Lab results for the senior (geriatric) population frequently shows low iron measurements. The most common parameters are Red Blood Cells, Hemoglobin, and Hematocrit. From these iron deficiency anemia may be diagnosed. Ferritin, a value reflecting iron reserves, is usually not measured. This seems striking to me–absence of an important element, an error of omission. Saving money?
Iron deficiency anemia may often be the only diagnostic or presenting sign of celiac disease/gluten enteropathy/gluten syndrome (CD). Celiacs don’t absorb their nutrients easily or efficiently. Often in the elderly a diagnosis of “anemia of chronic disease” is made and the work stops there. Further detective work and remedies stop also. Anemia of chronic disease could well be related to gluten. This point was discussed at the recent Celiac Sprue Association symposia.
A research article “Celiac disease diagnosed in the elderly.” by Lurie Y, Landau DA, Pfeffer J, Oren R. Clin Gastroenterol. 2008; 42(1):59-61 discusses the possibility of a CD/anemia relationship. For skeptics, the subject number is low and there will be a dismissal statement that more research is needed. Sometimes we miss the point that we know enough to take action.
A NAAC review of this article (review published 1 May 08) states:
…” more CD cases with a myriad of symptoms are now being reported in the elderly populations. However, CD diagnosis in elderly patients commonly occur long after the onset of symptoms, which can lead to a diminished quality of life and reduced longevity.”
“In the study group signs and symptoms reported included weight loss, iron deficiency anemia, abdominal pain, diarrhea, increased liver transaminases, severe osteoporosis. One subject had a history of peripheral neuropathy and folic acid deficiency. In most subjects lag time to a CD diagnosis (median duration of 8 years) was significant. Despite the variety and severity of symptoms in the study population, initiation of a gluten free diet (GFD) resulted in complete resolution of symptoms and significant weight gain in 6 patients” Only 13 were studied. Other research on the elderly describes sarcopenia-a loss of muscle mass and strength often seen in the elderly, so the weight gain in this population may be really important, especially if it is a gain in muscle and not fat. Wouldn’t it be interesting if there was a relationship with sarcopenia and gluten? “In addition, significant improvements were seen in 2 female patients with longstanding cognitive decline.” Dr. Rodney Ford, Dr Gluten in New Zealand. (we hope he and his clinic survived the recent earthquake) would like us to call gluten problems “Gluten Syndrome” because it is a neurological disease more than just a disease of the small intestine, getting away from the very inclusive term CD.
…” other clinical trials report that elderly patients comprise up to 25% of new CD cases. However, the lag of CD diagnosis is still unacceptably long, since many symptoms are attributed to old age and declining cognitive abilities in these patients.” Wonder of wonders. Ignorance is bliss. Here is a very interesting thought: “More clinical trials are needed to determine whether CD progresses into a clinical condition from a subclinical condition that develops from lowered body reserves or from other factors. Also, the link between cognitive decline and CD needs to be further explored. Although these associations are not well understood, the striking improvement of symptoms from a gluten free diet (GFD) merits much more investigation into this population.” My questions are: do those exhibiting overt symptoms later in life have strong immune systems that may have attenuated overt symptoms over their life span, normally eat less glutenous foods than others, have an incident that lowers their immune threshold, or…?
I also often wonder about the etiology of the eating disorder label. Did the problem originally start with gluten intolerance and feeling ill. Because of feeling ill, having abdominal pain, et al, altering food intake, habits, and avoidance, being mislabeled and channeled into the eating disorder world. One wonders after lengthy interviews with “ED” patients.
“The exact prevalence of CD among older individuals is not known yet, but it should become part of the differential diagnosis of iron deficiency, especially if the iron deficiency is associated with otherwise unexplained weight loss.” I think we should broaden the differential categories. There are at least 300 gluten induced diseases. I would emphatically add ruling out CD/gluten syndrome for any thyroid and psyche related problems. There I said it.