Fatigue, pain, anaemia, peripheral neuropathy, osteoporosis, headaches, joint pain, cognitive and balance issues. This list sounds like many that our older patients present with but did you know that these can all be symptoms of untreated coeliac disease? Coeliac disease can occur at any age, but when it manifests in later life it can be challenging to diagnose amidst the many other potential age related health conditions.
What is Coeliac Disease?
Coeliac (seel-ee-ak) disease (CD) is a long-term autoimmune condition that is triggered by eating gluten. If left untreated, it damages the delicate lining of the bowel, and prevents food from being digested and nutrients being absorbed properly as well as affecting a number of other organs in the body.
What is gluten?
Gluten is a part of a protein found in wheat, rye, barley and triticale (a cross between wheat and rye). Gluten is common in many foods including cereals, bread, pasta, baked products and pastry. It can also be found in many unexpected places such as soy sauce, milo and some lollies! Oats are not gluten containing but are easily cross contaminated and they have a protein similar to gluten that about 50% of people with coeliac disease will react to. In New Zealand oats are therefore classed as ‘gluten containing’.
What are the symptoms?
Firstly, thoughts often go to the “irritable bowel” type symptoms – diarrhoea, constipation, bloating, wind, abdominal pain, malabsorption, fatigue and anaemia.
Unfortunately, gluten doesn’t restrict itself just to the gut. Presentations of coeliac disease in other parts of the body is not uncommon – peripheral neuropathy, headaches, skin rashes (dermatitis herpetiformis), joint pain and cognitive impairment (that can be misdiagnosed as dementia) can also indicate untreated coeliac disease.
Osteoporosis or osteopenia are often seen in our older patients with coeliac disease, which can cause bone pain and increase the risk of fractures.
Malnutrition can occur as the body cannot absorb nutrients it needs via a damaged gut. This can lead to deficiencies in iron, fibre, calcium, magnesium, zinc, folate, niacin, riboflavin, vitamin B12 and vitamin D.
Because symptoms can be so varied and can mimic other health conditions we see in older adults, a diagnosis of coeliac disease can often be missed, delaying essential treatment.
How do you treat Coeliac Disease?
The treatment sounds simple. A strict gluten free diet, for life. For those living with coeliac disease this treatment can present many challenges, especially when eating outside of the home, and a future post will discuss tips for managing this.
My symptoms are pretty mild – do I need to follow a gluten free diet?
Firstly, it is important not to self-diagnose, and exclude foods from your diet before seeing your doctor or a dietitian. A formal diagnosis is essential before you begin to exclude foods.
Once you have excluded gluten from your diet you may be surprised at how ‘well’ you can feel. If you have been feeling unwell for a long time, you may have forgotten what feeling healthy feels like. For some the improvements are immediate, for others it may take a long time to feel the benefits of being gluten-free, especially if you have a range of symptoms that the body needs to recover from.
Contact us for support.
On the Go Physio is very lucky to have the skills of our NZ Registered Dietitian, Hayley, who can discuss whether changing your diet is the right course for you, taking into account your overall health and wellbeing, and support you with the challenges you may face changing what has been a life-long diet for you, and even your financial and support situation. Also keep in mind if you have been experiencing diarrhoea for a while or been following a gluten free diet for a period of time, nutrient deficiencies may be an issue, so talking to Hayley about how to ensure you have a full range of nutrients in your diet will make sure you are thriving!