Hear from our experts

Celiac disease and Type 1 diabetes

Lorraine Anderson, RD, CDE, Clinical Manager, Animas Canada

Did you know that people with Type 1 diabetes are at greater risk of having celiac disease as well?

The odds are five to seven times greater than the general population. Celiac disease is an autoimmune condition causing an inflammatory state of the small intestine that occurs in genetically predisposed individuals and resolves when gluten is removed from the diet. Gluten is a protein that is found in wheat, rye and barleys. Some individuals have inflammation resulting from oats even if uncontaminated.

When people with celiac disease eat foods containing gluten, their immune system responds by damaging the lining of the small intestine, which can affect how nutrients are absorbed by the body.

Celiac disease can cause symptoms such as diarrhea, weight loss, vomiting, constipation, malnutrition, abdominal pain and bloating. In many people, celiac disease can be present with only mild symptoms or even none at all.

In people with Type 1 diabetes, more than half have no symptoms of celiac disease when they are diagnosed. There are blood tests to screen for celiac disease, and because of the known connection between celiac and Type 1 diabetes, it is recommended that children and adults with diabetes undergo screening. As part of this screening, if the screening blood tests come back positive, your doctor may refer you to a gastroenterologist for further evaluation. A biopsy of the small intestine is currently the gold standard for how celiac disease is diagnosed.

Presently, the only treatment available is a gluten-free diet. The diet is very strict and even very small amounts of gluten may damage the intestine. In other words, people with celiac disease must avoid most grain products including pastas, cereals, breads and many processed foods. A dietitian can help you to plan a healthy gluten-free way of eating that will allow you to manage your diabetes as well. It is important to learn how to properly read ingredient lists on food labels to identify foods that contain gluten and to make gluten-free choices in the grocery store and when eating out. There are many foods that do NOT contain gluten (or are considered naturally gluten free) including “plain” meats, fish, milk, fruits and vegetables. There are many gluten-free grains such as: rice, quinoa, amaranth, millet, and buckwheat that may be new to your palate and your diet, but with some guidance from your dietitian, you will be able to incorporate them into your gluten-free meal plan. There are many available gluten-free recipes for baked goods that have been well formulated to replace the wheat flour using alternative flours such as rice, potato, soy, quinoa, amaranth, teff and bean flour. The carbohydrate content of gluten-free foods may be different than their gluten containing counterparts (gluten-free pasta and gluten-free bread may contain a higher carbohydrate content than regular wheat-based pasta and bread). It is important to be aware of the carbohydrate content of the gluten-free foods and your portion sizes so you are able to properly match your insulin to your intake. Keep in mind that gluten-free foods may also have a high glycemic index (GI) so it is very important to work with your dietitian to help you successfully manage both your celiac disease and diabetes.

There is still a lot that we don’t know about celiac disease and Type 1 diabetes. In Ontario, there is an upcoming study looking into the question of whether people with Type 1 diabetes (who don’t have symptoms of celiac but who test positive) may benefit from a gluten-free diet. It is very important to know if a gluten-free diet is helpful or not.

The research study is recruiting people who’ve had Type 1 diabetes for more than one year (ages 8-35), who have not been previously diagnosed with celiac disease or who have symptoms of the disease. If you or someone you know are interested in learning more about the CD-Diet Study, please contact Jolie Davies-Shaw at jolie.davies-shaw@sickkids.ca.

For more information on celiac disease, check out www.celiac.ca and find your local chapter of the Canadian Celiac Association. There are numerous resources, recipes and links available.

Many thanks to Esther Assor and Jolie Davies-Shaw from the Hospital for Sick Children in Toronto for their review of this article.

The information made available on the Animas website is not intended to be used or viewed as a substitute for consultation with a healthcare professional. The information provided on this site cannot be the basis for diagnosis or therapy. You are advised to obtain professional advice and should always discuss your treatment plan with your healthcare team.