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Diabetes: Gastroparesis, Diabetes and Celiac Disease
Scott Adams posted an article in Diabetes and Celiac Disease
The following was written by Joseph A. Murray, MD. (murray.joseph@mayo.edu) of the Mayo Clinic Rochester, MN, who is a gastroenterologist who specializes in treating Celiac disease: Subject: diabetes and celiac disease, gastroparesis There is a definite incidence of celiac disease in type one diabetes in Caucasians at least. Anywhere from of 3.3% to 10 % of people with type one diabetes will have or develop celiac disease. Any form of diabetes can lead to gastroparesis, usually after many years of diabetes. The symptoms can be similar in many ways, bloating after meals, abdominal pain. Diarrhea is not usually caused by the gastroparesis itself (diabetic diarrhea may occur as part of the nerve damage caused by the long-standing diabetes). I have several patients who have diabetes, gastroparesis and celiac disease. Certainly identifying the celiac disease often makes a big difference to the symptoms.- 1 comment
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Celiac.com 08/03/2015 - Patients with type 1 diabetes who have celiac disease face in increased risk for retinopathy and nephropathy. A team of researchers recently set out to investigate whether celiac disease associated with type 1 diabetes increases the risk of microvascular complications. The research team included T.R. Rohrer, J. Wolf, S. Liptay, K.P. Zimmer, E. Fröhlich-Reiterer, N. Scheuing, W. Marg, M. Stern, T.M. Kapellen, B.P. Hauffa, J. Wölfle, R.W. Holl; and the DPV Initiative and the German BMBF Competence Network Diabetes Mellitus. They are variously affiliated with the Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Saarland University Medical Center, Homburg/Saar, Germany,the Department of Pediatric and Adolescent Medicine, St. Vincenz Hospital, Paderborn, Germany, the Department of Pediatrics, Technical University Munich, Munich, Germany, the Department of General Pediatrics and Neonatology, Children's Hospital, University of Giessen, Giessen, Germany, the Department of Pediatrics, Medical University of Graz, Graz, Austria, the Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany, the Center for Pediatrics and Adolescent Medicine, Bremen-Mitte Hospital, Bremen, Germany, the University of Tübingen Children's Hospital, Tübingen, Germany, the Department of Pediatrics, University of Leipzig, Leipzig, Germany, the Division of Pediatric Endocrinology and Diabetology, Department of Pediatrics II, University of Duisburg-Essen, Essen, Germany, and with the Pediatric Endocrinology Division of the Children's Hospital at the University of Bonn in Bonn, Germany. Their team conducted a multi-center longitudinal analysis of 56,514 patients from the German-Austrian DPV database. Patients were over 10 years of age, with diabetes for less than 20 years from 392 centers in Germany and Austria. Patients were assigned to one of three categories (n): no celiac disease (50,933), biopsy-confirmed celiac disease (812), or suspected celiac disease (4,769; clinical diagnosis or positive antibodies). The team combined the confirmed and suspected groups, and analyzed them for retinopathy or nephropathy. The team used Cox proportional hazards regression to adjust for potential confounders, such as glycated hemoglobin [HbA1c], age at diabetes onset, sex, smoking, dyslipidemia, and hypertension. Kaplan-Meier analysis showed that retinopathy and nephropathy occurred earlier in the presence versus absence of celiac disease: The team found retinopathy at age 26.7 years (95% CI 23.7-30.2) in 25% of patients with celiac disease vs. age 33.7 years (33.2-34.4) in 25% without celiac disease. They also found micro-albuminuria at age 32.8 years (29.7-42.5) vs. 42.4 years (41.4-43.3). Compared to versus patients without celiac disease, patients with diabetes and celiac disease showed higher adjusted risk for both retinopathy (hazard ratio 1.263 [95% CI 1.078-1.481]) and nephropathy (1.359 [1.228-1.504]). Cox regression showed that celiac disease is an independent risk factor for microvascular complications after adjustment for confounders. Patients with type 1 diabetes who have celiac disease face in increased risk for retinopathy and nephropathy, and the team recommends regular serologic celiac disease testing for type 1 patients, even in the absence of clinical celiac disease. Additional prospective studies are needed to determine whether a gluten-free diet might lower the risk of microvascular disorders in patients with both diabetes and celiac disease. Source: Diabetes Care. 2015 May;38(5):801-7. doi: 10.2337/dc14-0683.
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Celiac Autoimmunity in Type I Diabetes Mellitus
Jefferson Adams posted an article in Diabetes and Celiac Disease
Celiac.com 02/10/2015 - A number of studies have shown a connection between celiac autoimmunity and type 1 diabetes mellitus (T1DM). Doctors recommend celiac screening for T1DM patients, but screening is not always conducted. Meanwhile, reports about the impact of celiac autoimmunity in T1DM have been varied. A team of researchers recently set out to determine rates of celiac autoimmunity in patients with T1DM, and to study the impact of celiac autoimmunity on nutritional parameters, glycaemic control, endocrine axes and bone health. The research team included A.S. Joshi, P.K. Varthakavi, N.M. Bhagwat, M.D. Chadha, AND S.S. Mittal. They are variously associated with the Department of Endocrinology of Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai Central in Maharashtra, India. For their study, the team conducted celiac autoimmunity screens on eighty-six consecutive patients with T1DM using immunoglobulin A (IgA) tissue transglutaminase as a marker (TTG; IgG anti-gliadin in IgA-deficient case). They compared CA positive (CA+) T1DM cases with age-matched and sex-matched CA negative (CA-) T1DM cases for anthropometry, glycaemic control (as assessed by glycated haemoglobin (HbA1c) and hypoglycaemic/hyperglycaemic episodes), endocrine (thyroid function, cortisol, growth hormone (GH) axis, gonadal axes), haematological (haemoglobin, iron profile and vitamin B12 status) and calcium metabolism parameters and bone densitometry (by dual-energy X-ray absorptiometry (DXA)). Consenting patients with celiac autoimmunity also underwent upper gastrointestinal (GI) endoscopy with duodenal biopsy. Results showed that 11 of the 86 patients, about 12.75%, screened positive for celiac autoimmunity. Of those, seven patients underwent duodenal biopsies which suggested two cases of Marsh grade III, three cases of Marsh grade II and two cases of Marsh grade I celiac disease. In terms of anthropometry, CA+ T1DM patients were comparable with CA- T1DM patients. Overall, CA+ patients had higher HbA1c (10.7±1.8 vs. 8.4±1.0 (93±19 vs. 68±11 mmol/mol); p The incidence of fractures in the past 3 years was four CA+ patients, and one CA- patient (p<0.05). There is an important autoimmune connection between celiac disease and T1DM. For people with T1DM, celiac disease adversely affects stature, bone health, glycaemic control and iron and B12 levels. The study team recommends that IgA sufficiency be established before using an IgA-based screening test for celiac autoimmunity. Source: Arab J Gastroenterol. 2014 Jun;15(2):53-7. doi: 10.1016/j.ajg.2014.04.004. Epub 2014 Jun 7.- 2 comments
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Can a Gluten-free Diet Lower the Risk of Diabetes?
Jefferson Adams posted an article in Diabetes and Celiac Disease
Celiac.com 07/14/2014 - Early life intestinal problems have previously been shown to influence diabetes rates. There is also some evidence that a gluten-free diet can lower rates of diabetes, but just how strong is the influence of gluten-free diet on the development of diabetes? A recent study by a group of researchers in Denmark suggests that maternal gluten-free diet greatly reduces inflammation and rates of diabetes in the offspring of certain mice. This study led the team to hypothesize that a gluten-free diet, which is known to decrease type 1 diabetes incidence, may also offer protection against diabetes when followed during the pregnancy and lactation period. The research team included Camilla H.F. Hansen, Åukasz Krych, Karsten Buschard, Stine B. Metzdorff, Christine Nellemann, Lars H. Hansen, Dennis S. Nielsen, Hanne Frøkiær, Søren Skov and Axel K. Hansen. They are variously affiliated with the Department of Veterinary Disease Biology of the Faculty of Health and Medical Sciences at the University of Copenhagen, the Department of Food Science, Faculty of Science, University of Copenhagen, the Department of Biology, Faculty of Science, University of Copenhagen, the Division of Toxicology and Risk Assessment of the National Food Institute at the Technical University of Denmark in Søborg, Denmark, and the Bartholin Institute in Copenhagen, Denmark. For their study, the team fed pregnant non-obese diabetic (NOD) mice either a gluten-free diet, or a standard diet, until all pups were weaned to standard diet. Overall, mice which experienced early life gluten-free diets had dramatically lower rates of diabetes and insulitis. An analysis of gut microbiota using 16S rRNA gene sequencing showed a major difference between both mothers and their offspring, marked by higher levels of Akkermansia, Proteobacteria, and TM7 in the gluten-free diet group. Gluten-free fed offspring showed increased M2 macrophage gene markers and tight junction-related genes in the gut, along with higher levels of pancreatic FoxP3 regulatory T cells. Gluten-free offspring also had reduced intestinal gene expression of proinflammatory cytokines. Finding more T cells in the pancreas expressing the mucosal integrin α4β7 suggests that this is due to an increase in gut-primed immune cells moving to the pancreas. The study shows clearly that a gluten-free diet during the fetal and early postnatal life lowers rates of diabetes. This may be due to a change in gut microbiota and a reduction in pro-inflammatory conditions in the gut and pancreas. Clearly, further study is needed to better understand the factors at play, and how they relate to diabetes reduction efforts. Source: American Diabetes Association. doi: 10.2337/db13-1612 -
Could Adverse Gut Reaction Trigger Diabetes?
Jefferson Adams posted an article in Diabetes and Celiac Disease
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 -
Celiac.com 05/21/2014 - A team of researchers recently studied the risk of renal disease in patients with both type 1 diabetes (T1D) and celiac disease. The research team included K. Mollazadegan, M. Fored, S. Lundberg, J. Ludvigsson, A. Ekbom, S.M. Montgomery, and J.F. Ludvigsson, with the Clinical Epidemiology Unit of the Department of Medicine at the Karolinska Institutet in Stockholm, Sweden. For their study, the team used the Swedish Patient Register to review data on cases of T1D recorded at or before 30 years of age between 1964 and 2009. The team used biopsy reports from 28 pathology departments in Sweden between 1969 and 2008 to gather data on patients with celiac disease with villous atrophy (Marsh stage 3). They found 954 patients with both T1D and celiac disease. They age and sex-matched each patient with T1D + celiac disease to five reference individuals with T1D only (n = 4,579). They used Cox regression to estimate the following risks of both chronic and end-stage renal disease in patients with celiac disease + T1D compared with T1D patients only. They found that forty-one (4.3%) patients with celiac disease + T1D and 143 (3.1%) patients with T1D only developed chronic renal disease. This corresponded to an HR of 1.43 for chronic renal disease (95% CI 0.94, 2.17) in patients with celiac disease + T1D compared with T1D only. In addition, for end-stage renal disease there was a positive (albeit statistically non-significant) HR of 2.54 (95% CI 0.45, 14.2). For chronic renal disease, the excess risk was more pronounced after >10 years of celiac disease (HR 2.03, 95% CI 1.08, 3.79). Overall the two groups showed similar risk estimates when the cohort was restricted to T1D patients who had an inpatient diagnosis of T1D; those who had never received oral glucose-lowering medication; and (3) those who had not received their first diabetes diagnosis during pregnancy. The team found no excess risk of chronic renal disease in patients with T1D and celiac disease. Interestingly, a sub-analysis did show a connection between long-term celiac disease and chronic renal disease in people with T1D. Source: Diabetologia. 2014 Mar 25.
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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. Staff at endocrine clinics were most likely to suggest celiac disease testing for patients with type 1 diabetes. 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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Celiac.com 05/27/2013 - A team of researchers recently investigated whether celiac disease influences risk for non–insulin-dependent diabetes mellitus (NIDDM) and metabolic syndrome. To do so, they examined the prevalence of NIDDM and metabolic syndrome among adults with celiac disease, compared with healthy matched control subjects. The research team included Toufic A. Kabbani, Ciaran P. Kelly, Rebecca A. Betensky, Joshua Hansen, Kumar Pallav, Javier A. Villafuerte–Gálvez, Rohini Vanga, Rupa Mukherjee, Aileen Novero, Melinda Dennis, and Daniel A. Leffler. They are variously affiliated with the Celiac Center, Department of Medicine, Division of Gastroenterology at Beth Israel Deaconess Medical Center, and the Harvard School of Public Health in Boston, Massachusetts. For their study, the team assessed medical records of 840 patients with biopsy-proven celiac disease for diagnoses of NIDDM, hypertension, or hyperlipidemia; body mass index (BMI); lipid profile; and levels of glucose or glycosylated hemoglobin, to identify those with metabolic syndrome. They matched 840 healthy control subjects for age, sex, and ethnicity. They then compared rates of NIDDM and metabolic syndrome in the celiac disease cohort with that of the controls and subjects included in the National Health and Nutrition Examination Survey. The team found that 26 patients with celiac disease (3.1%) had NIDDM compared with 81 controls (9.6%) (P less than .0001). Similarly, patients with celiac disease had lower rates of metabolic syndrome compared with the control group (3.5% vs 12.7%; P less than .0001). The average BMI of patients with celiac disease was substantially lower than the BMI of control subjects (24.7 vs 27.5; P less than .0001). However, even after controlling for BMI, celiac disease patients still had a lower risk of developing NIDDM, compared with non-celiac patients. From this study, the team concludes that rates of NIDDM and metabolic syndrome are lower among patients with celiac disease than in matched controls and the general population. These differences are not explained by differences in BMI. Further study is important so that researchers can determine exactly how celiac disease affects the risk for NIDDM and metabolic syndrome. Source: Gastroenterology, Volume 144, Issue 5, Pages 912-917.e1, May 2013
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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.
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Celiac.com 07/22/2011 - Many reports indicate a hypercoagulative state in diabetes mellitus as result of endothelial damage. Numerous researchers have reported a strong association between type 1 diabetes mellitus (DM1) and celiac disease. Clinical data indicate that vascular dysfunction can result from a cascade of biochemical events triggered by a metabolic malfunction. The net result changes the cells that line the interior surface of the blood vessels; from a surface called a thrombo-resistant surface to one called a thrombo-genic surface. A research team recently set out to determine whether celiac disease in a group of DM1 patients is connected with a different expression of certain hemostatic factors, and with a different manifestation and/or progression of microvascular complications of DM1, as compared to patients with diabetes alone. For the study, the team enrolled ninety-four adult patients with DM1, who they then screened for celiac disease. They found anti-endomysial antibodies (EMA) in 13 of 94 DM1 patients (13.8%). The team then confirmed celiac disease diagnosis by histology and organ culture. The mean age and duration of DM1 of patients also affected by celiac disease were similar to those patients with diabetes alone, but the groups showed very different parameters for metabolic control and hemo-coagulation. In DM1 patients with celiac disease those parameters include: Signiï¬cantly lower concentrations of glycosylated hemoglobin (HbA1c) (P.05), cholesterol (P.001), triglycerides (P.001), factor VII antigen (FVII:ag) (P.005), factor VII coagulant activity (FVII:c) (P.05), and prothrombin degradation fragments (F1+2) (P.001). Higher values of activated C protein (APC) (.001). DM1 patients with celiac disease showed no retinal abnormalities and no signs of renal damage.The results suggest a potential protective role of celiac disease in the pro-thrombotic state of DM1. Source: Acta Diabetol. DOI 10.1007/s00592-011-0301-1
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Celiac.com 12/25/2012 - The connection between celiac disease and type 1 diabetes mellitus is well known. Up to now, very little has been reported about rates of celiac disease in children and adults with type 1 diabetes in Sicily. A team of researchers recently set out to assess the prevalence of celiac disease in patients with type 1 diabetes mellitus who come from a specific region of western Sicily and to assess the clinical features of these patients. The research team included D. Greco, M. Pisciotta, F. Gambina, and F. Maggio of the Division of Diabetology at Paolo Borsellino Hospital in Marsala, Italy. For their study, they analyzed data from 492 consecutive patients with type 1 diabetes mellitus who were referred over a five year period. They found that, of the 492 patients with type 1 diabetes, 14 females and eight males (a total of 4.5%) suffered from celiac disease. The patients averaged thirteen years of age at the time of diabetes onset. The team found that patients were diagnoses with celiac disease either at about the same time as diabetes, or afterward. They found that eight patients (36%) had coexisting autoimmune thyroiditis. Their data show that, within this Sicilian population, the association between celiac disease and type 1 diabetes is common, though at lower rates than in other studies of the Italian population. They also found high rates of autoimmune thyroiditis in these patients. They also noted that celiac disease diagnosis often followed onset of type 1 diabetes, especially in females whose diabetes began at an early age. They conclude that this finding warrants an active search for the celiac disease for many years after the onset of diabetes. Source: Endocrine. 2012 Jun 16.
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Author: Rensch MJ; Merenich JA; Lieberman M; Long BD; Davis DR; McNally PR. Address: Fitzsimons Army Medical Center, Aurora, Colorado, USA. Source: Ann Intern Med, 124: 6, 1996 Mar 15, 564-7 OBJECTIVE: To determine the prevalence of celiac disease in a cohort of patients with insulin-dependent diabetes mellitus and to describe the clinical characteristics of patients with coexistent disease. DESIGN: Prospective cohort study. SETTING: U.S. Army medical center. PATIENTS: 47 patients with insulin-dependent diabetes mellitus. MEASUREMENTS: Antiendomysial antibody testing was used to screen for celiac disease. The diagnosis of celiac disease required histologic evidence of villous atrophy and crypt hyperplasia and a positive antiendomysial antibody test result. In patients identified as having coexistent disease, complete blood counts, multiphasic biochemical testing, D-xylose absorption testing, and bone mineral density estimates were done. RESULTS: 3 of 47 patients with insulin-dependent diabetes mellitus (6.4%; 95% CI, 1.4% to 17.5%) had positive antiendomysial antibody test results and small-bowel biopsy specimens consistent with celiac disease. The 95% CI lies entirely above the estimated prevalence of celiac disease expected in the general U.S. population, which ranges from 0.02% to 0.1%. Mean bone mineral densities were 0.8 and 1.1 SD below age-, ethnicity-, and sex-matched controls in each of the 2 antiendomysial antibody-positive patients tested. Small bowel absorption was abnormal in 1 of the 2 patients tested by D-xylose. Anemia and hypoalbuminemia were not detected in any of the patients with coexistent disease. Only 1 of the 3 patients had symptoms of diarrhea. All patients were at or above their ideal body weights. CONCLUSIONS: Celiac disease appears to be more common among patients with insulin-dependent diabetes mellitus than in the general U.S. population (p less than 0.001). Two of the three patients with coexistent disease in this study had sub-clinical or latent celiac disease.
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Celiac.com 09/19/2012 - Researchers have documented rising rates of celiac disease in patients with type 1 diabetes (T1D). A research team recently tried to assess the effect of celiac disease on growth and glycemic control in patients with T1D, and to determine the effects of a gluten-free diet on these parameters. The research team included I. Taler, M. Phillip, Y. Lebenthal, L. de Vries, R. Shamir, and S. Shalitin. They are affiliated with the Department of Pediatrics B, Schneider Children's Medical Center of Israel in Petach Tikva, Israel. To do so, they conducted a longitudinal retrospective case-control study, in which they reviewed the medical data on 68 patients with T1D and duodenal-biopsy-confirmed celiac disease. They looked at weight, height, hemoglobin A1c (HbA1c), frequency of diabetic ketoacidosis (DKA), and severe hypoglycemic events before and after diagnosis and treatment of celiac disease. They then compared their findings with 131 patients with T1D alone, who were all matched for age, gender, and duration of diabetes. In all, 5.5% patients with T1D who attended the center during the study period were diagnosed with celiac disease, while 26% of the patients with celiac disease were symptomatic. The data showed no significant differences in glycemic control or frequency of severe hypoglycemia or DKA events between the study group and control subjects. Body mass index-standard deviation score (SDS), height-SDS, and HbA1c values were insignificantly higher in the control group than in the study group, and similar in celiac disease patients with good or fair/poor adherence to a gluten-free diet during follow-up. Patients with T1D and celiac disease and following a gluten-free diet have growth and metabolic control similar to those with T1D with no celiac disease. To determine whether a gluten-free diet is appropriate for asymptomatic celiac patients or only symptomatic patients must be assessed against possible short- and long-term consequences of no intervention, and the decision should be based on more evidence from larger randomized studies. Source: Pediatr Diabetes. 2012 May 7. doi: 10.1111/j.1399-5448.2012.00878.x.
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Celiac Disease in Type 1 Diabetes Mellitus
Jefferson Adams posted an article in Diabetes and Celiac Disease
Celiac.com 08/20/2012 - People with Type 1 Diabetes (T1D) suffer from celiac disease at rates ranging from 4.4 to 11.1%, compared with rates of 0.5% for the general population. The reason for this connection is due at least in part to the fact that the HLA genotypes DR3-DQ2 and DR4-DQ8 are strongly associated with T1D, while DR3-DQ2 is associated with celiac disease. To get a better sense of the issue, a research team recently assessed celiac disease in type 1 diabetes mellitus. The research team included Maria Erminia Camarca, Enza Mozzillo, Rosa Nugnes, Eugenio Zito, Mariateresa Falco, Valentina Fattorusso, Sara Mobilia, Pietro Buono, Giuliana Valerio, Riccardo Troncone, and Adriana Franzese. The are variously affiliated with the Department of Paediatrics, "Federico II" University, the School of Movement Sciences (DiSIST) at Parthenope University, and the Department of Cellular and Molecular Pathology "L. Califano", "Federico II" University, all in Naples, Italy. People with T1D rarely show classical severe symptoms of celiac disease. Usually, they have few or mild symptoms of celiac disease, or show no symptoms at all (silent celiac disease). In fact for T1D patients, diagnosis of celiac disease is usually done by blood screening. The effects of gluten-free diet (GFD) on the growth and T1D metabolic control in celiac disease/T1D patient are controversial. There is some debate about whether gluten-free foods have a higher glycemic index compared with to gluten-containing foods; and also about whether gluten-free foods might be be lower in fiber and higher in fat. Adherence to a gluten-free diet by children with celiac disease-T1D has generally been reported at below 50%, compared with about 73% for those with celiac disease alone. Failure to follow a gluten-free diet is even more common among asymptomatic patients. The more severe problems of gluten-free diet adherence usually occur during adolescence when non-compliant subjects report the lowest quality of life. The researchers suggest providing psychological and educational support for these patients. Source: Ital J Pediatr. 2012; 38: 10. doi: 10.1186/1824-7288-38-10-
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Living With Celiac Disease & Diabetes
Betty Wedman-St Louis, PhD, RD posted an article in Autumn 2010 Issue
This article originally appeared in the Autumn 2010 edition of Celiac.com's Journal of Gluten-Sensitivity. Celiac.com 05/09/2011 - Living with celiac disease and diabetes can be a challenge, but it is not impossible. You can travel the world, eat out and enjoy life but assertiveness is important to maintaining good blood glucose management and digestive health. Individuals with diabetes may notice an elevation of their blood glucose after overeating gluten-containing foods at a party, sleep-over, or birthday celebration. The usual rationalization is that too many calories and/or carbohydrates were consumed. However, it may be a wake-up call for you to try and control blood glucose levels by reducing or excluding gluten-containing foods. When eliminating wheat is first proposed as an alternative for controlling blood glucose, a frequent response is to express how “nutritious” wheat is. As the nutritional comparison of flours in my book Living Gluten-Free (Charles C. Thomas, Publisher, 2008) illustrates, rice flour is comparable to wheat flour, and superior in Vitamin B6, Pantethenic Acid, Zinc, Copper, Manganese and many other vitamins and minerals. Gluten sensitivity may affect as many as 1 in 25 Americans. It is also becoming better recognized as a primary cause of inflammation. Celiac disease or gluten intolerance can masquerade as many other diseases, including diabetes. Many people given steroid medications for bowel inflammation can also develop diabetes as a side-effect of the steroid medication. Once a gluten-free diet has been started, it is not necessary to “go back on wheat” to get a diagnosis of celiac disease. A simple blood test can reveal whether one has the predisposing genes for gluten enteropathy, and therefore whether it is a cause of blood glucose problems. Far too many people are told by gastroenterologists that a small intestinal biopsy is the “gold standard” for diagnosis. A HLA-DQ2/DQ8 blood test is less invasive, more precise and more cost-effective than the “gold standard”. Genetic predisposition for celiac disease has been described by Alessio Fasano, MD and illustrates how celiac disease is not one disease. In addition, genetic sequencing has reported that both celiac disease and diabetes are located on Chromosome 6, along with Crohn’s Disease. For managing diabetes, a gluten-free, carbohydrate-controlled diet can be a healthier alternative than eating whole wheat. Ten years ago gluten-free products such as prepared muffins, cookies, pizza crust, etc. were not available. Rice cakes were the norm and homemade bakery products added variety to the diet. Today, there are aisles of gluten-free products in the supermarket and health food stores. Even major convenience bakery mix producers like General Mills, Minneapolis, MN offer gluten-free cookie brownies and cake mixes. The advantage of choosing recipes in Living Gluten-Free is that sugar and carbohydrate levels are reduced compared to the mixes and prepared frozen bakery products available. This is important for individuals with diabetes who must limit carbohydrates. If prepared products are used in the diet, remember to divide the sugars total on the nutrition label by 4 to calculate how many teaspoons of sugar are in a serving (Example: chocolate chip cookie 1= sugars 13g divided by 4g = 3 teaspoons sugar per cookie). The only therapy currently available to treat gluten intolerance is removal of gluten from the diet. Since gluten is a component of many common foods and widely available in so many convenience foods, avoidance can be challenging. Here are two menu ideas for a gluten-free diabetic diet. More menus are available in Living Gluten-Free. Day 1 Breakfast: Grits, Scrambled Eggs, Orange Juice Lunch: Taco Salad & Corn Chips Dinner: Rib-eye Steak, Baked Potato, Spinach, Tomato Salad Snack: Grapes Day 2 Breakfast: Turkey Sausage, Blueberry Muffin*, Apple Lunch: Sliced Ham on Rice Bread, Fresh Fruit Dinner: Baked Chicken, Sweet Potato, Roasted Cauliflower, Carrot Raisin Salad Snack: Rice Flour Brownie -
Celiac.com 06/08/2011 - A team of researchers recently set out to determine whether delaying gluten introduction in infants with genetic risk for islet autoimmunity is feasible, safe, and able to reduce the risk of type 1 diabetes–associated islet autoimmunity. The research team included Sandra Hummel, PHD, Maren Pflüger, PHD, Michael Hummel, MD, Ezio Bonifacio, PHD, and Anette-G. Ziegler, MD. They are variously affiliated with the Institute for Diabetes Research, Helmholtz Zentrum München, Forschergruppe Diabetes der Technischen Universität München, the Institut für Diabetesforschung der Forschergruppe Diabetes e.V. am Helmholtz Zentrum München, Munich, Germany, and the Deutsche Forschungsgemeinschaft Center for Regenerative Therapies Dresden, Technische Universität Dresden, Germany. For the study, the team recruited a total of 150 infants with a first-degree family history of type 1 diabetes and a risk HLA genotype. They then randomly assigned each infant to a first gluten exposure at age 6 months (control group) or 12 months (late-exposure group). The team followed-up on each infant at three month-intervals until the age of 3 years, and then yearly thereafter. The team tested for growth and autoantibodies to transglutaminase C [TGCAs]), islet autoantibodies to insulin, GAD, insulinoma-associated protein 2, and type 1 diabetes. A total of 70% of families reported following the dietary-intervention protocol. For the first three years, children in the control and late-exposure groups showed similar weight and height, along with similar probability of developing TGCAs (14 vs. 4%; P = 0.1). A total of eleven children in the control group and 13 children in the late-exposure group developed islet autoantibodies (3-year risk: 12 vs. 13%; P = 0.6). Seven children developed diabetes, including four in the late-exposure group. The team saw no significant differences when analyzing children as per protocol on the basis of the first reported reported gluten exposures for the children. From the data, the team concluded that delaying gluten exposure until the age of 12 months is safe, but does not significantly reduce the likelihood of islet autoimmunity in genetically at-risk children. Source: DiabetesCare.com
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Gluten May Play Role in Triggering Type 1 Diabetes
Jefferson Adams posted an article in Diabetes and Celiac Disease
Celiac.com 11/21/2011 - Celiac disease is common in people with type 1 diabetes (T1D). These people can show Abs reactions against tissue transglutaminase, the prime trigger in celiac disease. In short, gliadin seems to play a role in type 1 diabetes pathogenesis. An international research team set out to investigate whether gliadin contributes to enteropathy and insulitis in NOD-DQ8 mice, an animal model that does not spontaneously develop T1D. The researchers included Heather J. Galipeau, Nestor E. Rulli, Jennifer Jury, Xianxi Huang, Romina Araya, Joseph A. Murray, Chella S. David, Fernando G. Chirdo, Kathy D. McCoy, and Elena F. Verdu, and are variously affiliated with the Farncombe Family Digestive Health Research Institute at McMaster University Medical Centre in Canada, Laboratorio de Investigación en el Sistema Inmune, Departamento de Ciencias Biológicas, Facultad de Ciencias Exactas, Universidad Nacional de La Plata, Argentina, the Department of Internal Medicine, and the Department of Immunology at the Mayo Clinic College of Medicine in Rochester, MN, and with the Department of Clinical Research, University of Bern, Bern, Switzerland. Researchers know that gliadin-sensitized NOD-DQ8 mice develop moderate enteropathy, intraepithelial lymphocytosis, and barrier dysfunction, but do not develop insulitis. The team administered anti-CD25 mAbs before gliadin-sensitization induced partial depletion of CD25+Foxp3+ T cells, which triggered severe insulitis, but did not worsen mucosal dysfunction. The team isolated CD4+ T cells isolated from pancreatic lymph nodes. Those from mice that developed insulitis showed higher proliferation and pro-inflammatory cytokines after incubation with gliadin, but not with BSA. CD4+ T cells isolated from non-sensitized control mice showed no response to gliadin or BSA. From these observations, the team concluded that gliadin sensitization triggered moderate enteropathy in NOD-DQ8 mice. However, triggering insulitis required gliadin-sensitization and partial systemic depletion of CD25+Foxp3+ T cells. This study offers a model for explaining how mucosal intolerance to a dietary protein can trigger insulitis as a result of partial regulatory T cell deficiency. Source: J Immunol. 2011 Oct 15;187(8):4338-46. -
Celiac.com 12/12/2008 - For some time now scientists have been working to better understand the connection between celiac disease and diabetes. About 10% of children and 2% of adults with Type 1 diabetes also have celiac disease, as compared to just 1% of the general population. Moreover, celiac disease and diabetes are known to have a common genetic susceptibility locus in the HLA system, specifically, HLA class II alleles on chromosome six. The primary susceptibility genes for type-1 diabetes are HLA-DQB1 and HLA-DRB1, but they act in combination with non-immune system genes as well as environmental factors that are still undiscovered. Celiac disease also has a major susceptibility gene in the HLA system — HLA-DQB1 — as well as locations outside the HLA complex. Recently, a research team led by John Todd, Ph.D., of the University of Cambridge, set out to better understand the connection between the two diseases, and to determine if they shared any non-HLA regions. They discovered another seven regions outside of the HLA system that are tied to both celiac disease and diabetes. One of those regions is the 32-base pair insertion-deletion variant on chromosome three that leads to a non-functional CCR5 receptor on T cells. People who carry both pairs of these genes enjoy some protection against HIV infection, and its role in both celiac disease and diabetes indicates that lymphocytes are a key factor in both diseases. Carriers of these genes also face a greater risk of developing either celiac disease or diabetes, or both conditions in their lifetimes. In genome-wide association studies, eight loci outside the HLA system have been associated with celiac disease. Similarly, 15 non-HLA loci have been linked with Type 1 diabetes. Dr. Todd and colleagues genotyped single nucleotide polymorphisms (SNPs)—single letter variations in the genetic code—in the eight celiac loci and in the 15 diabetes loci. They then screened DNA samples from 9,339 control subjects, 2,560 subjects with celiac disease, and 8,064 subjects with diabetes. They also tested the diabetic children, along with both biological parents in 2,828 families. The overall statistical significance was P<1.00×10−4. At the same level of significance, three celiac disease locations—RGS1 on chromosome one, IL18RAP on chromosome two, and TAGAP on chromosome six—were also associated with Type 1 diabetes. The minor alleles of IL18RAP and TAGAP were associated with some protection from in Type 1 diabetes, but were associated with susceptibility in celiac disease. The CCR5 variant on chromosome three was newly tied to Type 1 diabetes (at P=1.81×10−8) and was also tied with celiac disease, together with PTPN2 on chromosome 18 and CTLA4 on chromosome two. Counting SH2B3 on chromosome 12, which already known to be a shared locus—the number of non-HLA areas strongly tied to both celiac disease and diabetes stands at seven. Dr. Todd and colleagues said it's possible that a common genetic background with respect to autoimmunity and inflammation—combined with disease-specific variation at HLA and non-HLA genes as well as non-genetic factors -- might lead to different clinical outcomes. It is possible that dietary exposure to gluten in the form of cereal grains might play a role in the pathogenesis of Type 1 diabetes. These findings offer support a growing scientific view that many common diseases share genetic risk factors, and indicate that celiac and diabetes may in fact have common biological causes, and that the two disorders may be more closely linked than previously understood. More research is needed to determine which shared risk factors might reveal previously unexpected biologic connections between diseases. New England Journal of Medicine 2008; 359: 2767-77, 2837-2838
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This article was posted to the Celiac Listserv by Ashton Embry at: embrya@cadvision.com in January, 1998: I became interested in the concept of a Paleolithic Diet in a circuitous way which began with the diagnosis of my oldest son with multiple sclerosis two and a half years ago. I hit the med library soon after I was told that there was no known cause and no effective treatment for MS. My goal was to determine the most likely cause and to then devise a therapy which countered this cause. After reading hundreds of papers and countless more abstracts I reached the conclusion that the main cause of MS is dietary and that dairy, gluten and saturated fat were the three main offending foods. I have summarized this analysis in an essay which is at The evidence I used to reach my interpretation was a combination of epidemiology, theory (molecular mimicry) and anecdotal data. After the essay was on the web I was contacted by Loren Cordain who pointed out that the foods implicated in MS were recently introduced to the human diet from a genetic point of view and he gave me the references to Boyd Eatons classic papers on Paleolithic Nutrition. From my geological background this concept seemed eminently reasonable so now I had an excellent unifying concept to go along with all the other data. One shortcoming of the evidence was that it was all circumstantial. There was no smoking gun evidence, that is, empirical evidence which demonstrates beyond a reasonable doubt that food proteins really do cause cell-mediated, organ-specific autoimmunity. As a dutiful civil servant, I made one of my required pilgrimages to Ottawa last week to participate in various mind-numbing meetings. I had a free afternoon so I went out to the Nutrition Research Division of Health Canada where I had the good fortune to meet with Dr Fraser Scott. Dr. Scott has been studying the effect of diet on the development of Type 1 Diabetes in BBdp rats for 20 years. He and co-workers have demonstrated conclusively that Type 1 diabetes can be generated by proteins derived from wheat, soy and milk. So now I had found the smoking gun. Food proteins can indeed induce cell-mediated autoimmunity and not surprisingly the foods which supply the pathogenic proteins are those added to the human diet during the Neolithic. I believe Dr. Scotts work is of great significance for understanding the cause of autoimmune disease and strongly supports Eatons suggestion the diet of our ancestors is the best defense against the diseases of civilization. References: The best reference for Scotts work is: Scott, FW, 1996, Food-induced Type 1 Diabetes in the BB Rat. Diabetes/Metabolism Reviews, v.12, p. 341-359. This paper summarizes all his results up to 1996 and contains references to all his earlier work.
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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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Celiac.com 08/14/2007 - A study on the effects of a gluten-free diet versus a gluten-enriched diet on the incidence of diabetes in mice has yielded some surprising results that are not fully understood. The results of the study were published recently in the journal Diabetes/Metabolism Research and Reviews. It is well known that environmental nutrition and infections play a key role in the development of diabetes (type 1). A Czech research team made up of doctors David P. Funda, Anne Kaas, Helena Tlaskalová-Hogenová, Karsten Buschard recently set out to study the relationship between type 1 diabetes and both gluten-free and gluten enriched diets. The team tested the hypothesis that early introduction of gluten into the diet might increase diabetes incidence in mice. For a period of 310 days, non-obese diabetic (NOD) mice were fed one of the following diets: standard diet, a gluten-free diet, a gluten + modified Altromin diet, or a hydrolyzed-casein based Pregestimil diet. The mice were observed for signs of diabetes, including evaluation for insulitis score, and numbers of gut mucosal lymphocytes. Compared to mice fed the standard Altromin diet, mice fed on the gluten-free and the Pregestimil diets showd markedly lower incidence of diabetes. Incidence rates were as follows (p < 0.0001): NOD mice fed gluten-free diet (5.9%, n = 34) and Pregestimil diet (10%, n = 30) compared to mice on the standard Altromin diet (60.6%, n = 33). Somewhat unexpectedly, the gluten+ diet also prevented diabetes to the same degree as the gluten-free diet (p<0.0001, 5.9% n=34). Of those mice who did develop diabetes, those on the gluten-free and Pregestimil diets did so at a later time than those on a standard diet. Compared to control mice, non-diabetic NOD mice on the gluten-free diet and to a lesser extent also gluten+ and Pregestimil diets showed lower insulitis scores. No significant differences were found in the number of CD3+, TCR-+, and IgA+ cells in the small intestine. The researchers concluded that a gluten-enriched diet prevents diabetes in NOD mice at the same rate as a gluten-free diet. Diabetes/Metabolism Research and Reviews, Volume 15, Issue 5 , Pages 323 - 327 health writer who lives in San Francisco and is a frequent author of articles for Celiac.com.
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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
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Celiac.com 09/24/2009 - Could a reduced level of antibodies against infectious agents indicate a protective role for such infections in T1DM development in susceptible individuals? Recent research points in that direction. Type 1 diabetes mellitus (T1DM) is an autoimmune disease with intricate and poorly understood associations between genetic and environmental factors. A joint Israeli-Colombian research team recently set out to examine the connections between anti-infectious antibodies and autoimmune-associated autoantibodies in patients with Type I diabetes mellitus and their close family members. Among other things, their findings confirmed a strong association between celiac disease and Type 1 diabetes mellitus. The research team was made up of Ilan Krause, Juan Manuel Anaya, Abigail Fraser, Ori Barzilai, Maya Ram, Verónica Abad, Alvaro Arango, Jorge García, and Yehuda Shoenfeld. The team compared levels of antibodies to numerous infectious agents and of autoimmune-associated antibodies between Colombian T1DM patients, their close family members and healthy control subjects. T1DM patients showed substantially reduced levels of antibodies against several infectious agents, including: cytomegalovirus (P= 0.001); Epstein-Barr virus (P= 0.02); Helicobacter pylori (P= 0.01); and Toxoplasma (P= 0.001). T1DM patients showed markedly elevated levels of IgG-anti-gliadin antibodies (P= 0.001) and IgG-antitissue transglutaminase antibodies (P= 0.03), and a marginal connection with anti-centromere antibodies (P= 0.06). T1DM patients also showed a reduced level of antibodies against infectious agents that may be associated with their younger ages, but could also indicate a protective role for such infections in T1DM development in susceptible individuals. The results reinforce the connection between T1DM and celiac disease, though the possible connection with the anti-centromere antibody requires a deeper examination. Studies like this are important to help build a record of all of the points of contact between these associated conditions so we can begin to understand the intricate web that ties these conditions together, and inch toward the deeper causes that lie at the heart of the mystery of celiac disease, diabetes, and so many other auto-immune/inflammatory disorders. Source: Annals of the New York Academy of Sciences - Volume 1173 Issue Contemporary Challenges in Autoimmunity, Pages 633 - 639
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Celiac.com 06/08/2007 - This study shows that celiac disease is as common among British Columbians with Type 1 diabetes as it is in Europeans with Type 1 Diabetes. The research team was made up of doctors P.M. Gillett, H.R. Gillett, D.M. Israel, D.L. Metzger, L. Stewart, J-P. Chanoine, H.J. Freeman. The team looked at 233 children with Type1 diabetes. In a blind study, the children were screened for celiac disease using immunoglublin A endomysium antibody (EmA), and the Immunoglublin A tissue transglutaminase. Children with positive results were offered small bowel biopsies. For those confirmed with celiac disease, doctors recommended a gluten-free diet. British Columbians with Type 1 Diabetes Get Celiac Disease at Rates Comparable to their European Counterparts Nineteen children tested positive for EmA and showed elevated tTG levels. Of the 18 patients who agreed to biopsies, one was normal, three showed normal morphology with elevated Intraepithelial lymphocyte counts, and 14 biopsies showed morphological changes consistent with celiac disease. 9 of the 19 children who tested positive for EmA were asymptomatic. Seven patients showed only mildly elevated tTG levels. Of this second group, five refused biopsy and two showed normal biopsies. In addition to the four known cases, the doctors uncovered at least 14 new cases of celiac disease. The total rate of biopsy confirmed celiac disease was 18 out of 233, or 7.7%. The doctors concluded that these results confirm that celiac disease is prevalent in pediatric type 1 diabetes. The doctors say the study reinforces the importance of celiac screening for children with type 1 diabetes, and also the advisability of keeping an eye on tTg serology as part of determining the effects of and compliance to a gluten-free diet. Participating Facilities 1. Division of Pediatric Gastroenterology at British Columbias Childrens Hospital Vancouver, British Columbia. 2. Division of Endocrinology, British Columbias Childrens Hospital, Vancouver, British Columbia. 3. Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia Journal of Pediatric Gastroenterology & Nutrition: Volume 29(4)October 1999p 495. About the Author: Jefferson Adams is a freelance health writer who lives in San Francisco and is a frequent author of articles for Celiac.com.
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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
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