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    New Celiac Disease Screening Recommendations Published by American Diabetes Association


    Scott Adams


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    Celiac.com 12/28/2006 - The American Diabetes Associations (ADA) Clinical Practice Recommendations have been updated to include new information about treatment and prevention that reflects the latest research. Changes have been made in numerous areas, including the management of hyperglycemia in type 2 diabetes; nutrition recommendations; and screening and treatment for children who have both type 1 diabetes and celiac disease.

    In 2006, the ADA published Medical Nutrition Therapy (MNT) guidelines for people with diabetes, specific to individual populations, such as those who are obese or pregnant. The Clinical Practice Recommendations have been updated to reflect these guidelines and to encourage people with diabetes or pre- diabetes to seek individualized MNT to help them achieve their treatment goals.

    Information about how to treat children who are diagnosed with both type 1 diabetes and celiac disease was also added to the Clinical Practice Recommendations this year. Up to 16 percent of children with type 1 diabetes are also diagnosed with celiac disease, an immune disorder that affects the digestive system, damages the small intestine and interferes with the absorption of nutrients from food. The recommendations call for more aggressive screening for celiac disease in children with type 1 diabetes who present symptoms such as weight loss, growth failure, abdominal pain and chronic fatigue. A gluten-free diet is recommended for those who test positive for celiac.

    Diabetes Care, published by the American Diabetes Association, is the leading peer-reviewed journal of clinical research into the nations fifth leading cause of death by disease. Diabetes also is a leading cause of heart disease and stroke, as well as the leading cause of adult blindness, kidney failure, and non-traumatic amputations.

    For more information about diabetes call 1-800-DIABETES (1-800-342-2383).

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  • About Me

    In 1994 I was diagnosed with celiac disease, which led me to create Celiac.com in 1995. I created this site for a single purpose: To help as many people as possible with celiac disease get diagnosed so they can begin to live happy, healthy gluten-free lives. Celiac.com was the first site on the Internet dedicated solely to celiac disease. In 1998 I founded The Gluten-Free Mall, Your Special Diet Superstore!, and I am the co-author of the book Cereal Killers, and founder and publisher of Journal of Gluten Sensitivity.

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  • Related Articles

    Dr. Murali Jatla
    Celiac.com 11/06/2007 - This study investigated the effect of screening detected celiac disease in type I diabetic children in a multi-center case-control fashion.  The research team consisted of B Rami, Z Sumni, E Schober et al from Austria, Czech Republic, and Slovenia, among other European countries.
    The team compared 98 diabetics with silent celiac disease to 196 control diabetics without celiac matched for age, sex, diabetes duration.  Mean age at diabetes diagnosis was 6.5 yrs, celiac diagnosis was 10.0 yrs.  Celiac screening included yearly antibody testing and positive patients underwent biopsy.  Hemoglobin A1c, hypoglycemia, ketoacidosis, insulin dosage, body-mass index, and height did not differ between cases and controls at celiac diagnosis or after a mean follow-up of 3.3 years.  After diagnosis of celiac disease, weight gain was diminished in boys with celiac disease compared to their controls.
    Although a clear link between type I diabetes and increased risk of celiac disease is established, the benefit of a gluten-free diet is unclear in these children.  This study followed 98 patients with diabetes and silent celiac for a mean of 3.3 years and compared them to 196 controls.  This is the largest, best designed case-control study to date and it did not demonstrate any significant differences between the two groups, except for a decreased Body Mass Index (BMI - though still greater than non-diabetic, control children) in males after diagnosis. 
    What is more intriguing is that at diagnosis, no significant differences in height, BMI, HbA1c, insulin need, or hypoglycemia events were seen, questioning the metabolic significance of silent celiac disease.  In this study, it is difficult to estimate the duration of silent celiac disease prior to diagnosis.  Although, given the fact that these patients were asymptomatic and their mean diabetes duration was 3.6 years, it likely implies that silent celiac disease was present for a few years.
    The data regarding the benefit of a gluten-free diet in screening detected celiac disease in type I diabetic children is scant but is slowly increasing.  Numerous psychological (burden of gluten free diet in addition to diabetic diet), cost (of diet), and ethical issues (potential long-term benefits of gluten-free diet, compliance with diet) exist regarding these children and hopefully this question will be answered soon and with good, convincing data. 
    Journal of Pediatric Gastroenterology and Nutrition, 41:317-321, 2005

    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.

    Destiny Stone
    Celiac.com 08/09/2010 - Modern scientists agree that scientific evidence connects celiac disease with Type 1 Diabetes. What scientists fail to agree on is what to do about the connection between the two autoimmune diseases. Some scientists promote celiac screening for all patients with type 1 Diabetes, while other scientists disagree.
    Celiac disease and Type 1 Diabetes are similar in that they are both autoimmune disorders resulting from a combination of genetic predisposition and environmental factors. The occurrence of celiac disease in patients with Type 1 Diabetes is documented to have a ratio 5-7 times higher than the general public. Also noted is an increased prevalence rate within ethnic groups.
    Classic celiac disease symptoms can be seen in Type 1 Diabetes patients, although most celiac and Type 1 diabetics are found to have mild or no symptoms. In fact, a study at a North American  celiac clinic examined children that had celiac and Type 1 Diabetes and showed that 71.4% of the subjects claimed to have no gastrointestinal symptoms at the time of their positive diagnosis.
    Another similar study in the United Kingdom reported that 76.4% of their patients studied exhibited at least one gastrointestinal symptom. In fact, the study goes on to state that when they further examined the Type 1 diabetics, 86% initially showed no symptoms but at the time of biopsy the percentage dropped to 22%.
    Serological testing has not only improved screening methods for celiac diagnosis, but also let to an increase in celiac diagnosis rates.  In Canada for example, celiac disease prevalence has shown a threefold increase since 1996. Consensus-based celiac testing guidelines have been developed by  many organizations, however, all of these organizations have a different idea of what to recommend to Type 1 diabetics when it comes to  celiac screening and treatments.
    The North American Society for Pediatric Gastroenterology and Hepatology (NASPGHAN) suggests screening  all Type 1 Diabetes patients for celiac disease and they encourage a gluten-free diet for asymptomatic children with other associated conditions. However HASPGHAN also recognizes that there isn't a lot of evidence supporting short-term improvements for diabetics on a gluten-free diet.
    The International Society for Pediatric and Adolescent Diabetes (ISPAD) agrees that there is limited data to support a gluten-free diet for diabetics. As such ISPAD refers children to a pediatric dietician if they test positive for celiac disease and Type 1 Diabetes.
    The National Institutes of Health promotes celiac screening for symptomatic Type 1 Diabetes patients, and they recommend treating patients that exhibit biopsy proven celiac disease.
    The American Diabetic Association (ADA)  advocates screening all Type 1 Diabetes patients for celiac. They also urge patients with a confirmed celiac diagnosis to maintain a gluten-free diet.
    The Canadian Diabetes Association (CDA) promotes screening Type 1 Diabetes patients for celiac but they emphasize that treatment of asymptomatic celiac disease  combined with Type 1 Diabetes is
    controversial.
    These  conflicting instructions for screening and treating celiac are partly to blame the fact that most physicians are unclear about proper  protocol for celiac diagnosis and treatment. With so many authorities offering conflicting advice, it's no wonder that  many celiacs remain misdiagnosed or undiagnosed. It is also further evidence that a mandated approach to detecting and treating celiac disease is critical in order to avoid  long term ramifications.
    Source:

    Int J Pediatr Endocrinol. 2010;2010:161285. Epub 2010 Jun 23.

    Jefferson Adams
    Celiac.com 07/11/2013 - A team of researchers wanted to better understand screening practices for celiac disease in patients with type 1 diabetes across North America. One question they sought to answer was whether diabetes centers screen for celiac disease in type 1 diabetes more frequently than other facilities.
    The research team included S.M. Simpson, E.J. Ciaccio, S. Case, N. Jaffe, S. Mahadov, B. Lebwohl, P.H. Green. All except Case are affiliated with the Celiac Disease Center at Columbia University, New York, USA. Shelley Case runs her own nutrition consulting business in Regina, Saskatchewan.
    For their study, the team conducted a survey with 27 questions on screening practices for celiac disease in patients with type 1 diabetes. The questions were compiled by experts in celiac disease and diabetes.
    The team sent surveys by email to diabetes educators and dietitians throughout the United States and Canada between December 2010 and May 2011.
    They received 514 responses from 484 endocrine clinics, diabetes clinics, private practices, community nutrition centers, and inpatient centers.
    Thirty-five percent of these locations screened for celiac disease, with endocrine clinics reporting screening at the highest rate of eighty percent.
    Not surprisingly, the most common test celiac disease test was tissue transglutaminase, while the most frequently recommended treatment of confirmed celiac disease was a gluten-free diet. However, only 365 respondents (71%) recommended biopsy in patients with positive blood results.
    More than half of those responding (55.3%) reported that patient symptoms improved once they adopted a gluten-free diet.
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    Due to low screening frequency as well as inconsistency in management of positive celiac disease blood tests, the research team is calling for increased education regarding celiac disease in patients with type 1 diabetes, along with the adoption of uniform protocols.

    Source:
    Diabetes Educ. 2013 May 14. 

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    Bakery On Main started in the small bakery of a natural foods market on Main Street in Glastonbury, Connecticut. Founder Michael Smulders listened when his customers with Celiac Disease would mention the lack of good tasting, gluten-free options available to them. Upon learning this, he believed that nobody should have to suffer due to any kind of food allergy or dietary need. From then on, his mission became creating delicious and fearlessly unique gluten-free products that were clean and great tasting, while still being safe for his Celiac customers!
    Premium ingredients, bakeshop delicious recipes, and happy customers were our inspiration from the beginning— and are still the cornerstones of Bakery On Main today. We are a fiercely ethical company that believes in integrity and feels that happiness and wholesome, great tasting food should be harmonious. We strive for that in everything we bake in our dedicated gluten-free facility that is GFCO Certified and SQF Level 3 Certified. We use only natural, NON-GMO Project Verified ingredients and all of our products are certified Kosher Parve, dairy and casein free, and we have recently introduced certified Organic items as well! 
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    Jefferson Adams
    Celiac.com 06/19/2018 - Could baking soda help reduce the inflammation and damage caused by autoimmune diseases like rheumatoid arthritis, and celiac disease? Scientists at the Medical College of Georgia at Augusta University say that a daily dose of baking soda may in fact help reduce inflammation and damage caused by autoimmune diseases like rheumatoid arthritis, and celiac disease.
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    The research was funded by the National Institutes of Health.
    Read more at: Sciencedaily.com

    Jefferson Adams
    Celiac.com 06/18/2018 - Celiac disease has been mainly associated with Caucasian populations in Northern Europe, and their descendants in other countries, but new scientific evidence is beginning to challenge that view. Still, the exact global prevalence of celiac disease remains unknown.  To get better data on that issue, a team of researchers recently conducted a comprehensive review and meta-analysis to get a reasonably accurate estimate the global prevalence of celiac disease. 
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    The team cross-referenced each article with the words ‘Asia,’ ‘Europe,’ ‘Africa,’ ‘South America,’ ‘North America,’ and ‘Australia.’ They defined celiac diagnosis based on European Society of Pediatric Gastroenterology, Hepatology, and Nutrition guidelines. The team used 96 articles of 3,843 articles in their final analysis.
    Overall global prevalence of celiac disease was 1.4% in 275,818 individuals, based on positive blood tests for anti-tissue transglutaminase and/or anti-endomysial antibodies. The pooled global prevalence of biopsy-confirmed celiac disease was 0.7% in 138,792 individuals. That means that numerous people with celiac disease potentially remain undiagnosed.
    Rates of celiac disease were 0.4% in South America, 0.5% in Africa and North America, 0.6% in Asia, and 0.8% in Europe and Oceania; the prevalence was 0.6% in female vs 0.4% males. Celiac disease was significantly more common in children than adults.
    This systematic review and meta-analysis showed celiac disease to be reported worldwide. Blood test data shows celiac disease rate of 1.4%, while biopsy data shows 0.7%. The prevalence of celiac disease varies with sex, age, and location. 
    This review demonstrates a need for more comprehensive population-based studies of celiac disease in numerous countries.  The 1.4% rate indicates that there are 91.2 million people worldwide with celiac disease, and 3.9 million are in the U.S.A.
    Source:
    Clin Gastroenterol Hepatol. 2018 Jun;16(6):823-836.e2. doi: 10.1016/j.cgh.2017.06.037.

    Jefferson Adams
    Celiac.com 06/16/2018 - Summer is the time for chips and salsa. This fresh salsa recipe relies on cabbage, yes, cabbage, as a secret ingredient. The cabbage brings a delicious flavor and helps the salsa hold together nicely for scooping with your favorite chips. The result is a fresh, tasty salsa that goes great with guacamole.
    Ingredients:
    3 cups ripe fresh tomatoes, diced 1 cup shredded green cabbage ½ cup diced yellow onion ¼ cup chopped fresh cilantro 1 jalapeno, seeded 1 Serrano pepper, seeded 2 tablespoons lemon juice 2 tablespoons red wine vinegar 2 garlic cloves, minced salt to taste black pepper, to taste Directions:
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    Cover and refrigerate for at least 1 hour. 
    Adjust seasoning with salt and pepper, as desired. 
    Serve is a bowl with tortilla chips and guacamole.