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Managing Celiac Disease

Celiac disease—a chronic autoimmune disorder marked by sensitivity to a protein found in grains like wheat, rye, and barley—was once considered primarily a childhood ailment.

But these days the age of people diagnosed with celiac disease is trending upward, and researchers understand that the illness can develop anytime in life; as many as one in three new cases occur in people age 65 and older.

Celiac disease results from your body’s negative reaction to gluten. When your immune system detects gluten, it produces antibodies that damage your small intestine. This causes malabsorption, which means your body can’t get the nutrients it needs, such as iron, folate, and vitamins D and B-12, from food.

Hallmark symptoms of celiac disease are diarrhea, indigestion, abdominal pain, bloating, and weight loss. But in older adults those symptoms are often not as prominent as in younger people. Instead, celiac disease may be marked by mild or unspecific symptoms like fatigue or signs of nutritional deficiencies like anemia, decreased bone mass, and even an itchy skin rash.

Malabsorption can lead to multiple health problems—some serious—including diarrhea and other intestinal ills, weight loss, and nutritional deficiencies. A vitamin D deficiency, for example, may accelerate bone loss.

Celiac disease also makes people prone to malignancies such as lymphoma and gastrointestinal tract cancers. And the risk for these problems has been observed to increase as people reach older ages.

The good news is twofold: Older people who have gone undiagnosed for years usually have a milder form of the disease than people who develop symptoms earlier in life. Second, proper dietary management can reverse much of the disease’s damage and reduce cancer risk. Seventy percent of people who begin a management program feel improvement within just a few weeks.

What’s involved in managing celiac disease?

The answer seems simple: Eliminate gluten from your diet. But long-term control of the disease means a lifelong commitment to a strict gluten-free diet. Cutting out bread, cereals, pastas, and other products made from gluten-containing grain isn’t enough. You must avoid products prepared with gluten—including drugs.

One common dilemma for celiac patients is cross-contamination; either a manufacturer doesn’t report using the same equipment for both wheat and a “supposed" gluten-free product or a restaurant’s kitchen uses the same utensils in preparing food for gluten-free and gluten-containing meals. You may unknowingly be exposed to gluten, spiking symptoms and exacerbating your illness.

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The problem is further complicated by the fact that most people have settled into comfortable eating patterns by the time they reach their 40s and 50s. Changing to a gluten-free diet requires a lot of work and effort. Education is part of the solution.

Guidelines published in 2013 from the American College of Gastroenterology emphasize working with a registered dietitian who knows about celiac disease.

Your dietitian can assess your nutritional needs and teach you how to develop a plan for gluten-free, nutritious—and possibly even delicious—foods. A trained dietitian can offer simple recipes that ensure you get a balanced diet from food and, sometimes, supplements.

Many people are surprised at how many gluten-free nutritious grains are out there: Most people can enjoy rice, wild rice, quinoa, corn, buckwheat, millet, and potato and soy flours as well as other fiber- and protein-rich foods like nuts, legumes, and beans. Your dietitian can also help you learn to read labels and show you how to recognize which gluten-free claims on product packages are legitimate.

In addition, ongoing medical care can help ensure your success. Routine exams, including annual assessment of antibody levels and intestinal damage, can spot problems early when they’re easier to correct. And working proactively with your health team to identify and treat problems such as bone loss or anemia can protect your health and prevent problems from worsening.

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