Dear Diabetes: What is celiac disease?
According to research, an estimated 10 percent of people living with type 1 diabetes may also have an autoimmune disease called celiac disease. Celiac disease, formerly known as celiac sprue, is a digestive disease that affects about 1 in 141 people in the U.S., although many may remain undiagnosed.
What exactly is the condition? People living with celiac disease cannot tolerate gluten, which is a protein found in wheat, barley, and rye. Ingesting gluten would cause damage to the small intestine and impede the body’s ability to absorb nutrients from food. If someone living with celiac disease eats gluten, their body creates antibodies against the gluten protein which attack the lining of the intestine. Damage to the tiny hairlike structures called villi in the walls of the intestine can lead to malnourishment over time. This happens because nutrients cannot be absorbed properly without healthy villi.
Symptoms of celiac disease
Symptoms of celiac disease may be highly variable from person to person and some people may have no symptoms. The most well known symptoms – diarrhea and weight loss – are only experienced by about one-third of people with a diagnosis of celiac disease. According to studies, twenty percent of people with celiac disease have constipation, and ten percent are obese.
Signs and symptoms of celiac disease are so variable that lists are divided by age. For adults, the signs may include:
- Unexplained iron-deficiency anemia
- Muscle cramps, joint/bone pain
- Tingling or numbness in hands and feet
- Sores in mouth
- Missed menstrual periods
- Infertility or recurrent miscarriage
- Itchy skin rash called dermatitis herpetiformis
- Bone loss (osteoporosis)
- Depression or anxiety
Talk to your healthcare team if you suspect any of the above signs or symptoms.
Who is at risk for celiac disease?
Celiac disease is genetically based and occurs in up to 1 in 22 people who have a first-degree relative with the disease – a parent, sibling or child, for example. Celiac disease is also more common in people who have other genetic disorders such as Down syndrome and Turner syndrome. In addition, celiac disease is more common in those who have another autoimmune disease including one or more of the following:
- Type 1 diabetes
- Autoimmune thyroid disease
- Autoimmune liver disease
- Rheumatoid arthritis
- Addison’s disease
- Sjogren’s syndrome
How is celiac disease diagnosed?
If you or your health care team suspect that you have celiac disease, you can expect to be given a thorough physical exam and a blood test for antibodies. (Doctors may advise not to alter your diet prior to these tests; if a person stops eating foods with gluten prior to being tested, the results may be negative for celiac even if the disease is present.) You may also be asked to collect a stool sample. In addition, a small sample (biopsy) may be taken from your intestine, using a thin, hollow tube called an endoscope to confirm the diagnosis. This sample can be examined under a microscope to detect damage to the villi in your intestine.
More than half the people living with celiac disease are undiagnosed. Missing or delaying a diagnosis of celiac disease may be dangerous since the longer someone has celiac disease, the more damage may occur in the intestines. This may lead to more malnourishment, which in turn may further damage the body’s organs.
Celiac disease vs. gluten sensitivity
Some people may be sensitive to gluten, but do not have celiac disease; although people with gluten sensitivity may have similar symptoms, they do not test positive for celiac. People with gluten sensitivity do not have autoantibodies or intestinal damage. The only way to differentiate between gluten sensitivity and celiac disease is to be screened for celiac disease. If a diagnosis of celiac disease is not determined by the screening process, a fully gluten-free meal plan may be tested; if it diminishes symptoms, and if symptoms return when gluten is reintroduced, then a diagnosis of gluten sensitivity is confirmed.
Treatment for celiac disease
As of now, the only effective treatment for celiac disease is a 100% gluten-free meal plan. The National Institutes for Health does provide a downloadable chart with foods to avoid, safe foods and foods that may contain gluten. In my experience, restaurants are getting better about labeling gluten-free menu items, although it is still wise to ask the chef how foods are prepared. More and more gluten-free foods are available in grocery stores as well. I’ve also found that the website Gluten-Free Living provides a good list of resources for people with celiac disease.
Although gluten is mainly found in food, it can also be present in medicines, vitamins, and lip balms. It is a good idea to meet with a dietitian to discuss effective approaches to eating and living well with celiac disease.
Jane K. Dickinson, RN, PhD, CDE* (@JaneKDickinson) is a nurse and diabetes educator in Northwestern Colorado. She is the program coordinator and on the faculty for the online Master of Science in Diabetes Education and Management Program at Teachers College, Columbia University. Dickinson is also the author of People With Diabetes Can Eat Anything: It’s All About Balance. Dickinson is a paid contributor for The DX. All opinions contained in this article reflect those of the contributor, and not of Sanofi US, its employees, agencies, or affiliates.
*“Certified Diabetes Educator” and “CDE” are certification marks owned and registered by the National Certification Board for Diabetes Educators (NCBDE). NCBDE is not affiliated in any way with Sanofi US. NCBDE does not sponsor or endorse any diabetes-related products or services.
© 2014 The DX: The Diabetes Experience