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    Gluten-free Diet Benefits Newly Screened Older Celiac Disease Patients


    Jefferson Adams
    Gluten-free Diet Benefits Newly Screened Older Celiac Disease Patients
    Image Caption: Photo: CC--pedrosimoes7

    Celiac.com 05/02/2012 - Doctors and researchers are still debating the usefulness of active blood screening for spotting celiac disease in older populations. Studies do suggest that many cases of celiac disease go undetected, especially in the older population. One unanswered question is whether screening does any good for older people who have been eating gluten many decades.

    Photo: CC--pedrosimoes7A team of researchers recently studied the clinical benefit of a gluten-free diet in screen-detected older celiac disease patients. The research team included Anitta Vilppula, Katri Kaukinen, Liisa Luostarinen, Ilkka Krekelä, Heikki Patrikainen, Raisa Valve, Markku Luostarinen, Kaija Laurila, Markku Mäki, and Pekka Collin.

    They are affiliated with the Department of Neurology, the Department of Internal Medicine and the Department of Surgery at Päijät-Häme Central Hospital, and the University of Helsinki's Department of Education and Development in Lahti, Finland, the Department of Gastroenterology and Alimentary Tract Surgery the School of Medicine, and the Paediatric Research Centre at the University of Tampere and Tampere University Hospital, Tampere, Finland.

    For their study, the researchers evaluated the benefit of active detection and implementation of a gluten-free diet in elder populations with for celiac disease.

    The team evaluated thirty-five biopsy-proven celiac patients over 50 years of age, each of whom had celiac disease detected by mass blood screening.

    They looked at bone mineral density, dietary compliance, disease history, quality of life, and symptoms at baseline and after 1-2 years of a gluten-free diet. They also looked at small bowel biopsy, serology, laboratory parameters assessing malabsorption, and bone mineral density.

    Using surveys, the team established gastrointestinal symptom ratings and quality of life by psychological general well-being. The used this information to rate symptoms.

    They found patient dietary compliance to be good overall.  Initial tests on the patients showed reduced serum ferritin levels, pointing to subclinical iron deficiency. This trend reversed after patients followed a gluten-free diet.

    Initially low vitamin B12, vitamin D and erythrocyte folic acid levels increased significantly on a gluten-free diet.

    Patient histories showed that those with celiac disease had sustained more low-energy fractures, and sustained such fractures more frequently than the general population. A gluten-free diet brings with it a beneficial increase in bone mineral density.

    The team also noticed that many gastrointestinal symptoms disappeared, even though though many patients reported only subtle symptoms upon diagnosis.

    Quality of life remained unchanged. According to the study team, two out of three patients would have been diagnosed even without screening if the family history, fractures or concomitant autoimmune diseases had been factored in.

    Results showed that patients who had celiac disease detected by mass blood screen did, in fact, benefit from a gluten-free diet. For doctors evaluating older patients, the team advocates a high index of suspicion and active case-finding in celiac disease as an alternative to mass screening.

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    Guest Donnie

    Posted

    Celiac disease in older people should not be ignored. Seniors are people, too, not the worthless drain on tax dollars that some would have you believe. Not giving them proper health care is inhumane, and should not be tolerated. Even the elderly deserve the good quality of life that a gluten free diet will provide, if they have Celiac, gluten intolerance, or if they need to avoid food allergens.

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    Guest Beverly

    Posted

    Celiac disease in older people should not be ignored. Seniors are people, too, not the worthless drain on tax dollars that some would have you believe. Not giving them proper health care is inhumane, and should not be tolerated. Even the elderly deserve the good quality of life that a gluten free diet will provide, if they have Celiac, gluten intolerance, or if they need to avoid food allergens.

    I agree. I was diagnosed at age 59 and was anemic, had osteoporosis, low on calcium, elevated liver enzymes and kidney issues. All were cleared up when I went gluten free and actually started absorbing my nutrients. I have always said we are what we eat, drink, and breathe, but now I know we are what we absorb also. I think many of the ailments of gluten sensitive seniors could be alleviated through accurate diagnosis and a GFD.

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    Guest Mary Louise

    Posted

    I was diagnosed after 50. It is difficult for me to believe that treating or not treating celiac in the over 50 population is even a question to waste time and resources on. I'm in the medical field and it is "studies" like this that prompt me to wonder where medicine is going in this age, where members of the older population are treated as throw aways because their "youth" is gone. Seriously!! We have so much to offer. I find this article shameful.

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    Guest Stu

    Posted

    Agreed! I was in my early 50's when I decided to try a gluten-free diet, and my state of health improved dramatically within a few weeks. Despite this, my doctor, who had been treating me for chronic bronchitis, gastritis, and a number of other symptoms, (with medicines that contained wheat starch, no less), to this day still thinks it's all in my head because he waited 3 years after the fact to test me for celiac and the results were negative, just as I told him they would be without a gluten challenge test. To say that a person with a disease should not treat it because of their age is simply antithetical - even when the doctors disagree. I, however, have become something of a cynic, and I seriously doubt our medical industry will respond in a positive manner while they're raking in billions of dollars treating the symptoms of a disease that can be easily and effectively treated and managed through diet alone.

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    Guest Cindy

    Posted

    First of all I was diagnosed at the age of 54 so do not necessarily consider myself "elderly" and yes there has certainly been a beneficial difference in my life with a gluten free diet. Second, I suspect that my mother may have had undiagnosed celiac disease as she had anemia from an unknown cause for many years and upon autopsy at her death, had severe osteoporosis. Screening for celiac disease may have picked up the reason for her anemia and certainly made a difference.

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    Guest Cindy

    Posted

    Dont ignore the over 50, I was 50 when I was diagnosed, had suffered with headaches plus other abnormalities, for 30 years! If I wouldn't have been diagnosed I would have been dead shortly after. I would of committed suicide, I couldn't stand the headaches. I am dealing with joint pain, cant get rid of that, only 54 years old. Don't Let us suffer...

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    Guest Debbie

    Posted

    Anyone who has a problem with celiac or gluten intolerance can benefit from becoming gluten free. Many symptoms of "aging" are nothing more than nutritional deficiencies which celiac definitely causes, and malabsorption also causes issues with the thyroid so most certainly seniors should be checked for celiac. Many people suffer from memory problems very similar to early Alzheimers when they are suffering from undiagnosed celiac, and those problems go away once on the gluten-free diet, so I can't help but wonder how many Alzheimer sufferers could actually benefit from becoming gluten free. Much more research into this issue needs to be done.

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    Guest Trish Llewelly

    Posted

    I have recently been diagnosed as celiac and I am 68 years old. My consultant wasn't entirely sure so he did more biopsies. I am so glad he did because 3 weeks after starting a gluten free diet I feel so much better. Thank heavens he persevered with me.

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    Guest Dee M

    Posted

    I was low on potassium and no iron age 77. Many test taken and results was need to be gluten free. Now 87 and strictly following celiac info I am doing fine. Strong heart and many other items has been helped. I believe that I was born with it as looking back I had a lot of the systems and just diagnose as a sick stomach. Test needs to be done on every one.

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    Guest anne

    Posted

    I was 75 when my doctor biopsied me and found it was celiac disease. I suffered for years and lost 49 pounds before he thought of celiac disease. I am now on a gluten-free diet and have gone from 103 to 115 lbs and am fine.

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  • About Me

    Jefferson Adams earned his B.A. and M.F.A. at Arizona State University, and has authored more than 2,000 articles on celiac disease. His coursework includes studies in biology, anatomy, medicine, and science. He previously served as Health News Examiner for Examiner.com, and provided health and medical content for Sharecare.com.

    Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of the book Dangerous Grains by James Braly, MD and Ron Hoggan, MA.

  • Popular Contributors

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    Scott Adams
    The following Medline abstract describes a unique study that was done on the quality of life of two groups of people with celiac disease: One that was diagnosed as the result of having symptoms, and the other which had little or no symptoms and whose diagnosis was reached via screen-detection. Both groups were treated for one year with a gluten-free diet, and were then studied to determine their overall response, including their psychological response. Here is the abstract:
    Eff Clin Pract 2002 May-Jun;5(3):105-13
    Mustalahti K, Lohiniemi S, Collin P, Vuolteenaho N, Laippala P, Maki M.
    Department of Pediatrics, Tampere University Hospital, Finland.
    CONTEXT: Since the advent of serologic testing for celiac disease, most persons who receive a diagnosis of celiac disease have few or no symptoms. Although pathologic changes of celiac disease resolve on a gluten-free diet, how a gluten-free diet affects the quality of life for patients with screen-detected celiac disease is unclear.
    OBJECTIVE: To evaluate the effect of a gluten-free diet on the quality of life of patients with screen-detected celiac disease.
    DESIGN: Prospective study of patients before and 1 year after initiating a gluten-free diet.
    PARTICIPANTS: 19 patients with screen-detected celiac disease (found by serologically testing first-degree relatives of celiac patients) and 21 consecutive patients with symptom-detected disease. In all cases, celiac diagnosis was confirmed by finding villous atrophy and crypt hyperplasia on small-bowel biopsy.
    INTERVENTION: Gluten-free diet (explained during a single physician visit). MAIN OUTCOME
    MEASURES: Gastrointestinal Symptoms Rating Scale (GSRS), in which scores range from 0 to 6 (higher scores represent worse symptoms); and quality of life measured with the Psychological General Well-Being Questionnaire (PGWB). Scores range from 22 to 132 (higher scores mean greater well-being).
    RESULTS: At baseline, patients with symptom-detected celiac disease had poorer quality of life and more gastrointestinal symptoms than those with screen-detected celiac disease. Reported compliance with the gluten-free diet was good. All mucosal lesions of the small bowel had resolved at the follow-up biopsy. After 1 year of following the diet, quality of life for patients with screen-detected disease significantly improved (mean PGWB score increased from 108 to 114; P
    CONCLUSIONS: Gluten-free diet was associated with improved quality of life for patients with symptom-detected celiac disease and patients with screen-detected celiac disease. Concerns about the burden of a gluten-free diet, at least over the short term, may be unfounded.
    PMID: 12088289


    Roy Jamron
    Celiac.com 07/31/2006 - A two-year study in the July 2006 Endoscopy showed older celiac patients on a gluten-free diet have an incomplete histological recovery even after two years. Only the younger patients (5 - 30 years) showed significant improvement of histology within 12 months (P < 0.034); older patients (>30 years) showed histological improvement but this was not statistically significant, even after 24 months on a gluten-free diet. This study was also previously discussed in an article by Dr. Antonio Tursi in the Spring 2006 Celiac.com Scott-Free Newsletter. This also means increased intestinal permeability and associated problems such as liver damage may continue to be a lasting problem in older patients beyond two years on a gluten-free diet. Below is the abstract:
     

    Endoscopy 2006 July; 38(7): 702-707
    Endoscopic and histological findings in the duodenum of adults with celiac disease before and after changing to a gluten-free diet: a 2-year prospective study
    Tursi, A.; Brandimarte, G.; Giorgetti, G. M.; Elisei, W.; Inchingolo, C. D.; Monardo, E.; Aiello, F.
     


    Background and study aims: Published follow-up data on small-intestinal recovery in patients with celiac disease are scarce and contradictory. This is especially the case for adult patients, who often show incomplete histological recovery after starting a gluten-free diet (GFD). We conducted a 2-year prospective study to evaluate the effectiveness of a GFD in improving the endoscopic and histological duodenal findings in adults with celiac disease.
    Patients and methods: We studied 42 consecutive adults with newly diagnosed celiac disease (13 men, 29 women; mean age 32.7 years, range 15 - 72 years). All the patients underwent esophagogastroduodenoscopy and small bowel biopsy. We devised our own grading system for the endoscopic appearance of the duodenum, which ranged from "normal" appearance to "mild", "moderate", or "severe" alterations. Small bowel biopsies were obtained from the second part of the duodenum (and from the duodenal bulb when it had a micronodular appearance). The histopathological appearances were described according to modified Marsh criteria.
    Results: A normal endoscopic appearance in the duodenum was found in 5/42 patients (11.9 %) at entry and in 32/42 patients (76.2 %) after 2 years on a GFD. Subdividing the patients according to age, patients aged from 15 years to 60 years showed significant improvement within 12 months (P < 0.0001 for patients aged from 15 years to 45 years; P < 0.003 for patients in the 46 years to 60 years group), whereas the improvement in endoscopic findings in patients older than 60 years was not statistically significant, even 24 months after starting the GFD. "Normal" histology was reported in none of the patients at entry, but in 25 patients (59.5 %) after 24 months on a GFD, but this parameter did not show a significant improvement until the patients had been on the GFD for 12 months (P < 0.0001). Only the younger patients (5 - 30 years) showed significant improvement of histology within 12 months (P < 0.034); older patients (>30 years) showed histological improvement but this was not statistically significant, even after 24 months on a GFD.
    Conclusions: This study shows for the first time that endoscopic recovery is faster than histological recovery in adults with celiac disease who go on a GFD. Moreover, older patients showed incomplete endoscopic and histological recovery even 24 months after starting a GFD. We therefore advise, as a minimum recommendation, that follow-up biopsies should be taken 1 - 2 years after starting a GFD in adults with celiac disease.

    Jefferson Adams
    Study Supports Gluten-free Diet for 'Potential' Celiac Disease Patients
    Celiac.com 12/26/2010 - Should everyone with symptoms of celiac disease go on a gluten-free diet? Current practice allows many patients with symptoms of celiac disease, but no gut damage, and thus no official diagnosis, to forgo a gluten-free diet.
    In a new study, researchers found that people with celiac disease symptoms have the same distinctive metabolic fingerprint as patients with full-blown disease, and who must follow a gluten-free diet to avoid permanent damage to the gut.
    The new study, by Ivano Bertini and colleagues, is stirring up the discussion about just which patients with symptoms of celiac disease should follow a gluten-free diet.
    Their research shows that people currently diagnosed as "potential" celiac disease patients and not advised to follow a gluten-free diet may not be "potential" patients at all.
    Celiac disease is widely regarded as undiagnosed or misdiagnosed. For their study, the researchers used magnetic resonance metabolic profiling to analyze the biochemical markers in the blood and urine of 61 patients with celiac disease, 29 with potential celiac disease, and 51 healthy people.
    The researchers found that people with unproven celiac disease largely shared the same profile as those with confirmed celiac disease and that the biochemical markers in both groups differed sharply from those of healthy individuals.
    The researchers conclude that their findings "demonstrate that metabolic alterations may precede the development of small intestinal villous atrophy and provide a further rationale for early institution of gluten-free diet in patients with potential celiac disease, as recently suggested by prospective clinical studies."
    The authors do note receiving funding from Boehringer Ingelheim Italy.
    Source:

    American Chemical Society Journal of Proteome Research

    Jefferson Adams
    Celiac.com 10/15/2014 - A team of researchers recently set out to assess the benefits of a gluten-free diet for people whose blood screens show markers for celiac disease, but who show no physical symptoms. Specifically, they investigated whether screen-detected and apparently asymptomatic adults with endomysial antibodies (EmA) benefit from a gluten-free diet.
    The research team included K. Kurppa, A. Paavola, P. Collin, H. Sievänen, K. Laurila, H. Huhtala, P. Saavalainen, M. Mäki, and K. Kaukinen. They are variously associated with the Tampere Center for Child Health Research, the Tampere School of Health Sciences of the University of Tampere and Tampere University Hospital, the Department of Gastroenterology and Alimentary Tract Surgery at Tampere University Hospital and School of Medicine, University of Tampere, the UKK Institute in Tampere, Finland, the Research Program Unit of the Immunobiology and Haartman Institute at the Department of Medical Genetics of the University of Helsinki in Helsinki, Finland, and the Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital and School of Medicine, University of Tampere, Tampere, Finland and Seinäjoki Central Hospital, Seinäjoki, Finland.
    For their study, they conducted a prospective trial of 3031 individuals at risk for celiac disease based on screens for EmA. They found 40 of 148 seropositive individuals who fulfilled inclusion criteria. They randomly assigned the 40 patients to groups receiving either a gluten-free diet, or a gluten-containing diet.
    They then evaluated ratios of small-bowel mucosal villous height:crypt depth, serology and laboratory test results, gastrointestinal symptom scores, physiologic well-being, perception of health by a visual analog scale, bone mineral density, and body composition at baseline and after 1 year. From that point on, they switched the group on the gluten-containing diet to a gluten-free diet, evaluated them a third time. Patients in the first gluten-free diet group remained on that diet.
    After 1 year on the gluten-free diet, the mean mucosal villous height:crypt depth values increased (P < .001), levels of celiac-associated antibodies decreased (P < .003), and gastrointestinal symptoms improved compared to patients on gluten-containing diets (P = .003).
    The gluten-free diet group showed less indigestion (P = .006), reflux (P = .05), and anxiety (P = .025), and better overall health, based on the visual analog scale (P = .017), compared gluten-containing diet group.
    Only social function scores improved more in the gluten-containing diet group than in the gluten-free diet group (P = .031). There were no differences between groups in terms of lab test results, bone mineral density, or body composition.
    Most measured parameters improved when patients in the gluten-containing diet group were placed on gluten-free diets.
    No subjects considered their experience to be negative and most expected to continue eating gluten-free.
    The results show that a gluten-free diet benefits asymptomatic EmA-positive patients, and show the benefits of actively screening patients at risk for celiac disease.
    Source:
    Gastroenterology. 2014 Sep;147(3):610-617.e1. doi: 10.1053/j.gastro.2014.05.003.