maintained improvement in the hematological and biochemical indices studied. The reduction of alkaline phosphatase…is noteworthy and may offer some protection against fractures, which is a particular problem in later life.

The Bottom Line

People with undiagnosed celiac disease are at risk for very serious complications. If you or anyone in your immediate family has celiac disease, make sure the elderly people in your family are aware that they might be at risk for the disease, too, particularly if they're a first- or second-degree relative. Be prepared to help them learn how to be gluten-free. Finally, if you’re an older person and you think you might have celiac disease -- and especially if you have anemia and chronic diarrhea -- then by all means talk to your doctor about it.

Sources:

Vilppula A et al. Undetected coeliac disease in the elderly: a biopsy-proven population-based study. Digestive and Liver Diseases 2008;40:809-13.

Lurie Y et al. Celiac disease diagnosed in the elderly. Journal of Clinical Gastroenterology 2008;42:59-61

Hu WT et al. Cognitive impairment and celiac disease. Archives of Neurology 2006;63:1440-46.

Hankey GL, Holmes GK. Coeliac disease in the elderly. Gut 1994;35:65-67.

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