Can Stress Trigger Celiac or Gluten Intolerance in Later Life

Can Stress Trigger Celiac Disease or Gluten Intolerance in Later Life? Dietitician Tiffany Torok, MA, RDN, discusses Stress and its relationship to developing celiac disease and other gastrointestinal illnesses. Celiac disease used to be thought of primarily as a pediatric disease, presenting before the age of 20. However, as more people become aware of the condition and primary care doctors have become more educated on how to screen for the disease, more people are being diagnosed with celiac and gluten intolerance as adults or seniors.

Celiac Can Occur At Any Age

Celiac disease prevalence peaks shortly after gluten and wheat products are introduced into the diet around the age of two or can present later in life when people are in their 20s or 30s. This may be due to hormonal changes, as is suspected in other autoimmune diseases that are more common in women, or due to stress or other factors. However, celiac disease can occur at any age and is well-distributed across all age groups. Celiac disease is believed to occur in about 1% of the global population (Caio, et al, 2019).

Chronic Stress Can Trigger Inflammation

Celiac disease, as well as other autoimmune diseases, can be triggered by stress, trauma, or other diseases (Ciacci, et al, 2013). These states naturally trigger an inflammatory response in part of the immune system. When the immune system becomes activated, this leads to higher rates of turnover in immune cells and the production of autoantibodies in genetically susceptible people under the right circumstances. Once these immune cells are recruited to become autoantibodies, it can be challenging for many autoimmune diseases to be “cured”.

Gastro Conditions Triggered By Stress

Environmental factors, lifestyle, and stressful life events can bring on many gastrointestinal diseases such as:

• Non-celiac gluten sensitivity
• Irritable bowel syndrome (IBS)
• Celiac disease (also called celiac sprue or coeliac disease)
• Inflammatory bowel diseases such as Crohn’s disease and Ulcerative colitis.

All of these conditions are thought to have an immune system component, which can be worsened or brought on by stress. This is because part of our immune system creates inflammation, which under normal circumstances helps heal our bodies but, during prolonged stress, can create damage instead of healing.

Additionally, in the case of autoimmune diseases such as celiac disease, Crohn’s disease, and ulcerative colitis, this immune response can cause the immune system to start attacking the body. Furthermore, celiac disease and inflammatory bowel diseases can occur together, which is due to immune system dysfunction and intestinal border breakdown (Pinto-Sanchez et al, 2020).

What is Celiac Disease?

Celiac disease is an autoimmune disorder that is triggered by eating gluten in genetically susceptible people who have a type of immune system cell in their intestines that is activated to recognize gluten as an invader.

The immune system in these individuals then attacks the intestinal lining, which can lead to malabsorption of nutrients and, ultimately, malnutrition. The condition can either be excruciating for some individuals or silent for others who have untreated celiac disease. However, it can lead to the same risk factors for those who are symptomatic or asymptomatic: increased risk of cancers of the intestines, lymphoma, or leukemia. Currently, the only treatment for celiac disease is lifelong adherence to a strict gluten-free diet, avoiding all sources of cross-contact with gluten.

Symptoms of Celiac Disease

Celiac disease has numerous symptoms that include more than just digestive issues. The condition can cause peripheral neuropathy, iron deficiency anemia, and dermatitis herpetiformis and is commonly found with other autoimmune diseases. It is diagnosed by blood tests and upper endoscopy, which uses a flexible tube to look for damage to the lining of the small intestines.

Can You Develop Celiac or Gluten Intolerance Later in Life?

I just read a statistic that over 19% of new celiac cases are in adults over the age of 60.

‘While abdominal symptoms are still common in elderly celiac patients, many of these individuals present with milder symptoms, such as abdominal bloating, flatulence, and abdominal discomfort, which make the diagnosis more difficult. The classic malabsorptive symptoms such as diarrhea, weight loss, and abdominal pain are less common in elderly celiac patients.’ – The Canadian Celiac Health Survey – PubMed (nih.gov)

People who lose the ability to tolerate gluten later in life, especially those who develop celiac disease, are at a higher risk of many complications from the condition, such as an increased risk of bone fractures from falls due to higher rates of osteopenia/osteoporosis.

Additionally, they face higher rates of iron-deficiency anemia and other nutritional deficiencies. There is also a much more significant treatment burden with the addition of other health problems due to other chronic medical conditions, which can decrease the quality of life.

Challenges of Managing Celiac or Gluten Intolerance In The Elderly

Many elderly live in independent or assisted living facilities and have lifelong patterns of eating. There is also a possible dementia diagnosis that can make it difficult for an elderly patient to grasp and implement a strict gluten-free diet fully. Since gluten can also be found in modified wheat starch, medications, vitamin capsules, envelopes, etc., grasping a gluten-free diet’s full extent can be challenging. However, the elderly can have dramatic improvement in symptoms adhering to a strict gluten-free diet.

Tips for Going Gluten-Free Successfully

The strict gluten-free diet can be challenging for beginners and can even trip up some old pros occasionally. Here are some of my tips for successfully going gluten-free:

1. Decide if your house will be 100% gluten-free or shared with someone who eats gluten-containing foods. This will help to determine if you need to organize your space into two areas.
2. Start in your pantry. Go through your pantry staples and either throw out or move all gluten-containing items to a lower shelf. Read our helpful article Hidden Sources of Gluten (with free PDF).
3. Consider consulting a dietitian or gastroenterologist for help implementing a strict gluten-free diet.
4. Here are books we love to support gluten-free healing an education: Best Selling Gluten Free Books for Healing

Helpful Tips for Organizing Your Gluten-Free Safe Kitchen

• Clean out your fridge and toss all gluten-containing condiments and foods, or move these gluten-containing foods to their own dedicated lower shelf. Read our article Easy Steps To Set Up A Safe Gluten-Free Kitchen- Guide and Tips
• Purchase gluten-free condiments and spices.
• Purchase new pots and pans. Create a separate area for your pots and pans, and only cook with these dedicated gluten-free cookware.
• Purchase dedicated items for strict gluten-free cooking, such as a new toaster, mixer, condiments, etc.
• I recommend ordering gluten-free foods online and setting your search criteria for “gluten-free.” This will help reduce confusion about reading food labels while navigating the grocery store with new dietary restrictions.
• Prepare to be unprepared – always bring gluten-free snacks wherever you go, and look up celiac-friendly or gluten-free restaurants ahead of time if you are traveling.

Types of Celiac Medications Being Tested

The first round of medications coming to market will likely target the gluten molecule’s damage to the intestinal lining by either breaking down the gluten molecule to free amino acids, which the immune system doesn’t recognize as an invader, or reducing intestinal inflammation post-gluten ingestion.

These potential medications could offer a complementary therapy to the gluten-free diet, meaning that they cover cross-contact but aren’t curative.

However, there are a few treatment options that are being developed which aim to be a cure for celiac disease. These treatments are still very early in their development, and research has not shown whether they deliver what they promise. These treatments are immune modulating and include vaccines and gene therapies (Pinto-Sanchez, et al, 2021), (Kim, et al, 2023).

Conclusion: Can Stress Contribute to Celiac and Gluten Intolerance?

Many factors can contribute to gastrointestinal illness, with chronic stress being a significant component. Paying attention to stress while cultivating a healthy, well-balanced diet and lifestyle is hugely important in helping to prevent and lessen the symptoms of all diseases. Learning mindfulness and relaxation strategies are also helpful in managing ongoing stress. Exercise is also an excellent tool for reducing stress and symptoms at any age. Almost anyone of any age can do simple activities such as deep breathing, stretching, and walking.