Diabetes and Celiac Disease (Part 2)

Last week, in "Diabetes and Celiac Disease (Part 1)," we started to take a look at celiac disease: what it is, how many people have it, and common symptoms. This week, we’ll look at how celiac is diagnosed and how it’s treated.


Diagnosis of Celiac Disease
Celiac disease is diagnosed in a very specific manner. For a person to be diagnosed with this condition, at least three factors need to be in place.

First, a person must have either the HLA DQ2 or HLA DQ8 gene (don’t worry; this won’t turn into a genetics lesson!). This means that a person is genetically predisposed to getting celiac. Eating gluten-containing foods doesn’t cause celiac.

Second, as with most autoimmune diseases, including Type 1 diabetes, something needs to “trigger” the onset of celiac, such as an illness or infection, stress, surgery, puberty, pregnancy, etc.

And third, you must have been exposed to gluten in some form (which is pretty easy to do, given the number of foods that contain gluten).

According to the Gluten Intolerance Group, diagnosis of celiac starts with a blood test, which looks for high levels of certain kinds of antibodies. Blood tests don’t confirm the diagnosis, however; the “gold standard” for diagnosis is a biopsy of the villi of the small intestine. A physician will do this by inserting a narrow, flexible tube down your throat into your small intestine, where a piece of the intestinal tissue is taken. If the biopsy indicates that you have flattened villi, in all likelihood, you have celiac. The final step in the diagnostic process is to go on a gluten-free diet for a period of time. If your symptoms improve, then it’s highly probable that you have celiac.

It’s important that people who suspect (or in whom their physician suspects) they might have celiac disease not go on a gluten-free diet before they are diagnosed. Otherwise, the biopsy may come out negative, and the person won’t truly know if they have celiac or not.

Also, because celiac can run in the family, first-degree relatives (parents, siblings, or children) of the diagnosed person may also wish to be tested. About 5% to 15% of a person’s first-degree relatives will have celiac.

Treating celiac is pretty easy, yet can be awfully hard at the same time. At this point in time, the only treatment for celiac disease is to follow a gluten-free diet. A gluten-free diet must be followed for life. Gluten is a kind of protein found in wheat (including spelt, triticale, and Kamut), barley, and rye, and is what causes damage to the small intestine. This means that the obvious grain foods, such as bread, pizza crust, cereal, crackers, and pasta, for example, must be completely eliminated from the diet. On the positive side, though, there are many products that can be included in the diet, such as:

  • Rice
  • Quinoa
  • Amaranth
  • Potato
  • Buckwheat
  • Corn
  • Soy
  • Bean flours
  • Oats (with caution; if you do choose to eat oats, look for oats that are specifically labeled “gluten-free” as they can sometimes be cross-contaminated)

This means that people with celiac disease can still eat bread, cereal, pasta, and crackers—as long as they’re made with gluten-free ingredients such as those listed above.

Many grocery stores and natural food stores now sell gluten-free products, along with gluten-free flours, such as rice flour, so that you can bake your own bread and pizza crust, for example. Of course, you can still eat fruits, vegetables, lean protein foods, and healthy fats, such as olive oil. Dairy foods are okay too, although you may have a temporary lactose intolerance due to flattened villi (which usually resolves once the villi heal).

Most people with celiac will say that the hardest part about the diet isn’t giving up regular bread or pasta; instead, it’s knowing what’s in the food that they eat. The tricky part about a gluten-free diet is that many processed and packaged foods contain additives and other ingredients that contain gluten. Wheat and wheat products are often used as thickeners and stabilizers. Other foods may contain modified food starch that contains gluten. One must become an astute label-reader and become very familiar with acceptable ingredients. Even a tiny amount of gluten is enough to cause damage to the intestine in people with celiac.

More on celiac next week!

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  • Roni

    About the testing for Celiac, you mentioned not to be on a gluten free diet prior to the procedure. My daughter was diagnosed with gluten sensitivity 3 years ago. If the test is being done for Celiac, how will her current diet affect the test. We call it a low gluten diet.

  • acampbell

    Hi Roni,
    One reason not to be on a gluten-free diet prior to being tested for celiac is that the biopsy of the small intestine may be negative (and the biopsy is usually considered “definitive” in terms of diagnosis) when, in fact, the person actually has celiac. However, if your daughter does need a biopsy, the test may still reveal that she has celiac, as she’s been on a “low” gluten diet as opposed to a gluten-free diet. Be sure to tell her physician about her diet, as he/she may decide to order additional antibody blood tests to help confirm the diagnosis.

  • phil

    My wife has been recently diagnosed w/celiac’s. However, she is also a diabetic taking a slew of medecine

    Was wondering what literature is out there that would help her with these ‘new’ carbs, in reference to #’s, how they are mettabloized, etc…any info will be appreciated.

  • acampbell

    Hi phil,

    A good resource that will provide nutrient information on various gluten-free grains is Calorie King. Check out http://www.calorieking.com or the Calorie King Calorie, Fat and Carbohydrate Counter. Another good resource on celiac is Living Gluten-Free for Dummies. Plus, go to http://www.celiac.com for more resources. Many of the gluten-free grains such as quinoa and amaranth are considered to be whole grains, for the most part, and may have less of an effect on blood glucose. However, your wife should start checking glucose levels about 2-3 hours after meals, at least on occasion, to learn how these “new” carbs affect her.

  • kreampuff

    I have type 1 Diabetes and recently was diagnosed with Celiac Disease, I also was told that I am allergic to Casein (a protein found in dairy that is similar in structure to gluten). I am 29 and my husband and I have been trying to get pregnant. I am so afraid that I won’t be able to conceive and if I can, what kind of diet will I need to be on? I haven’t been able to find anything about what to eat so that the baby gets enough nutrition and my blood sugars stay under control. Is this even possible? Has anyone had a successful pregnancy with these 3 issues (type 1 Diabetes, Celiac, casein allergy)? I would like to start on this diet ASAP so that I can get my blood sugars as under control on the diet as I can… so that the pregnancy is successful and we have a healthy baby. Please help me…

  • acampbell

    Hi kreampuff,

    Have you meet with a dietitian yet? It’s certainly a challenge to juggle diabetes, celiac and a food allergy and it will be difficult, as you’ve already found out, to do this on your own. If you don’t have a dietitian, ask your physician for a referral. And if possible, meet with a dietitian who is either also a certified diabetes educator or has experience in working with people with diabetes. You can also go to the American Dietetic Association’s website at http://www.eatright.org to find a dietitian in your area.

  • LJ

    I am 34 female who was just diagnosed with celiac disease. I have been gluten free for about 2 weeks. I have read that type 1 diabetes shares the same chromosome. I have never been diagnosed with diabetes but since being gluten free I get shaky more often. My next doctors appointment is next week. I was wondering if anyone had an answer now as far as the possibility of me being type 1 diabetic. This is all new to me. Thanks for your time in reading this.

  • acampbell

    Hi LJ,

    About 1 in 10 people who have type 1 diabetes also have celiac disease. And the American Diabetes Association, as part of their standards of care, recommends that people with Type 1 diabetes get screened for celiac. I am not sure, however, how likely it is for a person who already has celiac to develop Type 1 diabetes, but I suspect that there is a fairly good chance, given the similar genetic predisposition. My advice is to talk with your doctor about this at your appointment next week. He may decide to test you for diabetes (which is done with a blood test). And perhaps some of our other readers with celiac may chime in to share their experiences, too.