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The Celiac Section

The Link Between Celiac Disease and Type 1 Diabetes

The transition to a gluten-free diet while keeping blood sugar levels in check is no mean feat, explains Suzanne Simpson, a dietitian at the Celiac Disease Center at Columbia University in New York. She should know: she has worked with many diabetics to introduce a gluten-free diet and lives with both conditions herself.

Gluten-free foods can be significantly different in the amount of carbohydrates they contain. Take spaghetti, for example. Regular wheat noodles contain 23.8 grams of carbohydrate for 150 mL of pasta. Rice spaghetti has 42 grams for the same serving size, almost double. Also, foods can have different amounts of protein and fat, which can delay the rate of absorption of the carbohydrate. “People may end up requiring more insulin – or less insulin,” says Simpson.

Such was the case for Devon Carlson. She, like Oddenino, has had type 1 diabetes since she was a child. It wasn’t until she was 26 that routine blood testing picked up antibodies for celiac disease, which was confirmed with an intestinal biopsy.

As she transitioned to a gluten-free diet her blood sugars quickly went out of whack. “For about three months I was trying all these different [gluten-free] foods, and they add a lot of sugar and fat into them,” recalls Carlson.

The increased fat content caused her body to absorb carbohydrates at a different rate than she was used to, causing her insulin dose to be off. “Once I figured out which gluten-free processed foods I would keep in my diet and stopped trying all these different foods, I got my blood sugar back under control.” She also found that choosing whole foods, such as fruits and vegetables and gluten-free grains, made her insulin dosing a simpler task.

In addition to having to monitor closely how your body’s blood sugar levels will respond to the foods you’re eating, having both celiac disease and diabetes comes with a new set of challenges when dining out and traveling. When she was first diagnosed with celiac disease, Oddenino was in a job where she traveled weekly.

“Traveling with both celiac and diabetes requires thinking ahead in terms of where your next meal is going to be, and what you’re going to have to eat,” she says. While it can always be tricky to find gluten-free foods on the road, having diabetes means you can’t leave anything to chance because eating at regular intervals is key to keeping blood sugars under control.

Simpson agrees. When she travels, she calls the hotel to have a fridge put in her room and, upon arrival, finds out where the closest store is and stocks up on fruit, milk and gluten-free bars and cereal. To Oddenino, this forced planning was actually a blessing: “My colleagues and co-workers would frequently be stuck at some airport fast-food place, and I would have fresh vegetables and meat from my planning ahead.”

You might say Oddenino and Carlson are among the lucky ones, since they got fairly timely diagnoses of celiac disease. In contrast, many people who have celiac disease go undiagnosed for years, because symptoms are often vague (diarrhea, bloating, fatigue, etc.) and many family doctors aren’t aware of how common the disease is.

That’s a concerning issue since untreated celiac disease can increase the risk of osteoporosis, intestinal cancers, neurological disorders and infertility. Because of the strong association between the two autoimmune diseases, increasing numbers of people with diabetes are screened for celiac disease in the United States and Canada which means even those with “silent” celiac disease (they show no symptoms) are getting on the gluten-free diet.

At this point, there’s no reason to test people with celiac disease for type 1 diabetes, says Fasano. That’s because diabetes is easy to spot and likely won’t go undiagnosed. However he says there is evidence that people who develop type 1 diabetes have certain antibodies long before their diagnosis.

If one day scientists discover a way to slow down the progression toward type 1 diabetes, then screening may make sense. As researchers continue to discover the origins of these two diseases the relationship between them should become clearer. The hope is that diagnoses can be made, allowing more people to live to their healthiest potential.

First published in Allergic Living magazine.
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