Type 1 Diabetes And Celiac Disease: What's The Link?

Type 1 Diabetes and Celiac Disease are both autoimmune conditions, disorders where your body's immune system attacks itself. In Celiac Disease, your autoimmune system attacks the lining of your small intestine, preventing your body digesting nutrients. In Type 1 Diabetes, your body attacks the pancreatic cells, preventing your body's natural production of insulin.

What is Type 1 Diabetes?

Type 1 Diabetes is the genetic form of Diabetes (as opposed to Type 2 Diabetes, which is often caused or exacerbated by lifestyle). It is usually diagnosed in children, although environmental factors can lead to destruction of Beta Cells in the pancreas, and lead to the development of Type 1 Diabetes in later life.  Of 415 million diabetics worldwide, approximately 10% have Type 1 Diabetes.

Symptoms include: fatigue, thirst, frequent urination, hunger, weight loss, and dry mouth.

Diabetes is easier to test for than Celiac Disease. All it requires is a fasting blood test that measures how much glucose is in the blood. A certain level of glucose shows that an individual is diabetic or pre-diabetic. Another, highly reliable blood test is called the Glycated Haemoglobin (HbA1c) test. This measures your long-term blood glucose control, and may be a more accurate way at measuring your average glucose levels over a long period of time.

Treating Type 1 Diabetes involves following a healthy diet, and taking regular insulin injections.

What is Celiac Disease?

Celiac Disease is another inheritable condition, where eating gluten triggers the body's immune system to react as though it was being attacked by a foreign body. In Celiac Disease, the body perceives gluten as a threat, and responds accordingly. An estimated 1 in 100 people have Celiac Disease, according to current research.

Symptoms of Celiac Disease include: foul-smelling diarrhoea, bloating, flatulence (breaking wind), abdominal pain, fatigue, children not growing as they should.

Diagnosis is made by two methods: an initial blood test to screen potential sufferers, and a biopsy of the small intestine to confirm diagnosis. The blood tests for celiac antibodies. If antibodies are found, you will be sent for a colonoscopy and biopsies will be taken, which will confirm the diagnosis.

The only treatment for Celiac Disease is a strict, lifelong gluten-free diet.

So is there a link?

While no link has been established between Type 2 Diabetes and Celiac Disease, a link between Type 1 Diabetes and Celiac Disease has been suspected since 1960.

A study of children with Diabetes Type 1 (Barera et al, 2001) tested 273 children for Celiac Disease and found Celiac Disease present in 3.3% of their test population, more than the 1% of the general population. It has even been theorised by Hansen et al that, by the mother following a gluten-free diet throughout pregnancy and breastfeeding, she minimises the chance of her offspring developing Type 1 Diabetes.

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A further study demonstrated an 8% prevalence of Celiac Disease in patients with Type 1 Diabetes. They discovered that the Celiac Disease was more likely to be asymptomatic in patients with Type 1 Diabetes, or that patients may have symptoms that are confused with diabetes.

Other research has reported that between 4.4% and 11.1% of patients with Type 1 Diabetes also have Celiac Disease. The reverse is also true. Type 1 Diabetes has been found in 2-10% of all celiacs, more than the usual 0.75% of the population.  

Celiac Disease & Type 1 Diabetes: Why And What to Do

Why Is There A Link?

In a large study at the University of Cambridge, the researchers obtained genetic samples from 9000 healthy controls, 8064 samples with Type 1 Diabetes, and 2560 samples with Celiac Disease. They found a total of seven loci (regions of the chromosome) that were shared between celiacs and diabetics. These genes may be more susceptible to these autoimmune conditions.

What is still unclear is how environmental and other genetic factors might affect the shared regions of the chromosome, increasing the chance of developing these autoimmune conditions. While further research is needed to understand how the mechanisms these conditions have in common leads to the development of these diseases, locating these loci has opened up new understanding.

Does Being Celiac Affect Diabetes?

When you're diabetic, you require a balanced diet containing healthy carbohydrates (wholegrain bread, pasta, and so on). When you're a celiac, you can't digest the gluten in bread and pasta. This inability to digest nutrients can make it difficult to control your blood glucose, leading to hypoglycaemia (blood-glucose too-low).

Also, when you're following a gluten-free diet, you have to be careful because many gluten-free alternatives are higher in sugar (to make them taste more pleasant), so you have look at the sugar in your diet, so you don't go into hyperglycaemia (blood glucose too-high).

The Best Diet for a Diabetic Celiac

In order for your gut to return to normal, so you can digest all the nutrients from your food, you need to follow a strict, lifelong gluten-free diet. This is the case, even if you aren't really having any symptoms and feel well.

The next step is to eat three meals a day. Skipping meals will not help you balance your blood-glucose levels. Also, keep some low-sugar snacks with you, in case your blood glucose levels drop between meals. Gluten-free oatcakes are a good option (if you can eat gluten-free oats, not everyone can), or a plain gluten-free biscuit.

Eat a gluten-free carbohydrate at every meal. Carbohydrate is essential for controlling your blood-glucose levels. So try some toast at breakfast, a potato for lunch and some gluten-free pasta for dinner. Other good gluten-free carbohydrates include: all rice, yams, millet, quinoa, and tapioca.

Follow a healthy diet: Fish, chicken, lean meat, vegetables and pulses are all gluten-free and good for your diabetes, too.

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Avoid "Diabetic" versions of juices, sweets, and desserts. They cost a fortune, have as many calories, and as much fat as full sugar versions, still raise your blood-glucose, and cause a laxative effect. You're better off having a smaller amount of real sugar, or skipping it altogether.

If You've Been Diagnosed as a Celiac Diabetic

If you've been diagnosed a celiac diabetic, you may find that you need more insulin. You may find this because gluten-free staples tend to have higher sugar levels, or you may find it because - having removed gluten from your diet - your body is now digesting nutrients it couldn't digest before. You will need to keep a closer eye on your blood-glucose levels, and talk to your diabetes management team if your blood-glucose levels begin going too low or too high.

Although managing both Celiac Disease and Type 1 Diabetes can be a nuisance, as soon as you adapt to your new diet, you can look forward to a healthier you.