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Diabetes and Celiac Disease

A lifelong digestive disorder, found in individuals who are genetically susceptible, that results in damage to the small intestine by interfering with the absorption of nutrients. Celiac Disease (CD) is unique in that a specific food component, GLUTEN, has been identified as the culprit.

Gluten is the common name for the offending proteins in specific cereal grains that are harmful to persons with (CD). These proteins are found in all forms of wheat and related grains, rye, barley, and possibly oats.

Damage to the mucosal surface of the small intestine is caused by an immunological toxic reaction to the ingestion of gluten.


What happens?

When individuals with CD ingest gluten, the villi, tiny, hair-like projections in the small intestine that absorb nutrients from food, shrink or disappear. This is a destructive immunological reaction to gluten.

Damaged villis interferes with the body’s ability to absorb basic nutrients cases, water and bile salts.

If CD is felt untreated, damage to the small bowel can be chronic and life threatening, causing an increased risk of associated disorders both nutritional and immune related.

Some long-term conditions
that can result from untreated CD:

• Iron deficiency anemia
• Osteoporosis
• Vitamin K deficiency with risk for hemorrhaging.
• Vitamin and mineral deficiencies.
• Central and peripheral nervous system disorders
• Pancreatic insufficiency
• Intestinal Lymphomas
• Lactose intolerance.
Other autoimmune disorders:

• Dermatitis Herpetiformis (DH)
• Diabetes mellitus type 1
• Thyroid Disease
• Systemic lupus erythematosus
• IgA nephropathy
• IgA deficiency
• Primary Biliary Cirrhosis


Symptoms

Many patients are asymptomatic for years, with the disease becoming active for the first time after surgery, viral infection, severe emotional stress, or pregnancy and childbirth. CD may appear at any time in the life of a person with a hereditary pre-disposition.

Symptoms of CD are as varied as the nutritional deficiencies caused by the malabsorption. Infants, toddlers and children may exhibit growth failure, vomiting, bloated abdomen and behavioral changes.

Classic symptoms may include:
• Abdominal cramping, intestinal gas, distention and bloating
• Chronic diarrhea or constipation (or both)
• Weight loss with large appetite, or weight gain.


Cause

The cause of Celiac Disease, also called celiac sprue, or gluten sensitive enteropathy is unknown. Current research indicates that CD is strongly associated with a group of genes on Chromosome 6.

These genes (HLA class II antigens) are involved in the regulation of the body’s immune response to the gluten protein fractions.


Who gets CD Genetics?

Celiac Disease is most commonly found in genetically susceptible Caucasians. Recent studies suggest that at least 1 in 250 persons in the United States is affected.

Many cases go undiagnosed or are asymptomatic for years. CD occurs in 5-15 % of the offspring and siblings of the celiac. In 70 % of identical twin pairs, both twins have the disease. It is suggested that family members be tested.


Diagnosis

Specific antibody blood tests are used to identify the possibility of Celiac Disease and are the initial step in screening individuals who are at risk.

Certain antibodies are produced by the immune system in response to substances that the body perceived to be threatening, i.e. gluten.

It is recommended that patients with positive antibody tests have a small bowel biopsy to confirm the diagnosis and assess the degree of mucosal damage. Dermatitis Herpetiformis (DH) is diagnosed by a biopsy of skin lesion and staining for IgA in the tissues. More than 85 % of DH patients have small-bowel sensitivity to gluten.


Treatment

The only treatment for CD/DH is the life-long adherence to gluten-free diet. When gluten is removed from the diet, the small intestine will start to heal and overall health improved. Medication is normally not required. Because osteopenic bone disease is common and may be profound in patients with newly diagnosed Celiac Disease, bone densomitry should be measured in adults at or shortly after diagnosis.

Consult your physician regarding specific nutritional supplementation to correct any deficiencies. Their physician to ensure compliance with, and response to the gluten-free diet should monitor all patients. Dietary compliance decreases the likelihood of osteoporosis, lymphoma and other associated illnesses.

Adapting to the gluten-free diet requires some lifestyle changes. It is crucial to read labels, which are often imprecise, and learn to identify ingredients that may contain hidden gluten.

Be aware that hidden gluten can be found in some unlikely foods such as: cold cuts, soups, hard candies, soy sauce, many low or non-fat products, even licorice and jelly beans.

Gluten may also be used as a binder in some pharmaceutical products. Request clarification from food and drug manufacturers when necessary.

Raising an important question…
How often should people with type 1 diabetes screened for celiac disease?

•  The pediatrics association American diabetes suggested that children have a blood test for celiac disease when they are diagnosed and every year for several years afterwards.

Recommended that people with type 2 diabetes be given a blood test every tree to look for silent celiac disease.
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