Can adults develop celiac disease

Losing Tolerance to Gluten

“We are really on verge of an epidemic, and something is happening to make us more vulnerable,” he says. “This is likely due to a change in environment.”

The new findings may open up some new avenues for future research by allowing the investigators to work backward and determine how people can tolerate gluten for so many years, and then develop celiac disease.

“The prevalence of celiac disease appears to be increasing,” says Mark Sapienza, MD, associate chief of gastroenterology at Englewood Hospital Center in New Jersey. “We need to be more aware about celiac risk in older populations.”

“People may be losing their tolerance to gluten for some reason,” he says. “This may be due to something in our food supply or in the environment. Just because you were screened for celiac disease 30 or 40 years ago, doesn’t that you can’t develop it.”

If you have risks for celiac disease and some symptoms, talk to your doctor about a celiac panel, Sapienza advises.

“The new findings highlight the importance of looking for celiac because it is more common and untreated, it causes a lot of problems,” agrees Barry Zingler, MD, chief of gastoenterology at Englewood Hospital Center. Untreated celiac disease increases the risk for the brittle bone disease osteoporosis due to the body’s inability to absorb calcium and vitamin D, fatigue, and certain cancers.

Not so fast, says Mel Heyman, MD, MPH, the Anita Ow Wing Endowed Chair and Professor of Pediatrics, chief of pediatric gastroenterology, hepatology, and nutrition at the University of California, San Francisco Benioff Children’s Hospital.

Heyman tells WebMD that the blood test for celiac disease is not fail-safe. “We know that the test is not perfect, so some of these people could have been a false negative , which is why sometimes we go on to do a biopsy.”

Celiac Disease Strikes Some Late In Life

More people may be visiting the gluten-free aisle in their local supermarkets.

People with celiac disease can’t eat foods with gluten, including most pastas. hide caption

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People with celiac disease can’t eat foods with gluten, including most pastas.

There’s been an increase in people with celiac disease — particularly in the elderly, says a study published online by the Annals of Medicine. The finding surprised researchers, who didn’t expect to see a change associated with age.

Celiac disease is a hereditary autoimmune disorder triggered by the consumption of gluten — a form of protein found in wheat, barley and rye. Symptoms can include diarrhea, chronic fatigue and weakness.

Researchers from the U.S. and Italy used blood samples from more than 3,500 adults to screen for celiac disease in 1974 and then again in 1989. Over those 15 years, the incidence of celiac disease increased to 1 in 219 people from 1 in 501.

Shots spoke with the study’s lead author, Dr Alessio Fasano, director of the University of Maryland Center for Celiac Research, about the implications of his research. Here’s a selection from our chat, edited for length and clarity.

How is it that people who were eating foods with gluten — like spaghetti or bread — for 60 years were suddenly diagnosed with celiac disease?

That’s the most fascinating question of this study. When we designed it, we expected that the only thing that would change over time was the number of people with celiac disease whose symptoms would become clinically apparent. We never expected that there were people who could tolerate gluten for 60, 70 years before getting celiac disease.

We know that the recipe for celiac disease requires two elements: genes that you’re born with and exposure to grains that contain gluten. That’s the reason why folks who develop the symptoms were thought to always have the problem even though we weren’t seeing it in the clinic.

What might have brought on this change?

It may be the environment that has made this change over time. Grains now are more refined and therefore have more gluten. It could also be the quantity of grains that we eat. It could be the composition of the bacteria that live in our intestines that can trick our immune system differently now than the past. These are all obvious — but not solid — guesses.

So the new cases weren’t just undiagnosed cases?

Correct. The new cases came from the same 3,500 people that we had tested carefully for celiac disease.

What’s the implication of the research?

The obvious message is that you’re never out of the tunnel. You can develop celiac disease at any time. And therefore, as a physician, if I see someone in their 70s with signs or symptoms of celiac disease, I need to consider that this is still a possibility — even if this individual was tested 10 years before.

What about for patients?

We’re in the midst of an autoimmunity epidemic, and celiac disease is not an exception. If we learn how people are able to tolerate this instigator of autoimmunity for longer periods of time, we can use that information to put the development of celiac disease — and, hopefully, autoimmunity diseases — on hold indefinitely.

Should older people be tested for celiac disease frequently?

If you have signs or symptoms (diarrhea, chronic fatigue, weakness, joint pain) related to celiac disease, you should be tested irrespective of your age. It would be a travesty if you couldn’t play tennis or go skiing because you have joint pain not from arthritis, but from undiagnosed celiac disease.

Potential Adult Celiac Triggers

by Alex Reis PhD, GFT science writer

Celiac disease has a strong genetic component, but it’s curious to note that the two versions of genes associated with this condition are also found in about one-third of the general population. Considering that for those people it’s virtually impossible to “escape” gluten and yet only 1% develop celiac disease has raised intriguing questions about what other factors may trigger the onset of this disease.

Many studies have shown that celiac disease has been increasing over the past 50 years. Researchers believe this is not only caused by better diagnostic tools, but an actual increase in the number of people affected by this condition. As human genetics cannot change this quickly – which means the overall number of potential celiac disease patients remains stable – the boost must be due to changes in the triggers that cause the condition. It turns out that, for adults, the list includes not only infections, but also head trauma or even the bread we eat.

Not surprisingly given that celiac disease is an auto-immune condition, any recurrent illness or infections can trigger the development of celiac disease. The list of diseases includes HIV, thyroid disease, cardiomyopathy, diabetes, hepatitis and others. These conditions are likely to elicit a chronic immune stimulation, which in turn may trigger an immune reaction. When it comes to infections, researchers believe these conditions can “help” gluten peptides cross the intestinal barrier, and activate an immune response in susceptible individuals. It’s certainly not uncommon for patients to attribute the onset of their symptoms to a stressful episode or infection.

It doesn’t even have to be a life-threatening infection. For example, researchers have identified that a mild fungal infection with C. albicans can be sensed by the immune system in a similar way to the presence of gluten, which can trigger celiac disease in genetically-predisposed individuals. Other times, like with antibiotics, it’s not the infection per se, but the treatment that acts as a trigger. This seems to be the case with hepatitis, where popular treatments, particularly IFN-α, may set in motion this condition due to their effect on the immune system.

However, not all invading pathogens are actually bad … if present in small doses! Researchers have detected an inverse relationship between H pylori infection and risk of celiac disease. Serious infections can result in permanent gastric problems including ulcers, but it turns out low numbers of this bacteria can have a protective effect against the development of celiac disease. In this case, it’s their absence that represents the trigger for this condition. Again, the mechanism is not known but, if kept under control, this bacteria is associated with lower risks of allergic and inflammatory conditions.

Interestingly, what can be classed as an unexpected trigger for celiac disease involves cases of head trauma. It may be tempting to suggest that this is simply due to the rigorous medical surveillance after any serious accident or injury involving the head. Long term contact with physicians may lead to the detection of other unrelated conditions, including celiac disease.

However, the same effect is not observed with other types of equally dangerous accidents. After any injury, the body reacts against the inflammation by activating an immune response. The problem with this particular response to brain trauma is that it relies on a substance very similar to the one elicited by gluten. In a moment of “temporary confusion”, as the body reacts to one, it may also start reacting to the other and trigger celiac disease.

Finally, many researchers blame changes in our diet during the last half-century to explain the rise in the number of celiac disease patients. The main culprit: bread! This includes many changes in the process of making this food, from genetic selection in the wheat used resulting in varieties with a much higher gluten content to enzymatic modification of wheat prolamins caused by changes during mass production.

What’s important to note is that diagnosis as an adult really is a new onset of disease potentially triggered by one of these factors, and not simply a matter of delayed diagnosis of a childhood condition. The list could go on and there are several other factors currently seen as tentative triggers for celiac disease, including low birth weight, gender or educational level. More research is needed, but this long list only serves to emphasise how multi-factorial this condition is and how describing it as a simple auto-immune condition is a massive understatement.

This original article is made possible by Gluten Free Therapeutics. Our mission is to educate, inform, and provide the most effective nutritional products possible to allow those with celiac disease and serious gluten intolerances to heal their bodies. CeliVites complete line of superior gluten free supplements includes multivitamin/multimineral supplements, iron supplements, and calcium supplements for people living with celiac disease. All CeliVites products are designed to help you heal, restore and rebuild your body, because going gluten free isn’t enough!

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  • Ludvigsson JF, Hadjivassiliou M. Can head trauma trigger celiac disease? Nation-wide case-control study. BMC Neurol. 2013;13:105.
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Triggers for celiac disease: One possible answer


Triggers for celiac disease: One possible answer

What triggers celiac disease? How can someone who has eaten gluten their entire life suddenly become ill after ingesting it? Researchers at the University of Chicago Celiac Disease Center may be close to finding an answer to these questions. This is exciting news, as the discovery of potential triggers may lead to the development of therapies for the prevention of celiac disease.

Genes + Gluten + Trigger = Celiac Disease

In order to have celiac disease, three factors must be present:

Gluten: First, you must be ingesting gluten for the immune reaction to occur. If you never ate gluten, a protein that occurs naturally in wheat, rye and barley, you would never develop celiac disease. The majority of westernized countries are heavily dependent on wheat. Irrespective of the popularity of the gluten-free diet, the vast majority of Americans consume wheat every day.

Gene: Second, you must carry at least one of two genes (HLA alleles) associated with celiac disease for it to occur. But, having one (or both) of these genes does not guarantee you will get celiac disease. Thirty to forty percent of the general population carries one of the two genetic markers for celiac disease, but the condition is only triggered in five percent of the people who have a gene for it.

Trigger: The third factor needed for celiac disease to occur is an environmental trigger. Something must activate celiac disease in a person who is consuming gluten and carries the appropriate gene. There is very little data on the environmental factors that may be the trigger(s) for celiac disease but over time researchers have identified some possibilities: pregnancy, illness, menopause, antibiotic use, the anti-acne drug isotretinoin (marketed in the USA under the brand name Accutane until 2009), prolonged use of non-steroidal anti-inflammatories such as ibuprofen, and gastrointestinal infections.

Viral infections as a trigger for celiac disease

Another possible trigger not listed above is being investigated at the University of Chicago Celiac Disease Center. Researchers there are evaluating whether or not certain viruses trigger immune reactions that lead to celiac disease in susceptible individuals. The study is ongoing, but what they have found so far is interesting:

• Certain viruses can cause the immune system to “overreact.” If this reaction is prolonged or repeated, it may cause someone to lose the ability to tolerate gluten.

• Different celiac patients had different immune responses to the same infection. This may help explain why symptoms vary so much from one person with celiac disease to another.

• Certain viruses, such as rotavirus, are more likely to trigger these particular immune responses.

Why this information matters to you

If viruses are found to contribute to the development of celiac disease, the discovery could open up avenues for prevention. We may be able to vaccinate against these viruses and prevent the onset of celiac disease in certain individuals. This may be of particular importance to relatives of people with celiac disease. They are at higher risk for developing the disease. Treatments such as this may sound far off, but a vaccination already exists for rotavirus. If this virus is found to be one of the triggers for celiac disease, a simple vaccination may help prevent celiac disease in susceptible individuals.

Looking ahead

Although the University of Chicago’s research is not yet published, it appears the authors felt the findings are significant enough to do a preliminary release of their data.A 2015 review paper also discusses the role that infections and the gut microbiome may play in the onset of celiac disease. This is promising news for the celiac community, as it focuses attention on prevention of celiac disease for future generations. While we are lucky to have the gluten-free diet as a treatment, this may be an important step to a cure.



20 Things You Might Not Know About Celiac Disease

  1. Celiac disease is a chronic autoimmune disease, which means that you cannot “grow out” of it.
  2. 1 in 100 people worldwide have celiac disease.
  3. Celiac disease affects an estimated three million Americans.
  4. 80% of Americans with celiac disease are not diagnosed and are needlessly suffering.
  5. People with a first degree relative with celiac disease have a 1 in 10 chance of developing celiac disease themselves.
  6. More children have celiac disease than Crohn’s, Ulcerative Colitis, and Cystic Fibrosis combined.
  7. Celiac disease can affect every organ in your body.
  8. Lifelong adherence to the gluten-free diet is the only treatment for celiac disease.

  1. Approximately 20% of people with celiac disease do not respond to the gluten-free diet.
  2. There is an average delay of 6-10 years for an accurate celiac disease diagnosis.
  3. Without a timely diagnosis, celiac disease can lead to intestinal cancers, type 1 diabetes, osteoporosis, thyroid disease, multiple sclerosis, anemia, infertility and miscarriage, epilepsy, and more.
  4. There are over 300 symptoms associated with celiac disease.

  1. Approximately 20% of people with celiac disease are asymptomatic, meaning they don’t experience any external symptoms at all. However, everyone with celiac disease is still at risk for long-term complications.
  2. Celiac disease can develop at any age after people start eating foods or medications that contain gluten.
  3. The later the age of celiac disease diagnosis, the greater the chance of developing another autoimmune disorder.
  4. There are two steps to being diagnosed with celiac disease: the blood test and the endoscopy.

  1. People with celiac disease have an increased incidence of microscopic colitis and inflammatory bowel disease (Crohn’s disease and ulcerative colitis).
  2. People with celiac disease may have lactose and/or fructose intolerance, both of which can be diagnosed by a hydrogen breadth test.
  3. People recently diagnosed with celiac disease are commonly deficient in fiber, iron, calcium, magnesium, zinc, folate, niacin, riboflavin, vitamin B12, and vitamin D.
  4. Any food product that is labeled “gluten-free” cannot contain more than 20 parts per million of gluten, which is the safe threshold of gluten consumption for people with celiac disease.

Elderly Onset Celiac Disease

Older than 65?

You should know about celiac disease in the aging population

In recent years, celiac disease has gone from a relatively unknown condition to a highly discussed topic with extensive media exposure, celiac-friendly recipes, and a designated gluten-free space on the menus of many popular restaurants. Celiac disease is an autoimmune condition of the gastrointestinal tract, affecting an estimated 1 in 133 Canadians.

In those who have celiac disease, the protein gliadin, which is a component of gluten found in wheat, barley, rye, triticale, and some processed foods, triggers an unusual immune response. It leads to damage in the microscopic finger-like projections (villi) that line the inner wall of the small intestine, which reduces its ability to absorb valuable nutrients from food. Common celiac disease symptoms include iron deficiency, diarrhea, changes in weight, fatigue, breathlessness, cramps, bloating, irritability, and skin conditions.

Typically, a physician will request a blood test and, if the test is indicative of celiac disease, will then conduct a scoping procedure to obtain a biopsy of tissue from the small intestine. This remains the gold standard procedure to confirm diagnosis.

Currently, the only treatment for those diagnosed with celiac disease is a completely gluten-free diet. It is also important that patients avoid gluten contamination in their food and personal items, as well as avoiding cross-contamination from others who consume or use products containing gluten.

It is typical for celiac disease to develop at a young age, so physicians sometimes overlook the possibility that celiac disease is causing symptoms in older adults and seniors, leading to delayed treatment and prolonged suffering.

In children and young adults, celiac disease is more likely to present with symptoms of anemia, failure to thrive, diarrhea, and weight loss.

For those who develop celiac disease when they are older than 65-years-of age (elderly onset celiac disease), the symptoms can be different than they are in younger populations.1 Anemia and micronutrient deficiencies are common in individuals of all ages who have untreated celiac disease, since the small intestine is unable to absorb adequate amounts of nutrients from food. Certain other symptoms, such as constipation and obesity, are common in elderly celiac patients but rare in their younger counterparts.

Symptoms are often mild for elderly patients, who might mistake them for the common signs of aging, and could fail to bring up these symptoms with their physicians and delaying diagnosis and treatment.

Celiac Disease and Cardiovascular Health

Ideally, all individuals should make cardiovascular health a priority from an early age. Older celiac disease patients are at an increased risk of heart disease, possibly because the chronic inflammation they experience (while eating gluten) contributes to fatty buildup and stress on the blood vessels that support the heart.2 A diet rich in fruits and vegetables, legumes, lean proteins such as chicken and fish, and gluten-free grains and alternatives, such as brown rice and quinoa, can help to improve both heart health and celiac disease symptoms. In elderly patients, timely diagnosis is essential. Without avoiding gluten, the damage it causes means that patients might not get the nutrients they need to protect themselves against heart disease and other age-related conditions.


Due to improved knowledge about celiac disease and its symptoms, seniors are now more likely to bring up concerns with their physicians, which may lead to faster and more accurate diagnosis. The good news is that by avoiding gluten, all associated symptoms typically resolve.

First published in the Inside Tract® newsletter issue 202 – 2017
Image: .com
1. Cappello M et al. Elderly Onset Celiac Disease: A Narrative Review. Clinical Medicine Insights: Gastroenterology 2016;9:41-49.
2. Libby P et al; Leducq Transatlantic Network on Atherothrombosis. Inflammation in atherosclerosis: from pathophysiology to practice. J Am Coll Cardiol. 2009;54:2129-2138.

Celiac disease

Celiac disease is a condition in which the immune system is abnormally sensitive to gluten, a protein found in wheat, rye, and barley. Celiac disease is an autoimmune disorder; autoimmune disorders occur when the immune system malfunctions and attacks the body’s own tissues and organs. Without a strict, lifelong gluten-free diet, inflammation resulting from immune system overactivity may cause a wide variety of signs and symptoms involving many parts of the body.

Celiac disease can develop at any age after an individual starts eating foods containing gluten. The classic symptoms of the condition result from inflammation affecting the gastrointestinal tract. This inflammation damages the villi, which are small, finger-like projections that line the small intestine and provide a greatly increased surface area to absorb nutrients. In celiac disease, the villi become shortened and eventually flatten out. Intestinal damage causes diarrhea and poor absorption of nutrients, which may lead to weight loss. Abdominal pain, swelling (distention), and food intolerances are common in celiac disease. Inflammation associated with celiac disease may lead to an increased risk of developing certain gastrointestinal cancers such as cancers of the small intestine or esophagus.

Inflammation and poor nutrient absorption may lead to problems affecting many other organs and systems of the body in affected individuals. These health problems may include iron deficiency that results in a low number of red blood cells (anemia), vitamin deficiencies, low bone mineral density (osteoporosis), itchy skin rashes (dermatitis herpetiformis), defects in the enamel of the teeth, chronic fatigue, joint pain, poor growth, delayed puberty, infertility, or repeated miscarriages. Neurological problems have also been associated with celiac disease; these include migraine headaches, depression, attention-deficit/hyperactivity disorder (ADHD), and recurrent seizures (epilepsy). Many people with celiac disease have one or more of these varied health problems but do not have gastrointestinal symptoms. This form of the condition is called nonclassic celiac disease. Researchers now believe that nonclassic celiac disease is actually more common than the classic form.

Celiac disease often goes undiagnosed because many of its signs and symptoms are nonspecific, which means they may occur in many disorders. Most people who have one or more of these nonspecific health problems do not have celiac disease. On average, a diagnosis of celiac disease is not made until 6 to 10 years after symptoms begin.

Some people have silent celiac disease, in which they have no symptoms of the disorder. However, people with silent celiac disease do have immune proteins in their blood (antibodies) that are common in celiac disease. They also have inflammatory damage to their small intestine that can be detected with a biopsy.

In a small number of cases, celiac disease does not improve with a gluten-free diet and progresses to a condition called refractory sprue. Refractory sprue is characterized by chronic inflammation of the gastrointestinal tract, poor absorption of nutrients, and an increased risk of developing a type of cancer of the immune cells called T-cell lymphoma.

In the United States, approximately 1 in 141 individuals is diagnosed with celiac disease — a lifelong condition — which damages the lining of the small intestine and prevents it from absorbing parts of food that are important for health. The damage is due to a reaction from eating gluten, a protein found in wheat, barley, rye and sometimes oats. The lining of the intestines contains areas called villi, which help absorb nutrients. When people with celiac disease eat foods or products that contain gluten, their immune system reacts by damaging the villi. This results in an inability of the body to absorb nutrients properly. Individuals may become malnourished despite how much food they may eat.

Celiac disease can develop at any point in life, from infancy to late adulthood, with more women than men being diagnosed. And, interestingly, 80 percent of those with celiac disease may not have been diagnosed, partly because there are many symptoms that vary from person to person. For example, one person may have constipation, the second may have diarrhea and a third may have no trouble at all with stools.

Risk and Symptoms

The risk of developing celiac disease is greater for people who have a family member with celiac disease. More common in Caucasians and people of European ancestry, people with celiac disease may experience any or all of the following gastrointestinal symptoms, including abdominal pain, bloating, gas or indigestion, constipation, decreased appetite (may also be increased or unchanged), diarrhea, lactose intolerance, nausea and vomiting, abnormal stools (floating, foul-smelling, bloody or “fatty”) and unexplained weight loss (although people can be overweight or normal weight).

Additional symptoms may start over time and may include bruising easily, depression or anxiety, fatigue, growth delay in children, hair loss, itchy skin (dermatitis herpetiformis), missed menstrual periods, mouth ulcers, muscle cramps and joint pain, nosebleeds, seizures, tingling or numbness in the hands or feet and unexplained short height.

Children with celiac disease may have defects in tooth enamel and changes in tooth color, delayed puberty, diarrhea, constipation, fatty or foul-smelling stools, nausea or vomiting, irritable and fussy behavior, poor weight gain and slowed growth or shorter than normal height for their age.


The diagnosis of celiac disease requires a physician to assess symptoms, medical history and perform an exam. If celiac disease is suspected, blood and biopsy tests are done to confirm the diagnosis.

Some individuals are sensitive or intolerant to gluten, but do not have celiac disease. Symptoms include, but are not limited to, abdominal pain and bloating, diarrhea, joint pain, reflux, bloating and fatigue. Unlike celiac disease, gluten sensitivity does not cause atrophy, or deterioration, of the intestinal villi.

A gluten-free diet is the primary treatment for celiac disease and gluten sensitivity. Help from a registered dietitian nutritionist can ensure the dietary changes you make will be successful.

Definition & Facts for Celiac Disease

In this section:

  • What is celiac disease?
  • How common is celiac disease?
  • Who is more likely to develop celiac disease?
  • What other health problems do people with celiac disease have?
  • What are the complications of celiac disease?

What is celiac disease?

Celiac disease is a digestive disorder that damages the small intestine. The disease is triggered by eating foods containing gluten. Gluten is a protein found naturally in wheat, barley, and rye, and is common in foods such as bread, pasta, cookies, and cakes. Many pre-packaged foods, lip balms and lipsticks, hair and skin products, toothpastes, vitamin and nutrient supplements, and, rarely, medicines, contain gluten.

Celiac disease can be very serious. The disease can cause long-lasting digestive problems and keep your body from getting all the nutrients it needs. Celiac disease can also affect the body outside the intestine.

Celiac disease is different from gluten sensitivity or wheat intolerance. If you have gluten sensitivity, you may have symptoms similar to those of celiac disease, such as abdominal pain and tiredness. Unlike celiac disease, gluten sensitivity does not damage the small intestine.

Celiac disease is triggered by eating foods containing gluten.

Celiac disease is also different from a wheat allergy. In both cases, your body’s immune system reacts to wheat. However, some symptoms in wheat allergies, such as having itchy eyes or a hard time breathing, are different from celiac disease. Wheat allergies also do not cause long-term damage to the small intestine.1

How common is celiac disease?

As many as one in 141 Americans has celiac disease, although most don’t know it.2

Who is more likely to develop celiac disease?

Although celiac disease affects children and adults in all parts of the world, the disease is more common in Caucasians and more often diagnosed in females. You are more likely to develop celiac disease if someone in your family has the disease. Celiac disease also is more common among people with certain other diseases, such as Down syndrome, Turner syndrome, and type 1 diabetes.

What other health problems do people with celiac disease have?

If you have celiac disease, you also may be at risk for

  • Addison’s disease
  • Hashimoto’s disease
  • primary biliary cirrhosis
  • type 1 diabetes

What are the complications of celiac disease?

Long-term complications of celiac disease include

  • malnutrition, a condition in which you don’t get enough vitamins, minerals, and other nutrients you need to be healthy
  • accelerated osteoporosis or bone softening, known as osteomalacia
  • nervous system problems
  • problems related to reproduction

Rare complications can include

  • intestinal cancer
  • liver diseases
  • lymphoma, a cancer of part of the immune system called the lymph system that includes the gut

In rare cases, you may continue to have trouble absorbing nutrients even though you have been following a strict gluten-free diet. If you have this condition, called refractory celiac disease, your intestines are severely damaged and can’t heal. You may need to receive nutrients through an IV.

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