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The Celiac Disease and Type 1 Diabetes Screening Controversy

To screen or not to screen diebetics for celiac disease? 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.

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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

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.

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8 Responses:

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said this on
09 Aug 2010 11:13:40 AM PST
One little thing is not mentioned; there is no reliable test available which would rule out celiac disease. Well, that means all statistics about prevalence of celiac disease are wrong. I am just wondering when those sciences stop fooling people. According many respectable sciences; gluten is just not suitable food for any mammal, include human. Water containers made of led use to be OK, so mercury teeth feeling.
I have no Dr. on front of my name, so my voice wouldn’t count.

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said this on
11 Aug 2010 10:34:02 PM PST
One must not confuse their own personal opinion about gluten consumption with the disease known as celiac disease. A person with celiac disease will have certain genes, a specific immune system response to gluten, as well as the autoimmune destruction of their intestinal villi when they eat gluten. This simply does not occur in those without celiac disease, no matter how much gluten they eat. Gluten may not may not be a "safe" food for the general public, but the same could be said about many others foods. On another note, people can have allergic (not autoimmune per se) reactions to penicillin, strawberries, peanuts, fish, etc. but that doesn't mean the public should stop consuming these items. We celiacs must not assume *everything* is related to celiac/gluten. Granted, some new hings are now beginning to be realized, but we can't get carried away just yet. That said, I do believe all T1 diabetics should be screened for celiac, and 100% treated if they have it, even asymptomatic. I think while some diseases can be linked to gluten (autoimmune diseases primarily), the majority of people (non-celiacs) who blame gluten for their problems simply eat a poor diet in general, and changed their habits going gluten free. Hence why they feel better. Not all (some truly are gluten intolerant), but many.

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said this on
16 Aug 2010 8:17:28 PM PST
I'm a type 1 DM, diagnosed w/ celiac (biopsy proven) 7 years ago. Prior to diagnosis I was asymptomatic, and used to laugh I had an 'iron stomach'. Was eating tons of gluten. Now on the gluten free diet, I've found that a single crumb of gluten will have me in the bathroom the whole next day! There's no question I need the diet, and wonder if the same would happen for other asymptomatic type 1's...

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said this on
23 Aug 2010 7:44:13 PM PST
I am also Type I DM and had maybe very mild symptoms if any. Now that I have been on a gluten free diet I am very sensitive to foods and also get an upset stomach easily even if I just eat a cracker. So yes same thing here!

Mr. H
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said this on
11 Jan 2011 4:00:11 AM PST
Wheat protein causes Type 1 Diabetes.

google the following

A type 1 diabetes-related protein from wheat (Triticum aestivum). cDNA clone of a wheat storage globulin, Glb1, linked to islet damage.
this is from www.

Diabetes: Celiac Disease and Type 1 Diabetes - F. W. Scott's Research- Smoking Gun Evidence
this is from

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said this on
22 Jan 2012 11:44:55 PM PST
Excessive alcohol intake , like celiac, can destroy villi in small intestine, so perhaps mild gluten intolerance combined with long term excessive drinking can totally mimic celiac?

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said this on
10 Jun 2012 9:24:48 AM PST
I don't trust many of the studies done here in the US! About 2-3 years ago I came across my first study showing a signifcant correlation between type 1 diabetic children under age 5 and celiac (done in sweden or finland)and it showed even though many of the children tested negative, the diabetes were easier to treat (sugar levels were better under control) when put on a celiac diet. I've done TONS of research and found that those who are celiac, should be lactose free as well! since the body use gluten to make the enzyme that helps break down lactose, and stay away from soy as much as possible, since it is a phytoestrogen and they can significantly increase your chance of cancer, especially if you have a compromised immune system like T1D. The best example I have is my friends daughter was diabetic(undiagnosed) and I told her I believed her daughter was diabetic and the doctors tested her and came up negative. About 6 months later her daughter was rushed to the hospital and spent several days there trying to get the sugar levels down and she at the time was diagnosed diabetic (still type 2, not offically 1 yet). Now about 2 months before this( for some reason i do not know) I told her that when her daughter was diagnosed with diabetes she needed to put her on a celiac diet, so when the daughter was diagnosed diabetic, she had her tested for celiac, and it came up negative. About 6 months later her daughter became type 1 diabetic and a year after being tested for celiac, the pediatrian approached my friend with the same study I had mentioned to her about 2 years before hand, showing that many children under the age of 5 who are type 1 diabetics go undiagnosably celiac. Once my friend's daughter was put on a celiac diet, her sugar levels finally became easier to control and she wasn't getting sick like she used to, but the hardest thing to accept(which I had informed her of and the doctor confirmed) if she had gone on a celiac diet when her daughter was diagnosed, the pancreas probably wouldn't have failed and it could have repaired itself enough to the point she may have no longer been diabetic with in the next 5-10 years with continuous proper diet control and exercise. for my second example, I myself had and undiagnosed autoimmune disorder and after continually getting worse over 4-5 years, finally did all the reasearch and decided to go on a celiac diet, try for 6 months- a year and if it didn't work well, then i'd go back to the things I used to eat. Well after a month i started to noticce a slight difference and after 4 months I felt better than I ever had, an now if I have even the slightest thing of gluten, my autoimmune flares up for at least 1 week(of basically no functioning) before I can even start to get back on track. I've had both gluten and lactose tests and had negative results, but when either one is introduced into my diet, flare ups occur. I also am HIGHLY allergic to choclate and been allery tested at least 12 times for it and been negative every time. From talking to my doctor I found out that only about 80-90% of people actually get a true result(positive or negative), because sometimes the immune system can hide the true reaction and some bodies don't react to blood tests or the prick test, but as soon as it's ingested the have a reaction(mostly everyone in my family has this issue). Ultimately, take what you doctor has to say with a grain of salt, at times I've had over 20 doctors tell me the wrong things and when I followed my gut reaction, I proved them all wrong and allowed myself to get better. Make sure you do your own reasearch on top of whatever they tell you, because I've experienced sometimes, they just make shit up, to seem smart and in the end it might hurt you. there's so much more I could say about more studies, but I'll leave this for now...


said this on
08 Apr 2013 12:26:56 PM PST
This is kind of a last resort. My daughter is 16 and seriously been through the ringer most of her life. When she was 7 years old, she passed out on the ball field... I'm talking no breathing, pulse very faint and turning blue. Since this day, they have put her through so many tests and surgeries it's become irritating. She hates going to the doctor because they continue to test for nothing.

She has hypoglycemia; her sugar for the past month has gone as low as 48 and highest is 86. The doctors have had her on a gluten-free diet. This helped a little, but not a whole lot. She has severe stomach cramps, migraines, shakiness and sometimes she passes out. They are sending her to yet another specialist. My daughter is becoming mad and irritated (I don't blame her). She weighs 107 and is 5'4. Any type of insight or recommendations would be great. We are at our wits' end.

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From the Chicago Celiac Disease Center which is one of the premier celiac disease research & treatment centers in the world: Are you scheduled for a biopsy? Are you eating gluten? Any changes in your diet can affect the accuracy of your biopsy result...

My panel was the same as yours........all tests positive by large numbers so you can consider yourself a Celiac. Are you very symptomatic? I will add that I did not eat Whole Foods exclusively when healing. I needed to gain weight badly so ate gluten-free bread and a few other things that ...

My allergist did suggest I cut out gluten right away, but I?ll call the GI tomorrow and discuss that. Thank you!

He only did 2 of the full panel & you are positive on one of them, the DGP IgG. It only takes one positive to move on to an endoscopy. Here's the full celiac serum panel: Anti-Gliadin (AGA) IgA Anti-Gliadin (AGA) IgG Anti-Endomysial (EMA) IgA Anti-Tissue Transglutaminase (tTG) Ig...

That's about the most definitive positive across the board that I've ever seen. You're way positive on every one. Keep eating gluten every single day until the endoscopy! You don't have to eat a ton, 1 or 2 slices of gluten bread per day will do it. Orrrrrrrrrrr you could take this time to pig ou...