You may have heard of celiac disease—also known as gluten intolerance, sprue or gluten enteropathy. Gluten is a protein found in wheat, barley and rye. In celiac disease your immune system mistakes gluten for a foreign invader and attacks it as if it were a virus or an infection. This is an autoimmune response, similar to what causes type 1 diabetes.
Gluten is processed by an enzyme abbreviated as tTG that is found in many organs throughout our bodies. In people with a genetic predisposition, this interaction triggers the body’s immune system to attack the absorptive cells lining the intestinal tract, making it difficult for nutrients to be absorbed properly. People with classic celiac disease have diarrhea, abdominal pain and weight loss, along with nutrient deficiencies such as iron and zinc.
Celiac and type 1 diabetes share some genetic similarities. About 5 percent of people with type 1 diabetes will develop celiac disease. It is not easy to determine who is at risk since celiac disease is a complex genetic disorder with many genes playing a role.
One gene sequence identified as HLA –DQ2 is found in greater than 75 percent of people with proven disease. The HLA-DQ2 gene is also often found in people with type 1 diabetes. However, many people who do not have celiac disease or diabetes also carry these genes, so additional genetic factors are at work. Scientists have identified eight other genetic areas that may contribute to both celiac and diabetes, but this research is still in this infancy.
And, remember in order to develop either or both conditions you require an environmental insult.
Those with celiac have a lower risk of developing type 2 diabetes. Ironically, this may be related to untreated sprue causing malabsorption and weight loss.
For a long time it was thought that people of Irish decent were more likely than others to develop celiac. But it turns out this isn’t true. Unlike some other diseases such as sickle cell orTaySachs, celiac isn’t found more in any particular ethnic background. The number of cases of celiac worldwide is rising and people of all backgrounds can become gluten intolerant. It isn’t however, as common as the popular press and advertisers would make you believe. Only about 1 percent of the worldwide population has celiac.
Another misconception is that celiac is a disease of the gastrointestinal tract alone. While it is certainly true that the small intestine is usually affected, it can damage many organs in the body: lung, liver, kidneys and blood vessels, the skin and the reproductive organs. For example, up to 70 percent of people with untreated disease have osteopenia or osteoporosis .
Uncontrolled celiac can lead to cancer of the esophagus and small bowel as well as increasing the risk of placental abnormalities and miscarriages. An exact cause is unknown but it may possibly be due to the increased production of antibodies and disruption of the normal hormonal balance of pregnancy.
Gluten intolerance is one of the few disease for which diet (complete avoidance of gluten) is the sole treatment (at least presently). The diet is difficult for many reasons: personal food preferences, high carb content of many foods, social and professional occasions replete with inappropriate food, poor availability of gluten free products in some parts of the country, lax compliance with cross-contamination rules in some restaurants.
Although gluten intolerance isn’t an allergy, people who get the disease have to approach offending foods in the same way someone who is allergic does. There are no half measures with celiac. In fact if you are not completely adhering to the diet virtually all the time, your intestines won’t heal properly and you are subject to the same risks as someone who doesn’t follow the diet at all. That is why making an appointment with a dietitian who specializes can make all the difference.
Because of dietary compliance issues, Big Pharma is starting to test drugs to prevent the cellular damage caused by the disease. Two different drugs are in the works. One by Alvine Pharmaceuticals functions in the same way as allergy shots to desensitize the immune system; the other, called Alba, closes the spaces between cells in the small intestine making it more difficult for gluten to enter. These drugs are still very much in the development stage, but it does give some hope that having accidental or even intentional occasional gluten exposure will not be a cause for concern.
What to do?
- If you have diabetes and any symptoms such as anemia, unstable blood glucose numbers, bloating or lethargy- get tested. The gold standard for testing is an intestinal biopsy. However there are screening tests (tTG) that are about 90% accurate and are excellent at ruling out celiac disease.
- If you have had a child recently or are expecting, starting feeding your child gluten-containing foods (wheat, barley or rye) between 4 and 7 months. Those fed gluten products before 3 months or after 7 months have an increased risk of celiac disease.
- If you are diagnosed, ask for a referral to a dietitian specializing in diabetes and celiac disease.