During the German occupation of the Netherlands in World War ll, massive starvation took place, resulting in an estimated 22,000 deaths. Paradoxically one group of people with intestinal problems improved. Dutch physician Willem Dicke attributed their improvement to the lack of gluten, which is found in wheat. Since there was a shortage of bread, these patients got better.
As a result of this dreadful famine, understanding of celiac disease occurred worldwide.
Once considered a childhood malady, today celiac disease is being diagnosed in seniors with increasing frequency. According to the National Library of Medicine, in 1960 only 4 percent of newly diagnosed celiac disease patients were over 60 years old. Recent studies suggest that a substantial portion of patients are now being diagnosed after the age of 50. In fact, studies show that up to 34 percent of new cases are being diagnosed in the 50-plus age group.
The diagnosis is more challenging in older adults since the only gastrointestinal symptoms may be abdominal bloating or flatulence. But making the diagnosis is crucial because celiac disease greatly increases the risk of intestinal malignancies such as lymphoma or adenocarcinoma.
Primarily a digestive disorder, celiac disease is caused by an immune reaction to gluten, which in turn damages the lining of the small intestine. This leads to malabsorption or difficulty absorbing nutrients. Gluten is found in wheat, barley and rye, and also can be found in some medicines, beer, vitamins and ice creams.
Celiac disease tends to run in families but can occur in anyone of any age or race. In the United States approximately 1 in 100 are afflicted, but this is an estimate because most people are undiagnosed. Celiac disease is more common in females and in those who suffer from other autoimmune diseases such as lupus, rheumatoid arthritis, thyroid disease or Type I diabetes.
Although celiac disease mainly affects the digestive system, it can also affect other parts of the body, resulting in different symptoms. Children may have persistent diarrhea and abdominal bloating, delayed puberty, small stature and enamel defects in their teeth. Adults tend to have more systemic symptoms such as iron deficiency anemia, arthritis, osteoporosis, fatigue, peripheral neuropathy (numbness and tingling in hands or feet) and canker sores in the mouth.
If a patient has an abnormal blood test result, it’s important that the diagnosis be confirmed with an upper endoscopy and intestinal biopsy. I recall evaluating one patient who experienced a false positive with an abnormal blood test, but a follow-up intestinal biopsy confirmed that he did not have the disease. There are other conditions that can mimic celiac disease, which is why it’s important to have thorough physical and blood tests for a proper diagnosis.
Patients with celiac disease benefit from a gluten-free diet. Symptoms usually improve within a few days. Permanently excluding gluten allows the intestine to heal and improves absorption of nutrients. Unlike people with lactose tolerance who can take effective enzyme supplements, gluten enzyme supplements don’t work, so save your money.
Bear in mind, it’s not easy maintaining a totally gluten-free diet. There are products with gluten that you may not consider, such as cosmetics, toothpaste and mouthwash, and even the glue on envelopes.
If you have undiagnosed digestive symptoms or other chronic symptoms, ask your doctor for a physical and blood test before attempting to eliminate gluten, otherwise, your results may be inaccurate.
Fortunately, celiac disease is treatable with a modified diet. Not only do adults with celiac disease feel better when they avoid gluten, but by doing so they also improve their risk of developing a gastrointestinal malignancy. Even without a medical diagnosis of celiac disease, sometimes people choose to avoid gluten simply because it makes them feel better.
Dr. Jerry Saliman is a volunteer internist at Samaritan House Medical Clinic in San Mateo and a contributing medical blogger for the Peninsula Jewish JCC in Foster City. He retired from Kaiser South San Francisco after a 30-year career.