Celiac disease sometimes becomes active for the first time in older adults after surgery, viral infection, or severe emotional distress. Symptoms vary, but they tend to be related to how much the intestine is inflamed. Because the most common symptoms involve the digestive system (abdominal pain, bloating, gas, and diarrhea) celiac disease can be confused with conditions like irritable bowel syndrome, Crohn’s disease, diverticulitis, or intestinal infections.

“Older adults may have no gastric symptoms of celiac disease. Often they have vague symptoms like fatigue, unexplained weight loss, bone and joint pain, or signs of nerve damage like dementia,” Murray says. “Sometimes the only symptom is the diagnosis of a related condition like osteoporosis or anemia.” Patrick Roney, M.D., an Erickson Health physician at Wind Crest, an  Erickson-built and -managed community in Highlands Ranch, Colo., says, “What may not affect a younger person as much may have a more profound effect on an older adult. The malnutrition that happens with celiac disease can worsen already existing conditions like diabetes.”

“Finding out if you have celiac disease is especially important if you have other conditions like diabetes or osteoporosis. Your other medical problems may improve once you remove the gluten from your diet,” Roney says.

“Anyone who thinks they have a problem eating wheat needs to be tested for celiac disease before they decide to remove it from their diet,” Murray adds. Your doctor can test for celiac disease with a blood test and/or an intestinal biopsy.

Celiac disease versus gluten intolerance
Some older adults may be intolerant or sensitive to gluten but not have celiac disease. “Gluten intolerances vary from people who have fullblown celiac disease with intestinal damage to those who just feel poorly when they eat wheat products,” Murray says. “There are also those that have true allergies to wheat—they get symptoms like hives, eczema, mouth tingling, or tongue swelling, but that’s fairly rare.”

“Gluten intolerances exist more than we think. Older adults may become sensitive to some gluten-containing foods but not others,” Roney says.

“Some people may only notice symptoms at certain times—for example, if they eat wheat on an empty stomach, like a bagel first thing in the morning. They may have no trouble if they eat wheat later in the day,” say Doris Henning, a registered dietitian with Erickson Health.

Living gluten-free
The only treatment for celiac disease is a lifelong adherence to a gluten-free diet. Those trying to avoid gluten should look for products made with gluten-free grains. Refer to the chart above for some guidelines.

Often, it’s not easy to detect the presence of wheat or gluten in many foods. “Many prepared foods and multiple-ingredient products, like seasonings, contain wheat and gluten-derived ingredients such as modified food starch, hydrolyzed vegetable protein, or dextrin,” Henning says.

“Take more control of what you eat when you have celiac disease or gluten  intolerance,” Henning says. “Stick to natural, fresh products you prepare yourself. If you’re going to a restaurant, contact them first—frequently they can prepare something ahead of time or give you a list of gluten-free menu items. You can even prepare your own seasonings to add to dishes.”

The oat debate
Oats may cause problems for some people with celiac disease.

“While most studies have suggested pure oats are safe for many people with celiac disease, some will even react to pure oats,” Murray says. “More often, the concern is that the oats have become contaminated with wheat or other grains that definitely cause harm.”

Until answers about oats are known for sure, people with celiac disease should exercise caution and discuss the safety of oats with their doctor.

Other products to avoid
“Some medications (especially over-the-counter medication), herbal remedies, and vitamins have gluten-containing ingredients.

Occasionally prescription medications have gluten. Always ask your pharmacist if you’re unsure,” Murray says. You also might find gluten in cosmetics or  adhesives, like envelope glue or stamps.

“It can be challenging to change what kinds of foods you eat after so many  years. However, many older adults are excellent at changing their eating patterns—even better than younger adults in many cases—because they understand the importance of doing so and are highly motivated,” Murray says.

Gluten-free grains
OK to eat

amaranth—often popped like popcorn and mixed with honey
buckwheat
corn
millet—one of the most digestible grains available, mildly sweet
Montina (Indian rice grass)—in popular gluten-free flour and other baking products
quinoa —cooked frequently as a side dish, slightly nutty-tasting
rice
sorghum—neutral flavor, often cooked as a porridge
teff—sweet-tasting, versatile grain
wild rice

Food products that might contain gluten
MAY NOT BE OK to eat

breading
broth
coating mixes
communion wafers
croutons
imitation bacon
imitation seafood
marinades
processed meats
sauces (including soy sauce, malt vinegar)