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  • Type 1 Diabetics Frequently Have Undiagnosed Celiac Disease

      Journal of Gluten Sensitivity Spring 2011 Issue. NOTE: This article is from a back issue of our popular subscription-only paper newsletter. Some content may be outdated.

    Caption: Image: CC--Colcalli

    Celiac.com 03/01/2019 - About 30,000 new cases of type 1 diabetes are diagnosed annually in the US, typically in children. If a serious disease affected up to 10% of all type 1 diabetics, wouldn’t you agree that it’s time to sit up and take notice? Perhaps screening for this disease would also make sense.

    Celiac disease affects 1% of the population, making it a common disease. In the celiac population there is an increased prevalence of type 1 diabetes and this association is well established.  Despite celiac disease affecting a much greater percentage of the general population than type 1 diabetes, 90% of the patients suffering from both conditions are first diagnosed with diabetes.[1] Study results vary, but the prevalence of celiac disease among children with diabetes ranges between 4.5% (over 25 studies),[2] to 10%[3] and 12.3%[4] respectively. Opinions on whether screening of all diabetic patients should become part of the medical model are controversial, but fortunately, we are seeing increased support  [5,6,9]. 

    It is difficult to overestimate the stress associated with the diagnosis of a severe illness in a child. And perhaps the last thing that a parent wishes to hear is that a second severe illness may be involved.  I understand that. But consider the fact that both type 1 diabetes and celiac disease are autoimmune diseases.  When a patient has one autoimmune disease they are much more likely to develop another. And obviously the greater the number of such conditions that affect a single individual, the lower their vitality and life expectancy are likely to be.

    I would recommend to any parent of a child with type 1 diabetes, as well as any adult with the disease, that they get tested for both celiac disease and gluten sensitivity as soon as possible.  In my clinical experience we have seen excellent changes when a gluten-free diet was implemented. The facts are these: when celiac disease is diagnosed in diabetics it often occurs within a couple of years of the diabetes diagnosis, but after 5 years the cumulative numbers revealed an estimated 10% incidence of celiac.[3]     This is just too common to ignore and the ill effects it creates in these individuals can be dramatic.

    While it may seem overwhelming to consider, in the long run it could mean the difference between a stable health condition and life-long health challenges. 

    Please let me know if I can be of any assistance.  I am here to help.

    Sources: 

    1. Ludvigsson JF, “Celiac disease and risk of subsequent Type 1 diabetes” Diabetes Care 
    2. 29(11), 2483–2488 (2006).
    3. Holmes GK. “Screening for coeliac disease in Type 1 diabetes”. Archives of Disease in Childhood. 87(6), 495–498 (2002). 
    4. Larsson K, et al. “Annual screening detects celiac disease in children with Type 1 diabetes”. Pediatric Diabetes 9(4 Pt 2), 354–359 (2008). 
    5. Hansen D,  et al. “Clinical benefit of a gluten-free diet in Type 1 diabetic children with screening-detected celiac disease” Diabetes Care 29(11), 2452–2456 (2006).
    6. Holmes GK. “Coeliac disease and Type 1 diabetes mellitus – the case for screening”. Diabetic Medicine 18(3), 169–177 (2001). 
    7. Narula P, et al. “Gastrointestinal symptoms in children with Type 1 diabetes screened for celiac disease”. Pediatrics 124(3), E489–E495 (2009). 
    8. Sanchez-Albisua. “Celiac disease in children with Type 1 diabetes mellitus: the effect of the gluten-free diet. Diabetic Medicine 22(8), 1079–1082 (2005). 
    9. Goh C. “Prevalence of coeliac disease in children and adolescents with Type 1 diabetes mellitus in a clinic based population”. Postgraduate Medical Journal 83(976), 132–136 (2007). 
    10. Frohlich-Reiterer EE, et al. “Screening frequency for celiac disease and autoimmune thyroiditis in children and adolescents with Type 1 diabetes mellitus” Pediatric Diabetes 9(6), 546–553 (2008). 


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  • About Me

    Dr. Vikki Petersen, a Chiropractor and Certified Clinical Nutritionist is co-founder and co-director, of the renowned HealthNow Medical Center in Sunnyvale, California. Acclaimed author of a new book, "The Gluten Effect" - celebrated by leading experts as an epic leap forward in gluten sensitivity diagnosis and treatment. Dr. Vikki is acknowledged as a pioneer in advances to identify and treat gluten sensitivity. The HealthNOW Medical Center uses a multi-disciplined approach to addressing complex health problems. It combines the best of internal medicine, clinical nutrition, chiropractic and physical therapy to identify the root cause of a patient's health condition and provide patient-specific wellness solutions. Her Web site is:
    www.healthnowmedical.com

  • Related Articles

    Jefferson Adams
    Celiac.com 02/22/2017 - Type 1 diabetes mellitus (T1DM) and celiac disease (celiac disease) are autoimmune diseases that share similar genetic patterns. T1DM treatment is based on diet, physical activity and insulin therapy, whereas celiac disease treatment is based on a gluten-free diet.
    A research team recently set out to evaluate the quality of life (QoL) of individuals with the association of T1DM and celiac disease, to characterize their nutritional status and to compare it with those with only one disease and to healthier control subjects. The research team included JG Nunes-Silva, VS Nunes, RP Schwartz, S1 Mlss Trecco, D Evazian, ML Correa-Giannella, M Nery, and MS Queiroz. The are variously affiliated with the Nutrition and Dietetics Division, Central Institute of Clinics Hospital, the Lipids Laboratory (LIM-10), Endocrinology and Metabolism Division of Hospital das Clinicas, Faculty of Medical Sciences, the Radiology Institute of Clinics Hospital, the Cellular and Molecular Endocrinology Laboratory (LIM-18), and the Endocrinology Division, Internal Medicine Department, all at the University of São Paulo Medical School, São Paulo, Brazil.
    The researchers evaluated sixty patients controlled by sex, age and body mass index (BMI). Patients were further divided into the following groups based on previous diagnosis: DMCD group (T1DM and celiac disease); DM group (T1DM); celiac disease group (celiac disease); or HC (healthy control subjects). They used the SF-36 questionnaire to assess psychological well-being, and compared the results with glycemic control, presence of complications related to diabetes, and adhesion to gluten-free diet (GFD).
    Using BMI, waist circumference, bio-impedance, general laboratory tests and whole-body densitometry, they determined nutritional status and body mass composition.
    Both the DMCD and DM groups had similar times of diagnosis, but the duration of celiac disease was significantly higher in the celiac disease group compared with DMCD. The SF-36 analysis revealed statistically significant differences between DM and HC groups in two domains: general health (P=0.042) and energy/vitality (P=0.012).
    QoL was also correlated with compliance to a GFD, and scores were similar in both groups: DMCD and celiac disease. Forty percent of individuals in the celiac disease group had visceral fat area above 100 cm2, compared with just 20% in the other groups.
    So, are people with both Type 1 diabetes and celiac disease automatically doomed to worse health? It seems not. To be sure, they are generally less healthy than control subjects, but the study found that the DMCD group had similar scores to DM, celiac disease and HC on QoL, as well as on their nutritional status and bone metabolism. The researchers conclude from this that the association of T1DM and celiac disease did not deteriorate the health status of the individuals with both Type 1 diabetes and celiac disease.
    So, it seems that having both Type 1 diabetes and celiac disease dose not automatically mean having worse health, nutrition and well-being.
    Source:
    Nutr Diabetes. 2017 Jan 9;7(1):e239. doi: 10.1038/nutd.2016.43.

    Jefferson Adams
    Celiac.com 07/05/2017 - Numerous researchers have documented a connection between celiac disease and type 1 diabetes.
    One team of researchers recently set out to examine international differences in celiac disease rates and clinical characteristics of youth with coexisting type 1 diabetes and celiac disease compared with type 1 diabetes only.
    The research team included Maria E. Craig, Nicole Prinz, Claire T. Boyle, Fiona M. Campbell, Timothy W. Jones, Sabine E. Hofer, Jill H.Simmons, Naomi Holman, Elaine Tham, Elke Fröhlich-Reiterer, Stephanie DuBose, Helen Thornton, Bruce King, David M. Maahs, Reinhard W. Holl and Justin T. Warner.
    To analyze the relationship between outcomes, including HbA1c, height-standard deviation score [sDS], overweight/obesity, and type 1 diabetes with celiac disease versus type 1 diabetes alone, adjusting for sex, age, and diabetes duration, the team created multivariable linear and logistic regression models.
    The analysis included 52,721 people under 18 years of age with a clinic visit between April 2013 and March 2014. The team used the following data sources: the Prospective Diabetes Follow-up registry (Germany/Austria); the T1D Exchange Clinic Network (T1DX) (U.S.); the National Paediatric Diabetes Audit (U.K. [England/Wales]); and the Australasian Diabetes Data Network (ADDN) (Australia).
    The researchers found biopsy-confirmed celiac disease in 1,835 young people, or 3.5%. These patients were diagnosed on average at age 8.1 years, with a range of 5.3 to 11.2 years.
    Most young people (37%) with diabetes upon celiac disease diagnosis had it for less than one year. Eighteen percent with diabetes had it for 1-2 years at celiac diagnosis, 23% had diabetes between 3 and 5 years at celiac diagnosis, while 17% had diabetes for more than 5 years at celiac diagnosis. Celiac disease rates ranged from 1.9% in the T1DX to 7.7% in the ADDN and were higher in girls than boys (4.3% vs. 2.7%, P < 0.001).
    Children with coexisting celiac disease were diagnosed with diabetes at 5.4 years on average, compared with those with type 1 diabetes only, who were diagnosed at 7.0 years of age, on average. Also, fewer children with both conditions were non-white, 15 vs. 18%.
    Height-SDS was lower in those with celiac disease (0.36 vs. 0.48) and fewer were overweight/obese (34 vs. 37%, adjusted P < 0.001), whereas average HbA1c values were comparable: 8.3 ± 1.5% (67 ± 17 mmol/mol) versus 8.4 ± 1.6% (68 ± 17 mmol/mol).
    This study clearly documented that celiac disease is not uncommon in young people with type 1 diabetes. Differences in disease rates may be due to variations in screening and diagnostic practices, and/or risk levels.
    Although the groups showed similar glycemic control, the research team encourages close monitoring of growth and nutrition in this population, due to the lower height-SDS.
    Source:
    Diabetes Care 2017 May; dc162508.  
    The researchers in this study are variously affiliated with the Children’s Hospital at Westmead, Sydney, New South Wales, Australia; University of New South Wales, Sydney, New South Wales, Australia; Charles Perkins Centre Westmead, University of Sydney, Sydney, New South Wales, Australia; Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany; German Center for Diabetes Research, Munich-Neuherberg, Germany; Jaeb Center for Health Research, Tampa, FL; Leeds Children’s Hospital, Leeds, U.K.; The University of Western Australia, Perth, Western Australia, Australia; Telethon Kids Institute, Perth, Australia; Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria; Vanderbilt University Medical Center, Nashville, TN; Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, U.K.; Women’s and Children’s Hospital, Adelaide, South Australia, Australia; Department of Pediatrics, Medical University of Graz, Graz, Austria; St. Helens and Knowsley Teaching Hospitals NHS Trust, St. Helens, U.K.; John Hunter Children’s Hospital, Hunter Medical Research Institute, University of Newcastle, Callaghan, New South Wales, Australia; Lucile Salter Packard Children's Hospital Stanford, Stanford University Medical Center, Palo Alto, CA; and the Children's Hospital for Wales, Cardiff, U.K.

    Dr. Vikki Petersen D.C, C.C.N
    Celiac.com 10/27/2017 - It has long been understood that two autoimmune diseases, celiac disease and type 1 diabetes are related. They share common genes and the incidence of celiac disease is higher among type 1 diabetics. There have been some anecdotal reports regarding children diagnosed with type 1 diabetes who were put on a gluten-free diet soon after their diagnosis and for a period of two years or more didn't require any insulin. The thought was that the gluten-free diet effectively halted the progression of the diabetes, at least for the duration of the study.
    Studies of mice have shown that despite utilizing a genetic strain of mice that were strongly in-bred to increase the risk of type 1 diabetes, 2/3 of them did not do so when a drug was administered to prevent leaky gut. This study was performed by Dr. Alessio Fasano at the University of Maryland Celiac Research Center. Dr. Fasano is one of the world's acclaimed researchers in the area of celiac disease and gluten sensitivity.
    Leaky gut is associated with the initiation and continuation of autoimmune disease and Dr. Fasano's work with these genetically predisposed mice shed a great deal of light on the power of an undamaged gut lining to effectively forestall development of a genetic condition, in this case type 1 diabetes.
    A recent study out of Immunology, dated August 22, 2012, is titled "Dietary gluten alters the balance of proinflammatory and anti-inflammatory cytokines in T cells of BALB/c mice". The title is a mouthful but here is what the researchers out of Denmark found:
    Their initial premise was based on the idea, as I mentioned above, that dietary modifications, specifically a gluten-free diet, could reduce the risk of developing type 1 diabetes. The question they posed was, "How did this occur?"
    They discovered that wheat gluten induced the production of pro-inflammatory chemicals called cytokines that would damage the intestinal lining and immune tissues of the small intestine. More importantly, a gluten-free diet didn't just neutralize the negative effects just mentioned, but it actually caused the production of anti-inflammatory chemicals that would provide protection for the immune system and gut. So, while gluten is a known bad guy, a gluten-free diet doesn't just take the negative away, it actually induces a positive, healing response.
    Clinically we frequently see this with patients. As soon as we meet a patient with any history of autoimmune disease, we quickly test them for celiac disease and gluten sensitivity via lab tests and a 30 day elimination diet. If we discover any negative immune reaction to gluten, we begin a strict gluten-free diet.
    Happily, we often see stabilization, if not reversal, of their autoimmune disease. We support the gluten-free diet with our other protocols for normalizing gut permeability (healing a leaky gut) and strengthening the immune system. Taken together this program yields excellent results.
    If you know anyone suffering from an autoimmune disease, please show them this article. Gluten could be a component in furthering their disease and a gluten-free diet could be a positive influence in their journey to improved health.
    I hope this was helpful. Please feel free to contact me should you have any questions. And if your health is not at the level you would like, I can also offer you a free health analysis. Call us at 408-761-3900.
    Our destination clinic treats patients from across the country and internationally and we would be delighted to help you.
    To your good health.

    Jefferson Adams
    Celiac.com 10/19/2018 - Work to develop a vaccine for celiac disease could soon lead to a vaccine for diabetes.
    After successful phase 1 studies of Nexvax2, their peptide-based therapeutic vaccine for celiac disease, ImmusanT has seen a significant investment from venture philanthropy organization JDRF T1D. ImmusanT's peptide therapy program for celiac disease may provide lessons for a similar therapeutic treatment for Type 1 diabetes.
    The investment will support ImmusanT as it attempts to develop a vaccine to prevent Type 1 diabetes, based on the early success of its peptide immunotherapy program for celiac disease, the two entities announced in a press release.
    ImmusanT’s celiac peptide therapy program works by identifying antigens that trigger an inflammatory responses in people with autoimmune diseases. Once identified, the peptide therapy is used to neutralize the autoimmune response. This celiac disease program goes back to 1998, when Anderson first began his efforts to find and identify the peptides. 
    The findings were published in 2010, and the company was founded shortly afterward by Leslie Williams, BS, RN, MBA, director, president and CEO of ImmusanT. 
    From there, ImmusanT conducted five phase 1 trials for its celiac therapy. Those trials have proven very promising, and the latest investment into a similar drug for diabetes is proof of that promise. In the case of celiac disease, the drug works by “targeting T cells in patients. Those T cells that are engaged as peptides are distributed throughout the body after the injection, and we see evidence that the T cells are being activated about 2 hours later,” Robert Anderson, BMedSc, MB, ChB, PhD, FRACP, chief scientific officer for ImmusanT, told Endocrine Today. “We found that if we gradually increase the dose in patients building up to a maintenance dose level, they become non-reactive to those peptides.”
    With much of the early research targeted towards demonstrating the drug’s safety, and getting the right dose and dose regimen, the development of a version targeted at diabetes, says Anderson, “should be more streamlined due to the lessons learned during the celiac disease program.
    That’s partly because the team knows “a lot more going into Type 1 diabetes about how peptide therapy works and how to optimize it than we did when we started celiac disease, where it was a blank slate.”
    This is really exciting news. A vaccine for celiac disease is exciting, to be sure, but a viable vaccine for diabetes would be a major development in disease prevention. Stay tuned for more news as the story develops. 
    Read more at Healio.com

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    Doritos does make a few gluten-free versions.     
    Just wanted to chime in. During my 2 plus years of healing I had joint pain and muscle pain with some of the nightshade mainly peppers and tomato. I stopped them. I can now eat them again. My theory is when my gut gets cc my holey gut dumps some of my food in my blood stream and my already ticked off immune system let's me know what is allowed. Apparently for a time nightshades  of potato, tomatos, and peppers were an issue. I was able to gradually introduce potatoes first and then tomatos, then
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