Celiac Disease: What You Need to Know

Celiac disease is an autoimmune condition that affects nearly 8% of all people living with diabetes and only 1% of the general population. Celiac presents as an immune response to eating gluten, which is a protein found in wheat, barley, and rye products, which can cause inflammation of the gut.

Type 1 diabetes and celiac disease are often diagnosed together, both being autoimmune conditions. This article will explain what celiac disease is, what are the common symptoms, how to treat it, and strategies for living with this condition if you have diabetes.

What Exactly Is Celiac Disease?

Celiac disease is a common autoimmune disease in the United States, with more than 200,000 new diagnoses per year. In people who develop celiac disease, their immune system responds to the protein gluten, creating inflammation that can damage the lining of the small intestines over time. If left untreated, it can cause serious medical complications such as chronic diarrhea, malnutrition, anemia, weight loss, ulcers, and bowel cancer.

What Are the Symptoms of Celiac Disease?

The most common symptoms of celiac disease include:

  • Diarrhea
  • Bloating
  • Fatigue
  • Foul-smelling stool
  • Weight loss
  • Stomach pain
  • Vomiting
  • Nausea

Many adults with celiac disease present with symptoms completely unrelated to the GI tract, including:

  • Anemia
  • Osteoporosis
  • Skin rashes
  • Headache
  • Extreme fatigue
  • Mouth ulcers
  • Joint pain

Even worse, some patients have no symptoms at all, so if you are at heightened risk for celiac disease, be sure to get checked regularly to catch it early to prevent negative health outcomes later on down the line.

How Is It Diagnosed?

According to the Mayo Clinic, celiac disease is diagnosed by two blood tests. Doctors will use serology testing to detect elevated levels of antibodies in the blood. If detected, this indicates an immune response to gluten, and thus a diagnosis of celiac disease is made. Additionally, genetic testing for leukocyte antigens (HLA-DQ2 & HLA-DQ8) can be used to rule out celiac disease in patients. If you have symptoms of celiac disease or suspect that you have the condition, talk with your doctor about getting these blood tests.

What Is the Connection Between Diabetes and Celiac Disease?

Since type 1 diabetes and celiac are both autoimmune diseases, developing one condition increases the likelihood of developing the other condition. There is no link between developing type 2 diabetes and celiac disease. Nearly 8% of people with type 1 diabetes also have celiac disease, which is 8 times higher than the general population of 1%.

Since the prevalence is so high, it is helpful that people with both type 1 diabetes or celiac disease are regularly tested for the other condition. Undiagnosed celiac disease in people with type 1 diabetes can cause unstable blood sugar levels, and damage absorption of nutrients in foods necessary to manage diabetes.

What Causes Celiac Disease?

Like type 1 diabetes, the exact cause of celiac disease is unknown. It is a combination of genetics and environmental triggers such as infant-feeding practices (bottle versus breastfed), gastrointestinal infections, and the health of one’s microbiome may contribute as well. Other environmental triggers such as surgery, blunt trauma, pregnancy, childbirth, stress, or infections can also cause celiac disease.

What Are the Risk Factors for Celiac Disease?

Risk factors for celiac disease include:

  • Type 1 diabetes
  • Family history of celiac disease
  • Having either the HLA-DQ2 or HLA-DQ8 gene
  • Down syndrome or Turner syndrome
  • Hashimoto disease
  • Colitis
  • Addison’s disease

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How Do You Treat Celiac Disease?

There is no cure for celiac disease, but by following a strict gluten-free diet, you can live a long and healthy life with the condition. Work with your doctor to find an eating plan that will work for you.

A recent study found a small but significantly increased risk of death in people with celiac disease, with mortality at the highest risk for those diagnosed between 18 and 39 years old. The study revealed that the risk of death was increased in the first year after diagnosis, but persisted even ten years later.

The increased risk of death for people with celiac disease is associated with complications from chronic inflammation, such as heart disease, cancer, and respiratory disease.

Managing Celiac Disease With Type 1 Diabetes

Managing celiac disease with type 1 diabetes will take more discipline, intention, and structure to what and how you eat. While a double diagnosis of celiac disease and type 1 diabetes is not something that anyone wants, people who already live with type 1 diabetes are somewhat advantageous when they receive a celiac disease diagnosis.

People living with diabetes are already used to closely monitoring what and how they eat, and are more likely to already follow a lower-carbohydrate diet, usually with fewer grains, and thus gluten. More than ever before, grocery stores and restaurants are offering gluten-free options, with everything from cereal to bread to waffles to lasagna being accessible for people with celiac disease. Check out our top recommendations for gluten-free and diabetes-friendly snacks.

Work with your doctor and nutritionist to find an eating plan that will work for both your celiac disease and type 1 diabetes to ensure that you’re getting all of the vitamins, minerals, and nutrients you require to thrive. As you assimilate to a gluten-free lifestyle, make sure to keep a close watch on your blood sugars, as malabsorption issues may have been having an altering effect on your levels. Note any differences, and talk about them with your doctor and care team.

Complications of Celiac Disease

You can live a long, normal life with celiac disease, but it will take some lifestyle adjustments. If left untreated, celiac disease can contribute to the following complications:

  • Osteoporosis, due to malabsorption of key nutrients such as calcium and vitamin D
  • Malnutrition, leading to anemia and weight loss. This can also stunt or slow growth
  • Infertility and miscarriage
  • Lactose intolerance, from a damaged small intestine; once you’ve been eating a gluten-free diet for 6 months to a year, the healed small intestine should help with the digestion of dairy once again
  • Cancer, including intestinal lymphoma and small bowel cancer
  • Nervous system problems, such as seizures and peripheral neuropathy

While it’s a serious and incurable condition, celiac disease doesn’t have to greatly affect your life. Work with your doctor and care team to adjust to a strict, gluten-free diet, and you can live a long, healthy life with celiac. If you have signs or symptoms of celiac disease and are at heightened risk for developing it, contact your doctor to get tested right away.

Source: diabetesdaily.com

Updates on the Environmental Triggers of Type 1 Diabetes (ADA 2020)

The onset of type 1 diabetes (T1D) usually entails a genetic predisposition to developing the condition, as well as an “environmental trigger” (such as a viral infection, or another exposures). As we previously reported, a multi-center international research effort called TEDDY (The Environmental Determinants of Diabetes in the Young) has been investigating potential environmental triggers that may induce the onset of type 1 diabetes in children since 2004.

As described in the most recent press release:

“TEDDY is aiming to discover viruses and nutritional factors that interact with genes to “trigger” immune destruction of the beta cells, marked by the appearance of islet autoantibodies. The study enrolls infants identified as “at-risk” for developing T1D and follows them for 15 years to look for the appearance of various beta-cell autoantibodies and diabetes. TEDDY has also studied biomarkers that can predict faster or slower progression to diabetes after the autoimmune destruction has begun.”

Now, new data on environmental connections between type 1 diabetes as well as celiac disease were just presented today at the American Diabetes Association (ADA) 80th Scientific Sessions. Dr. Marian Rewers, MD, PhD from the Barbara Davis Center for Diabetes at the University of Colorado School of Medicine, along with other presenters, provided the new research updates.

Key Takeaways

Here are the major highlights:

  • It appears that beta cell destruction often begins very early in life; as early as in the first two years of life.
  • There may be two distinct subtypes of type 1 diabetes that are characterized by differences in their genetics, immune system, and various metabolomic markers.
  • The value of HbA1c as a predictive factor for developing type 1 diabetes may differ between youth and adults who develop the condition.
  • Presence of enterovirus B in stool samples is predictive of islet autoimmunity development in children.
  • The gut microbiome composition tends to be different in children who develop islet autoantibodies as compared to those who do not. The use of probiotics may help to mitigate this risk.
  • Use of antibiotics WAS NOT shown to be related to autoimmunity.
  • Vitamin D, vitamin C, and polyunsaturated fats may carry preventative benefits against autoimmunity, although this needs to be validated in further studies.

Another interesting update was concerning the environmental determinants of celiac disease. There is some overlap in the genetic factors that are associated with the development of type 1 diabetes and celiac disease. Interestingly, recent research has identified a link between the consumption of gluten early in childhood and an increased risk for developing celiac disease among those with a genetic predisposition.

Dr. Rewers had this to say in summary:

“While T1D and celiac disease share a lot of genetic characteristics, there are intriguing differences in the ways these diseases develop and progress,” added Dr. Rewers. “TEDDY is contributing exciting clues for design of future trials to prevent both T1D and celiac disease.”

Conclusions

The multidisciplinary international TEDDY research effort continues to uncover important pieces of the complex puzzle to explain exactly how and why certain individuals develop type 1 diabetes and other autoimmune conditions. Understanding the relationships between genetic predispositions to autoimmune disease and how they may be triggered is critical to the development of effective preventative strategies in the future.

Stay tuned for more research updates from ADA 2020!

Source: diabetesdaily.com

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