Celiac disease can be one of the toughest things to diagnose. So many times I hear about people going to several doctors and being diagnosed with all kinds of ailments before they are finally diagnosed with celiac disease.
My story was a little different.
Within minutes of telling my doctor the symptoms I was experiencing, she accurately guessed that it was celiac disease. Sure enough, blood work and an endoscopy proved her right.
Why was it so easy in my case? I was, and am, a type 1 diabetic. Astoundingly, celiac disease affects as much as 10% of type 1 diabetics.
What exactly is the connection between these two diseases? Let’s take a look at how and why these two diseases are associated with one another. Here are a few useful facts about celiac disease and type 1 diabetes…
- Both celiac disease and diabetes are autoimmune diseases. In autoimmune diseases, the human immune system malfunctions and attacks healthy body tissue. Formerly referred to as juvenile diabetes, type 1 diabetes can actually occur at any age, though it most commonly has a childhood or adolescent onset (I was diagnosed when I was 12). It is an autoimmune disease that involves the body attacking the cells of the pancreas that make insulin.Celiac disease can have a childhood, adolescent or adult onset (I was diagnosed when I was 16). It is massively under-diagnosed, and it is common to find older adults diagnosed for the first time with what may have been a lifelong active form of the disease. Celiac disease’s autoimmune process involves the body attacking the intestinal villi when exposed to the gluten protein. The resulting damaged intestinal cells lead to nutrient malabsorption.
- Having one autoimmune disease typically predisposes a person to having others. There are more than 80 known autoimmune diseases. Having one autoimmune disease is thought to increase a person’s chance of developing others. Research exists to support the association of autoimmune thyroiditis with rheumatoid arthritis and type 1 diabetes, for example, as well as type 1 diabetes with celiac disease and Addison’s disease. It is widely thought to be a genetic connection between celiac disease and type 1 diabetes, and in someone with a genotype predisposed to these diseases, either or both conditions can be triggered by infection, stress, or other factors. According to a recent Italian study, only 0.5 percent of the general population has celiac disease, but 4.4 to 11.1 percent of people with type 1 diabetes have celiac disease. How I fell into this tiny subset of the population? Must be my good luck.
- Untreated celiac disease may trigger development of diabetes. Some researchers believe that celiac disease that goes undiagnosed or undertreated (through less than total compliance with a gluten-free diet) may trigger the development of type 1 diabetes in children who are genetically predisposed to both diseases. This is supported by research, such as the Italian study cited above, that shows that children who have both diseases develop diabetes younger than those who will ultimately only have diabetes. There is a hypothesis held by some medical professionals that diagnosing celiac disease and treating it with a gluten-free diet earlier may help prevent the development of both diabetes and other endocrine conditions (such as thyroid disease).
- Gluten-free diets tend to be high-glycemic, so diabetics must use caution. The typical American gluten-free diet puts diabetics at risk of blood glucose spikes and dips. While many gluten-free individuals replace wheat-based carbohydrates and processed foods with those made from the most typical gluten-free replacements (white rice and white rice flour, white potatoes, potato starch, tapioca starch), these foods are some of the worst options for diabetics. Gluten-free processed foods tend to be both high in sugar and low in fiber, fat and protein, which can all have a negative impact on blood glucose.People with diabetes and celiac disease, therefore, may benefit from working with a dietitian to identify lower-glycemic gluten-free products and recipes. A gluten-free diet for someone with diabetes will de-emphasize processed gluten-free food and focus instead on lean proteins, low-fat dairy, high-fiber whole grains (such as quinoa and buckwheat), vegetables, nuts, legumes and fruits with the appropriate balance of carbohydrates, fats and proteins. Working with a doctor and nutritionist, a diabetic with celiac disease can also learn to adjust their insulin doses according to which gluten-free foods they consume. This will help compensate for occasional consumption of higher-glycemic dishes.
- People with diabetes and celiac disease report better quality of life when a gluten-free diet is maintained. Although staying gluten-free will not automatically improve a diabetic’s blood glucose control, and controlling blood glucose will not automatically improve celiac disease symptoms, research indicates that diabetics with celiac disease who are consistent in their adherence to the gluten-free diet report a higher quality of life than those who do not.In one publication from the Juvenile Diabetes Research Foundation, parents discussed how they had assumed their diabetic child’s dizziness, headaches or fatigue were from diabetes, only to happily see those symptoms dissipate when the child was diagnosed with celiac disease and placed on a gluten-free diet. When dealing with multiple health conditions, treating one effectively can only have a positive impact on the rest of one’s health. Despite posing some new challenges when it comes to food and blood glucose control, maintaining a strictly gluten-free diet can only improve the health outlook for celiacs who have type 1 diabetes.
So what about you guys? Any fellow celiac / type 1 diabetics out there? What do you find most challenging about managing both diseases?