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Diabetes and Celiac Disease (Part 1)

Amy Campbell

Aug 25, 2008 @ 04:36 PM

You may recall that I attended the American Association of Diabetes Educators (AADE) annual meeting a few weeks ago.  When I arrived at the conference on Wednesday, I was a little late getting to the 1:30 session that I really wanted to go to and, as a result, got closed out. I then wandered across the hall to another session called "Managing Diabetes with Celiac Disease."

I figured, "What the heck, this will be a good review for me." I have to say that I'm really glad I attended, and I wanted to share some things that I learned. I know that Jan Chait wrote about celiac back in April ("Exploring the Gluten-Free World"), so I'll try not to repeat too much of the information that she shared.

Celiac disease is an autoimmune digestive disorder that is caused by eating foods that contain gluten, a type of protein found in wheat, rye, barley, and possibly oats. When a person with celiac eats a food that contains gluten, an immune reaction occurs that results in damage to the villi of the small intestine. Villi are finger-like projections that protrude from the lining of the small intestine and help increase the surface area, allowing nutrients to be absorbed at a fairly fast rate. With celiac, these villi are damaged and flattened out, leading to malabsorption.

If celiac isn't treated, nutrient deficiencies can result, causing problems with the nervous system, bones, and liver. People with untreated celiac are also at an increased risk for intestinal lymphoma and bowel cancer.

Facts and Figures
About three million people in the U.S. have celiac disease, but only 5% (150,000) are actually diagnosed. Twenty-five percent of new diagnoses occur in adults older than 60 years of age. And 6% of people with Type 1 diabetes have celiac. In people with Type 2 diabetes, about 1 in 250 have celiac. Having a family history of celiac increases the risk by between 5% and 15%. Celiac disease tends to be more common in people of European ancestry, as well as in people who have autoimmune diseases, including Type 1 diabetes, lupus, rheumatoid arthritis, and autoimmune thyroid disease.

Symptoms
Celiac disease often goes undiagnosed for many years. This is in part due to the malabsorption symptoms that occur, and health-care providers often look for other possible causes, such as irritable bowel syndrome, ulcers, and Crohn disease. Also, some people with celiac never get any gastrointestinal symptoms, which makes celiac even trickier to diagnose. However, some of the more common symptoms of celiac are:

  • Diarrhea
  • Abdominal pain
  • Bloating
  • Vomiting
  • Lack of appetite
  • Failure to thrive (in children)

Some less common symptoms include:

  • Anemia
  • Osteopenia (low bone density)
  • Fatty liver
  • Recurrent miscarriages
  • Short stature (in children)
  • Skin rash
  • Unexplained hypoglycemia (in people with diabetes)

In fact, celiac can affect all of the body's systems, not just the gastrointestinal tract. A particular skin condition called dermatitis herpetiformis (DH) is linked with celiac. DH is characterized by red bumps and blisters that cause intense itching, burning, and stinging. These lesions are symmetrically found on the elbows, legs, buttocks, shoulders, neck, and back. Diagnosis of DH is done by biopsy, and although medicine is prescribed, a strict gluten-free diet must be followed. In most cases, eating foods with gluten will trigger an outbreak of this skin condition, even if the condition has been healed.

More on celiac next week!

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