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  • Jefferson Adams
    Jefferson Adams

    Could Adverse Gut Reaction Trigger Diabetes?

    Celiac.com 09/16/2009 - People with certain genetic markers may be more likely to develop adverse gut-reactions, which may help trigger the development of other immune problems, such as Type 1 diabetes, according to Dr. Fraser Scott, a member of the research team and a senior scientist at the Ottawa Hospital Research Institute.

    In a recent study of 42 Ottawa-area young adults with Type 1 diabetes researchers analyzed white blood cells, looking for a response to partially-digested wheat proteins. They found that people with certain genes are more likely to develop an over-reaction to wheat in the gut. Type 1 diabetes occurs when the immune system attacks the pancreas, the organ that regulates blood sugar. No such response was seen in another 22 diabetics in the study, nor in a separate control group of non-diabetics.

    The gastrointestinal tract is home to the largest variety of immune cells in the human body. In healthy people, the presence of food molecules in the gut does not spark an immune response against food molecules, Scott said. However, if the normal process breaks down, the gut can become inflamed or damaged. Celiac disease is one example of such a breakdown. Folks with Type 1 diabetes suffer higher rates of celiac disease than non-diabetics.

    One hypothesis for this is that certain immune cells may be stimulated by food triggers and migrate to the pancreas, where they damage insulin-producing cells, Scott said. The human gut is one of the main places where the human body interacts with its environment, including food, chemicals, bacteria and toxins. “It important to understand the role the gastrointestinal tract plays in this disease and other autoimmune diseases,” says Scott. “There are probably a large number of people who have diabetes risk genes, but only a small proportion of them develop Type 1 diabetes. These people have difficulty handling what is present in the environment.”

    Previous research has shown a gluten-free diet to reduce rates of diabetes in animal models. However, that does not mean that parents who want to keep their children from developing diabetes should adopt a gluten-free diet, says Scott. The genetic risk for diabetes is very complex, he adds.

    First, it's not easy to know for certain who will contract diabetes; 9 out of 10 people who develop Type 1 diabetes don’t have a relative with Type 1, Scott said. In the mean time, the Ottawa study touches on a very important part of the diabetes mystery. A number of scientists have suspected a link between diet, the gut and Type 1 diabetes for about 20 years now, Scott said. This is one of the first studies to affirm this connection in human cells.

    For Scott, the fact that 22 diabetics in the Ottawa study did not show a reaction to wheat protein means only that the condition is far more complicated than clinicians can conceive at present.

    In theory, there are myriad ways in which people may come to develop diabetes, and, says Scott, each may have developed by a separate route.

    Source:
    Ottawa Hospital Research Institute



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    I really think that in the end a whole lot of different autoimmune diseases will turn out to be due to microscopically leaky gut, of levels that can't be noticed with endoscopy/biopsy, nor our existing blood antibody tests. I have HLA DQ8, and just last week a 4th autoimmune disease was confirmed in me even though the blood antibodies, endoscopy and biopsy were all negative for celiac.

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    I'm happy to see more and more information on this subject, however it still hurt when you go to your doctor for help, and they treat you like you are crazy and the the pain in your gut is not real. So very sad. Yes, let's all work together to get the word out about celiac disease and the real pain that it causes in a person life on a daily basic.

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  • About Me

    Jefferson Adams earned his B.A. and M.F.A. at Arizona State University, and has authored more than 2,000 articles on celiac disease. His coursework includes studies in biology, anatomy, medicine, science, and advanced research, and scientific methods. He previously served as Health News Examiner for Examiner.com, and devised health and medical content for Sharecare.com. Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of the book "Cereal Killers" by Scott Adams and Ron Hoggan, Ed.D.

  • Related Articles

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    Pediatrics 2002;109:833-838.
    Celiac.com 06/06/2002 - The results of a study conducted by Dr. Graziano Barera and colleagues from the Scientific Institute H San Raffaele, Milan, Italy and published in the May issue of Pediatrics indicate that those with type 1 diabetes are 20 times more likely to also have celiac disease. The researchers collected data on 274 consecutive newly diagnosed type 1 diabetes patients with a mean age of 8.28 years. These patients were studied for the following 6 years. At the time of their diagnosis 10 of them (3.6%) already had celiac disease, and over the next 4 years an additional 12 children tested positive for antiendomysial antibodies, and 7 underwent biopsies and were confirmed to have celiac disease. The overall prevalence of biopsy confirmed celiac disease in the group was 6.2%, and most of the cases were asymptomatic and the children showed no obvious signs of the disease. The researchers conclude that greater than 10% of children with newly-diagnosed type 1 diabetes had developed serological markers for celiac disease within the first 6 years of diagnosis, and they recommend that children in this category be screened annually for celiac disease for several years following their type 1 diabetes diagnosis.

    Scott Adams
    Celiac.com 02/25/2005 - Today a team of scientists at Alba Therapeutics Corporation and the University of Maryland School of Medicine report a direct link between zonulin-mediated increased intestinal permeability and Type 1 Diabetes (T1D) in the BB/wor Rat Model of Diabetes. Even more remarkable, the investigators were able to successfully prevent the onset of the autoimmune destruction of pancreatic beta cells and the onset of T1D in these animals by using the specific zonulin blocker AT-1001. Daily, oral administration of the drug beginning before the onset of auto-immunity in the diabetic prone rats cut the incidence of the disease by 2/3, and completely blocked the development of autoimmune antibodies in the treatment responders.
    Published in the latest issue of the Proceedings of the National Academy of Science (PNAS), these results constitute the first successful result in preventing the autoimmune process characteristic of T1D by blocking the zonulin-mediated abnormal intestinal permeability. These results go well beyond the development of a prevention strategy for T1D, says Dr. Alessio Fasano, lead author of the paper and Professor of Pediatrics, Medicine and Physiology and The University of Maryland School of Medicine. They open a new field of investigation in which the interplay between host and environment at the mucosal level may help us understanding the molecular basis of many diseases.
    These results reinforce our conviction that the zonulin pathway provides a roadmap for the discovery and development of innovative products to treat many important diseases, including diabetes, in ways previously thought to be inconceivable stated Dr. Blake M. Paterson. These preclinical proof-of-concept results with AT-1001 support the salvaging of beta cell function in pre-diabetics or in new-onset diabetes, giving us the impetus to rapidly move through the development process, bringing this dream to a reality for treatment in the diabetes community.
    T1D is an autoimmune disease that results in the destruction of the insulin producing cells of the pancreas, the islet beta cells. Current treatment of T1D is limited to the administration of insulin and other medications to treat the consequence of diabetes, elevated blood sugar and the complications thereof. The inability to treat the cause of T1D - a process known as autoimmunity, in which the bodys immune system attacks the beta cells of the pancreas - has been the key obstacle to the freeing patients from the yoke of this disease.
    Autoimmune diseases are thought to occur in individuals with the genetic pre-disposition to attack and destroy various organ tissues by the bodys own immune system. This immune misrecognition is thought to be triggered by the presence of an environmental stimulus; in the case of T1D, the trigger is unknown. While the majority of research efforts have focused on identifying the trigger of T1D and modifying immune pathways, little is known about how such a trigger might enter the body and about how such an entry-way might serve as a target for the treatment of the disease. The discovery of zonulin - a gatekeeper of intestinal barrier function, and its involvement in celiac disease, led to the hypothesis that its malfunction could be involved in a series of other autoimmune diseases characterized by a leaky gut, including T1D. Previous work by Dr. Alessio Fasano has shown a close association of celiac disease in children at risk of developing T1D and led to the novel discovery research in support of AT-1001.
    About Alba:
    Alba Therapeutics is a Baltimore based biopharmaceutical company dedicated to commercializing disease-modifying therapeutics and drug delivery adjuvants based on the zonulin pathway. Albas lead molecule, AT-1001, is targeted towards the treatment of Celiac Disease and Type 1 Diabetes and is in the final stages of pre-human testing.
    Contact Alba Therapeutics Corporation, Baltimore Dr. Blake Paterson, 410-522-8708

    Jefferson Adams
    Celiac.com 01/05/2010 - Researchers have found that celiac disease often precedes Type 1 diabetes in children with both conditions, and that up to 10% of children with Type 1 have clinical celiac disease, according to findings presented at Gastro 2009 in London, UK by T. Hansson of Uppsala University Hospital, Sweden.
    Hansson explained that researchers detected elevated levels of celiac disease-associated antibodies in children with recent onset Type I diabetes.
    “The presence of autoantibodies against tissue transglutaminase (anti-tTG) implies that celiac disease was present already at the time of Type 1 diabetes onset in all children having both diseases,” he said. “Hence, celiac disease may precede and cause Type 1 diabetes in children with both diseases.”
    A team of researchers looked for anti-tTG in blood samples from 169 children with new-onset Type 1 diabetes, 88 siblings of the patients, and 96 age- and gender-matched controls.
    A total of 21 patients with Type 1 diabetes, six siblings, and three controls showed elevated levels of anti-tTG.
    The team confirmed celiac disease via intestinal biopsy in five children before Type 1 diabetes, and 12 children after onset. Interestingly, blood samples from all but one of the 12 showed elevated anti-tTG at time of Type 1 diabetes onset and the remaining child showed elevated levels within 6 months of onset.
    From this, the research team concludes that 10.1% of children with Type 1 diabetes patients showed confirmed celiac disease, compared with 4.5% of siblings, all of whom were asymptomatic, and 2.1% of controls.
    The researchers suggest that a "change in diet in individuals with genetic susceptibility may reduce the risk of developing Type 1 diabetes." They add that “all Type 1 diabetes children and their siblings should be routinely screened for celiac disease-related antibodies.”
    Source: Gastro 2009, UEGW/WCOG; London, UK: 21–25 November



    Destiny Stone
    Celiac.com 07/07/2010 - There is mounting evidence that people with Type 1 diabetes are at high risk for celiac disease. Even with that knowledge, it is estimated that 97% of people with celiac disease go undiagnosed, which begs the question,  "should there be routine screening for celiac disease in those with type 1 diabetes?" Dr. Speiser and Dr. Rosenzweig explore the question  the further.
    Doctor Phyllis Speiser, Chief of the Division of Pediatric Endocrinology at North Shore-Long Island Jewish Health System in New Hyde Park, New York explains her stance in an interview with Medscape Diabetes and Endocrinology. Doctor Speiser notes that even at her institution there is a vast spectrum of varying opinions among pediatric endocrinologists regarding when and how to screen for celiac. Dr. Speiser believes that more awareness of celiac disease needs to occur, especially pertaining to atypical celiac patients, or those that do not exhibit any obvious signs of celiac disease.
    According to Dr. Speiser, research has shown that the prevalence of  celiac disease in patients with diabetes (both autoimmune diseases) is considerably higher, from 1%-16%, compared to the general population, from 0.3% to 1%. Moreover, when undiagnosed celiac disease can lead to secondary complications, including; stunted growth, weight loss, and bowl malignancy.
    Dr. Speiser and her coauthors studied the medical records of 532 consecutive patients with type 1 diabetes who were evaluated at some point between over a 3 year period by the Pediatric endocrinology division of her institution.
    Within 3 months of receiving a type 1 diabetes diagnosis, 493 patients were screened for celiac disease. Upon initial testing,  5.1% the patients with Type 1 diabetes were seropositive for celiac disease. Of those 11 patients, 44% were shown to have biopsy proven celiac disease. Of the other 94.9% of the subjects that tested seronegative for celiac on their initial screening, 5.4% were given a second screening. After being diagnosed with type 1 diabetes at least 5 years prior,  one of those patients  had biopsy-proven celiac disease.
    Twelve of the type 1 diabetic patients that had biopsy-proven celiac disease were placed on a gluten-free diet. It is interesting to note,  that approximately 58% of the patients with biopsy proven celiac, had been diagnosed for longer than a year, and up to 10 years after their type 1 diabetes diagnosis.
    Additionally, there were no reports from type 1 diabetic patients with biopsy-proven celiac disease reported gastrointestinal symptoms prior to receiving a  confirmed celiac disease diagnosis. Dr. Speiser emphasized the importance of early screening stating that this finding  “underscores the importance of not delaying screening for celiac disease until overt GI symptoms present”. Furthermore, based on her study, Dr. Speiser recommends screening for celiac disease as soon as a patient is positively diagnosed with diabetes.
    Dr. Speiser further stresses the importance of frequency in testing for celiac in diabetic patients. According to Dr. Speiser, some patients don't develop celiac for many years after receiving a diabetes diagnosis. Therefor, Dr. Speiser  recommends celiac screening once a year for patients with diabetes. Dr. Speiser notes that while celiac disease is often asymptomatic, symptomatic hypoglycemia often occurs in type 1 diabetic patients withing 6 months of receiving a positive celiac diagnosis.
    Doctor James L. Rosenzweig, an endocrinologist and associate professor of medicine at Boston University School of Medicine in Massachusetts, confirms that there is a well-known connection between type 1 diabetes and celiac however, he believes more studies are needed before he is convinced that more celiac screenings for pediatric diabetics.  are necessary.  Dr. Rosenzweig said in his interview that more tests require more money, and the cost of screening for celiac can really add up.
    While screenings for celiac may be expensive, the cost of medical bills for secondary medical problems as a result of undiagnosed celiac disease can be exorbitant, and possibly life threatening. At this juncture however, it is still a patients responsibility to  advocate for themselves where celiac screenings are involved.
    Source:
    ENDO 2010: The Endocrine Society 92nd Annual Meeting: Abstract P2-111. Presented June 20, 1020.

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    All of Schars products are gluten-free.  They don’t make any that are not.
    Yes, I had to stop eating Schar bread because I was getting sick on it all the time. I believe if I am not mistaken (it has been a long time) the Artisan line does not. I received this tip from someone else, and I don’t know if it is accurate but it seemed to help me, at least. 
    @Alaskaguy With regard to the timing, I think that everyone is a bit different! I used to have a shorter time to onset when I was first diagnosed (within 24h). As time has gone on, and I've glutened myself less and less, I have noticed that the time gets a bit longer.  Recent history seems to matter a bit too - if I've been glutened recently and then get glutened again, the rash will show up faster on the second round. For example, in the last 3 weeks I got slightly glutened by inadvertent
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