National Celiac Disease Awareness Day recognizes and supports the three million Americans living with this subtle auto-immune disease. Celiac disease is an immune response to eating gluten, a protein found in barley, rye and wheat. It has no cure. The only therapy is adhering strictly to a gluten-free diet. Caregivers in San Diego should know that though seniors make up a quarter of all new celiac diagnoses, the symptoms in many adults are often dismissed as the normal signs of aging. Celiacs live in a state of chronic inflammation which increases the risk of fatal heart disease and other auto-immune conditions. If you’re receiving or giving home care in San Diego, recognizing unaddressed celiac disease in seniors is crucial to quality of life and heart health.
Most of us associate celiac disease with the “I’m gluten-free” diet craze that blew up about ten years ago, filling restaurants with people who insisted they were allergic to gluten. Since most of those people moved on to paleo, and now keto, we’ve assumed ‘eating gluten-free’ was a fad. For a full one percent of the population, though, keeping to a strictly gluten-free diet is anything but a whim. For a celiac, eating gluten triggers an immune response in their small intestine, damaging the little villi that line it (think little fingers that move the food along.) The constant assault of a diet full of gluten eventually damages these villi beyond repair, which means the nutrients in food don’t get absorbed into the body.
This malabsorption explains the most common symptoms of celiac disease: diarrhea or constipation, fatigue, bloating and gas, nausea and vomiting, and weight loss or gain. These symptoms are dramatic in infants and children, and prompt testing and diagnosis quickly. Adults, especially seniors, can go years before a proper diagnosis because the symptoms can be more subtle and more easily dismissed as something else. Severe headaches, and migraine, are often the first symptom that adult celiac patients report, but testing for celiac disease isn’t the obvious next step. Companion caregivers can help seniors in home care in San Diego address fatigue, weight loss or other symptoms, but the lack of a formal diagnosis has more serious consequences.
As Celiac.org says, “While celiac disease was previously thought to be a rare condition primarily affecting children and young adults, it is now known to be one of the most common genetic autoimmune diseases worldwide, and it can present at any age. Collin et al. report that about 25% of all celiac disease diagnoses are now made in persons aged 60 or above, and approximately 60% of cases in older adults remain undetected due to vague or non-classical symptoms obscuring the diagnosis.” In addition to the common symptoms listed above, the Mayo Clinic says that adults can also experience seemingly unrelated symptoms such as:
- “Anemia, usually from iron deficiency
- Loss of bone density (osteoporosis) or softening of bone (osteomalacia)
- Itchy, blistery skin rash (dermatitis herpetiformis)
- Mouth ulcers
- Headaches and fatigue
- Nervous system injury, including numbness and tingling in the feet and hands, possible problems with balance, and cognitive impairment
- Joint pain
- Reduced functioning of the spleen (hyposplenism)”
If you’re a home care companion for a senior, then you should watch for these symptoms as well as the traditional ones. Further, celiac disease is genetic and commonly associated with other conditions. The elderly in home care who have Type 1 diabetes, autoimmune thyroid disease, microscopic colitis, Addison’s disease, Down or Turner syndrome or a relative with celiac disease or dermatitis herpetiformis should be alert to the possibility of celiac disease.
Senior celiac patients often experience constipation and obesity, are more likely to test negative on the celiac diagnostic blood test and have lower levels of tissue transglutaminase antibodies (a diagnostic marker for celiac disease). This explains why up to 60% of cases in seniors are undetected. The risk to the senior heart is high: celiacs have an increased risk of dying from heart disease, though they don’t have the typical risk factors. Celiacs develop coronary heart disease and atrial fibrillation at nearly double the rate of the general population, presumably because the state of constant, chronic inflammation caused by their triggered immune systems also affects the heart.
A celiac disease diagnosis for an adult over 65 often leads to an improvement in quality of life, as symptoms and discomfort assumed to be just a part of aging can be addressed with a change in diet. Seniors can work with their in home care agency in San Diego to go gluten-free, and Celiac.Org offers this senior meal plan as a start. Or, find a dietician through the Academy of Nutrition and Dietetics: www.eatright.org. And newly diagnosed celiacs are urged to find support in their local communities or online through the Celiac Disease Foundation, Celiac Sprue Association, and Gluten Intolerance Group.