People with type 1 diabetes (T1D) are at an increased risk of developing other autoimmune diseases, with celiac disease being the most common. In fact, nearly 10% of those with T1D also have celiac disease. Here, we explore what celiac disease is, how to treat it, and its connection to T1D.
What is celiac disease?
Celiac disease is an autoimmune condition in which a person’s body cannot digest foods that contain gluten, a protein found in wheat, rye, barley, and some oats. If a person with celiac disease consumes gluten, their immune system reacts by attacking the lining of the small intestine (part of the gastrointestinal tract).
Because most essential nutrients in food are absorbed in the small intestine, the damage caused by celiac disease can lead to decreased nutrient absorption, resulting in nutritional deficiencies. Over time, these deficiencies can cause secondary issues, including slow growth, anemia, and osteoporosis.
What are the symptoms of celiac disease?
Gastrointestinal symptoms of celiac disease include:
- gas and bloating
- diarrhea
- vomiting
- stomach pain
- weight loss
- dermatitis herpetiformis (skin rash)
A survey conducted by Beyond Celiac found that neurological and physiological symptoms of celiac disease are often just as common as GI symptoms. The most commonly reported non-GI symptoms include brain fog, headache, joint pain, and fatigue.
How is celiac disease diagnosed?
Celiac disease diagnosis requires a medical evaluation of symptoms. This may require a blood test to measure levels of specific autoantibodies and a tissue biopsy from the small intestine to check for damage to the lining, often performed via endoscopy.
What is the connection between celiac disease and type 1 diabetes?
Celiac disease and type 1 diabetes share a common genetic background linked to the human leukocyte antigen (HLA) genotype. Approximately 95% of individuals with type 1 diabetes and nearly 99% of those with celiac disease carry the HLA class II genes DQ2 and DQ8. However, most people with these high-risk genes do not develop T1D or celiac disease.
“The reasons why some people with type 1 diabetes develop celiac disease while others do not, despite the common genetic background, is an area of active research,” says Farid Mahmud, MD, from the Hospital for Sick Children in Toronto. “The T1D population is also unique when it comes to celiac disease because they are largely asymptomatic.”
Because of this close genetic relationship, screening for celiac disease is frequently recommended in people living with T1D, regardless of age. “There is often an incorrect perception of celiac disease with type 1 diabetes as a largely pediatric condition,” Mahmud said. “In reality, autoimmune comorbidities increase with age, and data from our large screening study showed that adults with type 1 diabetes had higher celiac disease-seropositivity rates than children.”
Screening for celiac disease in those with type 1 diabetes is crucial because, according to a recent study, only 10% of people with celiac disease develop “classic” severe digestive symptoms; most have mild symptoms, vague neurological or physiological symptoms, or may even be asymptomatic.
Autoimmunity Screening for Kids (ASK) Program
T1D and celiac disease are the two most common autoimmune diseases of childhood. Breakthrough T1D supports the Autoimmunity Screening for Kids (ASK) Program, based at the Barbara Davis Center for Diabetes in Denver, CO. The program offers free screening to all U.S. children and adults to detect T1D or celiac disease.
The goals of ASK are:
- Find early signs of type 1 diabetes or celiac disease in children before they get very sick
- Offer close monitoring, education, and early treatment when needed
- Offer participation in studies of new interventions that might stop or slow the progression of the disease
- Increase public awareness of T1D and celiac disease
How is celiac disease treated?
While there is no cure for celiac disease, it can be effectively managed through a strict gluten-free diet. Removing gluten (wheat, rye, barley, and some oats) from the diet allows the small intestine to heal, improving nutrient absorption.
Many foods are naturally gluten-free, including:
- Fruits
- Vegetables
- Beef
- Poultry
- Fish
- Nuts
- Eggs
Today, gluten-free bread, pasta, and even pizza crust are widely available in most grocery stores. Restaurants have also become more accommodating to gluten-free diets. FindMeGlutenFree.com is a good resource for finding restaurants in your area with gluten-free options.
Going gluten free with type 1 diabetes
Individuals with T1D who are diagnosed with celiac disease may notice a change in their blood-glucose control after starting a gluten-free diet. As gluten is removed, the gut lining can heal, leading to improved absorption of nutrients, including carbohydrates. Pay special attention to blood-glucose levels until the body becomes more efficient at absorbing nutrients.
Gluten-free products tend to be higher in saturated fat, lower in protein and fiber, and have a high glycemic index, which could contribute to difficulties controlling blood sugar. Some individuals with type 1 diabetes may also require more insulin after being diagnosed with celiac disease. It is important to keep your T1D healthcare team informed about how you are managing your gluten-free diet and its effect on your blood-glucose levels.
