Celiac disease was once believed to only affect younger individuals - it was thought to be unlikely that the elderly could become newly diagnosed celiac patients. However, more and more seniors are being diagnosed with celiac disease. The effects of celiac disease can be dangerous in seniors, so it’s important to become educated in celiac and gluten so you can properly adjust your care. Before participating in the following however, be sure to consult with your client’s doctor.
What Is Celiac Disease?
According to the Celiac Disease Foundation, celiac disease is a serious autoimmune disorder in which the ingestion of gluten damages the small intestine. More specifically, “when people with celiac disease eat gluten (a protein found in wheat, rye and barley), their body mounts an immune response that attacks the small intestine.” About three million Americans suffer from celiac.
As previously stated, it was initially thought that this disease only affects younger individuals. However, according to the U.S. Department of Health and Human Services, “Epidemiologic studies have suggested that a substantial portion of patients are diagnosed after the age of 50”. For example, a study conducted in 1960 found that “...only 4% of newly diagnosed celiac disease patients were over 60 years of age.” However, more recent studies have discovered that as many as 34% of newly diagnosed celiac patients are over the age of 60. Despite this, a large amount of elderly celiac patients remain undiagnosed as the symptoms are similar to other diseases, such as irritable bowel syndrome (IBS). Specifically, a survey of elderly celiac patients found that a large number of these patients were wrongly diagnosed with IBS, “...leading to an average delay of 17 years in the [celiac disease] diagnosis.”
There is currently no cure for celiac disease other than eating a gluten-free diet. This involves avoiding foods such as bread, pasta, and beer, and instead eating their gluten-free substitutes. Gluten-free options are available in most grocery stores and many restaurants. In addition, avoid cross contamination with gluten. Small traces of gluten on cooking surfaces can still damage the small intestine. In this regard, avoid cooking gluten-free foods on the same surfaces as foods with wheat, barley, or rye, unless the surfaces have been fully cleaned. Keep in mind that crumbs containing gluten found in toasters and microwaves can also damage the small intestine. Keep these kitchen electronics clean.
Symptoms of Celiac Disease
Because celiac disease is a serious autoimmune disorder, its symptoms can be dangerous in seniors. If your client hasn’t been diagnosed with celiac but has all (or some) of the following symptoms, notify their doctor and suggest testing for the disease. It should also be noted that not all celiac patients experience every one of these symptoms.
- According to the U.S. Department of Health and Human Services, “anemia is present in 60-80% of elderly patients with celiac disease” due to the lack of iron. Therefore, it’s important to make sure your client is getting enough iron in their diet. Iron is found in lots of gluten-free foods, particularly in dark, leafy vegetables such as spinach and kale. Consult with your client’s doctor if they have anemia.
- Abdominal symptoms. These include:
- Abdominal discomfort
- Deficiencies in calcium and vitamin D
- These deficiencies can be especially dangerous in seniors as they can lead to decreased bone mass
- Dermatitis herpetiformis (DH) 
- Also known as Duhring’s disease, this skin condition is caused by the ingestion of gluten and causes bumps and blisters on the skin. DH affects about 25% of celiac patients.
- Autoimmune thyroid disorders
- Autoimmune thyroid disorders “...are the most common associated autoimmune diseases in elderly celiac patients.” The most common autoimmune thyroid disorder in these patients is hypothyroidism.
Examples of Gluten-Free Foods and How To Identify Them
A gluten-free diet may seem strict and intimidating at first, but there are plenty of foods that are naturally gluten-free as well as gluten-free alternatives. To identify these foods, read the ingredients list on the packaging. Look for ingredients such as wheat, barley, rye, or gluten and if the allergen information states that the food contains the above ingredients. If any of these items are present, the food is not gluten-free and should be avoided. Some examples of gluten-free foods include:
- This includes rice noodles, rice cakes, rice crackers, and rice flour
- Fruits and vegetables
- Gluten-free bread, pasta, and flour
- There are lots of gluten-free alternatives to foods that contain gluten, such as bread and pasta. Gluten-free versions of these foods are usually made with rice or corn flour and can be found in most grocery stores. Be sure to check the freezer aisle for gluten-free bread as many need to be frozen due to the lack of gluten.
- Such as beans and chickpeas
- Corn products. These include:
- Corn tortillas
- Corn flour
- Be careful when purchasing oatmeal and check the ingredients. Some brands roll their oats in flour to prevent them from sticking and thus, the oatmeal isn’t gluten-free
- Tamari soy sauce 
- Tamari soy sauce is different than than standard soy sauce as it does not contain gluten. Typical soy sauce does contain gluten, so tamari is a great alternative as it tastes the same and will not cause any intestine damage.
- Most grains are gluten free. Again, check the label before purchasing. Gluten-free grains include:
- Rice (see above)
- Gluten-free oats
- Including nut flours like almond flour
Before purchasing these gluten-free foods, it’s still important to double check the ingredients as some foods may contain “sneaky” forms of gluten. For a full list of gluten-free foods, click here. For a list of some gluten-free recipes, click here.