Celiac Disease: What You Need to Know

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Cases of celiac disease are on the rise — especially in older adults. Find out what symptoms your doctor could be overlooking

Imagine a common protein that can make you sick — really sick.

For people who suffer from celiac disease, the body’s inability to tolerate gluten can cause problems ranging from persistent tummy troubles and fatigue to malnutrition, bone loss and an increased risk for certain cancers. Once thought to be a rare disease that shows up in children, celiac disease is on the rise — and it’s showing up more often in older adults.

This medical condition, also known as gluten intolerance or gluten-sensitive enteropathy, is an autoimmune condition where the body’s immune system reacts to gluten, a protein found in grains like wheat, barley, rye and spelt. The result? Damage to the intestinal villi — the tiny, finger-shaped structures that line the small bowel — that makes it difficult for the body to absorb essential nutrients like iron, calcium, vitamin D and protein. It’s not an allergy or intolerance to wheat, but rather a component of the grain.

Over time, the accumulating damage can result in malnutrition, bone loss, infertility, miscarriages and an increased risk for lymphoma and gastrointestinal cancers. Even more troublesome is the fact that celiac disease keeps company with other chronic conditions like rheumatoid arthritis, type 1 diabetes, lupus, Down syndrome and thyroid disease.

Research in the past few years has been challenging what we thought we knew about the condition. A study conducted at the University of Maryland School of Medicine Center for Celiac Research, recently published in the Annals of Medicine, revealed two interesting trends:

First, celiac disease is more common than we think. Blood tests from over 3500 participants revealed that the number of people with blood markers for celiac disease roughly doubled every 15 years — from 1 in 501 people in 1974 to 1 in 219 by 1984 and finally 1 in 133 in 2003.

Second, you’re never too old to develop celiac disease. As the study’s participants aged, the incidence of celiac disease increased. While the numbers were relatively small, the findings supported previous studies — including research out of Finland that reported that seniors were two and a half times more likely to have celiac disease than the general population.

Another thing experts are questioning is the cause. There is a genetic connection — roughly one in 10 people with celiac disease have a close relative who has the disease. However, there’s more to the story: Some people the gene but never develop the disease, and doctors don’t know exactly why some patients develop it well into adulthood. Current thinking is that environmental factors also play a role in triggering the disease, though it’s going to take a lot more research to find a connection and a cause. Some possible catalysts include surgery, emotional stress, infections or pregnancy.

Another possibility is that the microbes that live in our gut change as we age, which could affect our tolerance for gluten. Armed with this information, future research can focus on preventing celiac disease and other autoimmune disorders, not just treating them.

What’s the bottom line? Experts warn that patients and doctors alike should be on the look out for celiac disease, especially as we age.

NEXT: The Symptoms 

The symptoms

Could you or someone you know be unknowingly suffering from celiac disease? The symptoms and severity vary from person to person, but can include:

– Digestive issues including bloating, gas, indigestion, nausea, constipation and recurring diarrhea.

– Signs of malabsorption. Many people with celiac disease have deficiencies of iron (anemia) as well as vitamins A, D, E, K, B12 and folate. Many people with celiac disease are also lactose intolerant because the intestinal damage affects their ability to break down lactase, a naturally occurring sugar found in dairy products.

– Extreme weakness and fatigue.

– Unexplained weight loss.

– Bone or joint pain.

– Easy bruising or abnormal bleeding.

– Ulcers or canker sores in the mouth.

– Migraine headaches.

– Fluid retention, particularly swelling in the ankles or hands.

– Infertility (which occurs in both men and women).

– Menstrual irregularities.

– Depression.

– Unexplained neurological symptoms like loss of balance and numbness or tingling in the extremities.

– An itchy rash or blisters on the skin (a condition known as dermatitis herpetiformis).

Again, this list is a pretty broad one — some people only experience one or two symptoms, and not everyone experiences gastrointestinal issues.

Getting the right diagnosis

We bet you’ve noticed that these symptoms can also indicate other common health conditions, which is why diagnosis can be tricky. Celiac disease is often misdiagnosed as conditions like irritable bowl syndrome, chronic fatigue syndrome or diverticulitis.

So what’s a patient to do? Talk to your doctor if you suspect celiac disease could be the cause. The challenge isn’t the lack of reliable ways to diagnose the disease — it’s a lack of awareness.

The first step is to take a blood test — specifically the IgA anti-transglutaminase antibody test (tTG) and the IgA anti-endomysial antibody test (EMA). This doesn’t necessarily have to involve your doctor. There is a home test kit on the market that measures tTG antibodies in the blood with a pinprick on the finger and ten minutes of your time. While the kit has been approved by Health Canada, it’s not perfect and it’s not meant for self-diagnosis. Experts warn if you get a positive result, talk to your doctor before you do anything else.

However, blood tests alone can’t provide a definitive diagnosis, so doctors usually order a biopsy of the small intestine (the procedure considered the “golden standard” for celiac disease diagnosis). Don’t worry, it’s not major surgery — it’s often performed under sedation and on an outpatient basis.

Of course, there is one catch: if you suspect gluten is the culprit, do not change your diet until you have a diagnosis. Dropping gluten from the menu means test results could show a false negative — plus you’ll need an accurate baseline for follow-up tests to monitor the condition.

NEXT: Living well with celiac disease

Living well with celiac disease

Right now, the only treatment available for celiac disease is to follow a gluten-free diet. The good news is that some people begin to see relief within days of starting the diet — but it is a lifetime commitment. The intestinal damage will heal, but the intolerance never goes away.

Living gluten-free means avoiding the obvious culprits like certain grains and all products containing gluten. That last part is harder than it sounds because gluten can show up where you don’t expect it, like in sauces, candy, processed meats, some medications and supplements, malt vinegar and beer. Careful label reading is a must, as is consultation with a dietician to help create a balanced diet.

While the gluten-free diet is challenging and expensive, there are more resources and better awareness than ever before. More gluten-free products are available, even in mainstream stores, and better efforts are made to ensure accurate labeling. There are even gluten-free restaurants and bakeries popping up across the globe. Gluten-free food bloggers and cookbooks also make it easier to prepare tasty meals and baked goods (many of which will fool non-celiacs too).

Need a little inspiration? Here are some recipes to get you started:

Brown Rice Cuban Burgers
Stuffed Portabella Pizza
Pear Quinoa Breakfast Bowl
Maple Walnut Rice Cakes
Main Dish Cherry Quinoa