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The following report was prepared by Ann Whalen, celiac, and editor/publisher of Gluten-Free Living , which is a bimonthly newsletter for celiacs - Gluten-Free Living, PO Box 105, Hastings-on-Hudson, NY 10706. On March 10th, more than 20 members of the celiac community and celiac disease specialists (see list at end) attended a meeting of the Digestive Diseases Intra-agency Coordinating Committee, a part of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The meeting, held to update the current status of Celiac Disease, was chaired by Jay Hoofnagle, M.D., Director of the Division of Digestive Diseases and Nutrition at the NIDDK. At the meeting, presentations were made by Martin Kagnoff, M.D., Joseph Murray, M.D., Alessio Fasano, M.D., and Frank Hamilton, M.D. Dr. Kagnoff is a gastroenterologist and Professor of Medicine at the University of California, San Diego. He spoke about his research into the genetics of Celiac Disease, focusing on the pathogenesis. Dr. Kagnoff is well known for his research into the genetics of Celiac Disease, and several of his studies have been funded by the NIH. Dr. Murray, Associate Professor of Medicine and clinician at the University of Iowa Hospitals and Clinics, described his experience with Celiac Disease both in Iowa and in Ireland, noting that his interest in celiac disease is clinical. He emphasized what he called the Classic II symptoms, meaning the actual symptoms patients have today and not the Classic symptoms many doctors may be familiar with. He said the rate of diagnosis is proportional to suspicion. Dr. Murray described the celiac disease experience at the University of Iowa from 1985 to 1997, presenting statistics that indicated a steep increase in diagnosis. At our institution, Celiac Disease is an adult disease, he said, and is now seen as frequently as Crohns Disease. Anticipating the question, Why look for Celiac Disease?, Dr. Murray gave his reasons: preventing lymphoma and osteoporosis, as well as resolving fatigue and nonspecific symptoms and shortening the current significant delays in diagnosis. Dr. Fasanos presentation was called Where Have All the American Celiacs Gone? He described what has happened in the field of celiac disease in various parts of the world, including some parts of the United States, but emphasized the European experience. Dr. Fasano noted that plans are already underway in Italy to screen all seven-year-olds in 1999. Dr. Fasano explained why an epidemiology study is critically needed in this country. He pointed out the benefits of such a study for four groups: The American health care community: lower health care costs, increased awareness of celiac disease and more knowledge of its protein manifestations in the US Participating physicians: publications, more patients and increased credibility. The American people: the prevalence will be established and celiac disease will be diagnosed more quickly. Celiac Patients: free screening of first-degree relatives, federal support for dietary and drug regulations, an improved food supply, stronger local support groups and more funding for celiac research. Dr. Fasano added that such a study, whatever its findings, would end in a win-win situation for everyone. If the study shows that celiac disease is underestimated in this country, patients will benefit as physicians begin looking for the problem with the knowledge that they might well find it. If the study shows celiac disease is indeed rare in the United States, its even more exciting because we will be able to figure out why. Dr. Hamilton, chief of the Digestive Diseases Program Branch at the NIDDK, briefly described the celiac disease research, to date, that has already been funded by the NIH. He said $1.4 million has been granted for such research, adding that over the last five years, we have seen growth in the funding of Celiac Disease. He said he was pleased funding has increased, and felt a lot of work has to be done. Dr. Hamilton ended by saying, Todays meeting will serve as an impetus for a partnership between the National Institutes of Health, academe, and the lay groups to foster more research. He added that it was important for the investigators and support group representatives present at the meeting to get the word out, referring to information about Celiac Disease. These talks were followed by a round table discussion, between the members of the committee and the presenters. Later, audience comment was invited. The committee showed an interest in the current adult nature of the disease, the changing symptoms, current testing methods, and identification of the most critical research needs. Patients who spoke were anxious to let the committee know what they felt were the important concerns in the real world. At the end of the meeting, Dr. Hoofnagle said his division will prepare a short, pithy plan, then present it to Drs. Kagnoff, Murray and Fasano. He noted that the important issues are pathogenesis, delivering the message to physicians, clinical research issues and pediatric health concern. Some Quotes from the Meeting Elaine Monarch: There is a general lack of knowledge, awareness and interest in Celiac Disease among the medical profession. We celiacs can go for years with substantial symptoms but not diagnosis...The cost to the medical community is enormous. Joseph Murray, M.D.: There is more than one gene involved in Celiac Disease. Most Europeans are homogenous. Here we have a mongrelized population. What happens when you mix? How much does it change? Our mongrelized population may be at risk at a later age. Martin Kagnoff, M.D.: The issue of other genes is not at all clear. Like Joe (Dr. Murray), I see adult celiacs. Their time delay to diagnosis is not exaggerated, but what is striking is the lack of knowledge of doctors, even at the University of California. They really are not aware of this disease. Alessio Fasano, M.D.: We receive 10-15 calls a day. The vast majority are self diagnosed. They say, I know more than my gastroenterologist. Peter Green, M.D.: We need to emphasize education of gastroenterologists. At my institution (Columbia-Presbyterian Medical Center in New York City), doctors are not used to looking at the duodenum...We need to educate many levels of the medical community and tell them, If you dont recognize something, take a biopsy. Sue Goldstein: Im concerned about the people who have not yet been diagnosed and the reasons why a physician wont consider Celiac Disease. It all boils down to, its rare and you cant have it. In addition to the speakers, the following were among those who attended: Phyllis Brogden, celiac, founder and chairperson of the Greater Philadelphia Celiac Sprue Support Group. Winnie Feldman, celiac, Celiac Disease Foundation Kenneth Fine, M.D., gastroenterologist/ researcher at Baylor University Medical Center in Dallas. Al Fornace, M.D., celiac, National Cancer Institute Sue Goldstein, celiac, founder and advisor, Westchester Celiac Sprue Support Group Peter Green, M.D., clinician/researcher at Columbia-Presbyterian Medical Center in New York City. Joanne Hameister, celiac, former chairperson, Western New York Gluten-Free Support Group Ivor Hill, M.D., clinician/researcher at Bowman Gray School of Medicine, Winston-Salem, North Carolina. Beth Hillson, celiac and proprietor of the Gluten-Free Pantry. Karoly Horvath, M.D., clinician/researcher at the University of Maryland School of Medicine in Baltimore. Marge Johanamen, celiac, CSA Kentucky state coordinator Pam King, University of Maryland Bob Levy, Celiac Research Foundation Ruth Levy, spouse Jax Lowell, celiac and author of Against the Grain Elaine Monarch, celiac, founder and Executive Director of the Celiac Disease Foundation Selwyn J. Monarch, Board of Directors, CDF Diane Paley, celiac, governing board CSA/USA Michelle Pietzak, M.D., pediatric gastroenterologist at Childrens Hospital, Los Angeles Connie Tur, celiac, president Greater Louisville Celiac Sprue Support Group
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Celiac.com 07/10/2007 - Studies have shown children with Type 1 diabetes to have a greater risk of developing celiac disease. A study published recently in Diabetes Care shows that people with celiac disease who follow a strict gluten-free diet frequently have inferior body composition and nutritional uptake compared to healthy people without celiac disease. Faced with a shortage of solid data on the exact nature of the levels at which children with type 1 diabetes are at risk for developing celiac disease, a Swedish research team set out to review the Swedish national inpatient registry for the years 1964 to 2003. The research team was made up of Anders Ekbom, Michael Fored, Jonas F. Ludvigsson, Johnny Ludvigsson, Nders Ekbom, Ola Ole, & Scott M. Montgomery. They looked at data for patients with celiac disease who are following a strict gluten-free diet, and who were in full clinical, biochemical, and histological remission. They looked at data from 45,680 patients. Children with a one year follow-up after entering the study were added to the final results. Celiac Disease in Children Linked to Type-1 Diabetes The results showed that children with celiac disease face an increased risk of developing type 1 diabetes before the age of 20 (hazard ratio 2.4 [95% CI 1.9 –3.0], P 0.001). Children with celiac disease also faced an increased risk of ketaocidosis or diabetic coma before the age of 20 (2.3 [1.4 –3.9], P 0.001). This increase showed up without regard to the age at diagnosis [those diagnosed between 0 and 2 (2.2 [1.7–2.9], P 0.001) or 3 and 20 (3.4 [1.9 – 6.1], P 0.001) years of age.] Given that 95% of individuals with celiac disease are HLA-DQ2 positive, these increased risk levels were comparatively low, though still significant. Diabetes Care. 2006 Nov;29(11):2483-8. health writer who lives in San Francisco and is a frequent author of articles for Celiac.com.
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Celiac.com 12/28/2006 - The American Diabetes Associations (ADA) Clinical Practice Recommendations have been updated to include new information about treatment and prevention that reflects the latest research. Changes have been made in numerous areas, including the management of hyperglycemia in type 2 diabetes; nutrition recommendations; and screening and treatment for children who have both type 1 diabetes and celiac disease. In 2006, the ADA published Medical Nutrition Therapy (MNT) guidelines for people with diabetes, specific to individual populations, such as those who are obese or pregnant. The Clinical Practice Recommendations have been updated to reflect these guidelines and to encourage people with diabetes or pre- diabetes to seek individualized MNT to help them achieve their treatment goals. Information about how to treat children who are diagnosed with both type 1 diabetes and celiac disease was also added to the Clinical Practice Recommendations this year. Up to 16 percent of children with type 1 diabetes are also diagnosed with celiac disease, an immune disorder that affects the digestive system, damages the small intestine and interferes with the absorption of nutrients from food. The recommendations call for more aggressive screening for celiac disease in children with type 1 diabetes who present symptoms such as weight loss, growth failure, abdominal pain and chronic fatigue. A gluten-free diet is recommended for those who test positive for celiac. Diabetes Care, published by the American Diabetes Association, is the leading peer-reviewed journal of clinical research into the nations fifth leading cause of death by disease. Diabetes also is a leading cause of heart disease and stroke, as well as the leading cause of adult blindness, kidney failure, and non-traumatic amputations. For more information about diabetes call 1-800-DIABETES (1-800-342-2383).
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Celiac.com 11/07/2006 – In the first multi-country population based study of its kind, Danish researchers have found that around 1 in 8 children with Type 1 diabetes also have celiac disease, and of these the prevalence of stunted growth is abnormally high. Dr. Dorte Hansen and colleages from Odense University Hospital screened 269 children with type 1 diabetes for celiac disease using immunoglobulin A anti-endomysium antibody, anti-tissue transglutaminase antibody, and intestinal biopsy. The researchers found 33 cases of celiac disease, and in 5 of these cases the children had no symptoms of the disease whatsoever. The children with celiac disease were diagnosed with diabetes at a significantly youger age than their non-celiac counterparts and each was also significantly shorter and lighter. The 33 celiac disease patients were put on a strict gluten-free diet for 2 years, and amond the 24 who complied with the diet all symptoms resolved. Additionally most of the children gained weight and the children who were under 14 also regained their height. A gluten-free diet relieved symptoms of celiac disease and restored normal growth patterns to most of the children. The doctors conclude that regular screening for celiac disease should be conducted in all children with type 1 diabetes. Diabetes Care 2006;29:2452-2456.
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Arch Dis Child 2004;89:871-876. Celiac.com 07/12/2005 – Australian researchers have determined that a gluten-free diet in children with Type 1 diabetes mellitus and celiac disease can improve both growth and diabetes control. In the study 21 children (mean age 7.5 years) with both conditions went on a gluten-free diet for 12 months, and their growth and insulin dosages were carefully measured and compared with that of two matched diabetic, non-celiac controls. The group on a gluten-free diet showed significant increases in weight and body mass index compared with the control group, although an increase in height found in the study was not found to be significant. At the time of diagnosis insulin dosages for the celiac disease group were less than that of the control group, but became similar to the controls once a gluten-free diet was started—although the increase in insulin dosage had no effect on HbA1c levels. The researchers conclude: “Identification and dietary treatment of celiac disease in children with diabetes improved growth and influenced diabetic control. Evaluation of the outcome of treatment of celiac disease in diabetics should include assessments of gluten intake.” Obviously all children (and everyone) with celiac disease should be on a gluten-free diet, but what is noteworthy about this study is that a connection was found between insulin levels, diabetes control, and the gluten-free diet.
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Diabetologia. 2005 Apr 14 Celiac.com 04/29/2005 – According to Italian researchers an improper immune response to wheat may play an important role in the pathogenesis of Type 1 diabetes. The researchers fed one group of female non-obese diabetic (NOD) mice a standard gluten-free diet, while another group of NOD mice was fed a standard gluten-free diet that also included wheat proteins. The researchers then evaluated the small intestinal architecture of the mice and found that the wheat-protein group "showed reduced villous height, increased intraepithelial infiltration by CD3(+) cells and enhanced expression of H2-IA and IFN-gamma mRNA when compared with mice on the gluten-free diet." After 43 weeks the cumulative incidence of diabetes was 65% in the gluten-free group, and 97% in the wheat-protein group. The researchers conclude that the mice that ate wheat proteins had a much higher incidence of diabetes and small intestinal enteropathy that included higher mucosal levels of pro-inflammatory cytokines.
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Celiac.com 02/25/2005 - Today a team of scientists at Alba Therapeutics Corporation and the University of Maryland School of Medicine report a direct link between zonulin-mediated increased intestinal permeability and Type 1 Diabetes (T1D) in the BB/wor Rat Model of Diabetes. Even more remarkable, the investigators were able to successfully prevent the onset of the autoimmune destruction of pancreatic beta cells and the onset of T1D in these animals by using the specific zonulin blocker AT-1001. Daily, oral administration of the drug beginning before the onset of auto-immunity in the diabetic prone rats cut the incidence of the disease by 2/3, and completely blocked the development of autoimmune antibodies in the treatment responders. Published in the latest issue of the Proceedings of the National Academy of Science (PNAS), these results constitute the first successful result in preventing the autoimmune process characteristic of T1D by blocking the zonulin-mediated abnormal intestinal permeability. These results go well beyond the development of a prevention strategy for T1D, says Dr. Alessio Fasano, lead author of the paper and Professor of Pediatrics, Medicine and Physiology and The University of Maryland School of Medicine. They open a new field of investigation in which the interplay between host and environment at the mucosal level may help us understanding the molecular basis of many diseases. These results reinforce our conviction that the zonulin pathway provides a roadmap for the discovery and development of innovative products to treat many important diseases, including diabetes, in ways previously thought to be inconceivable stated Dr. Blake M. Paterson. These preclinical proof-of-concept results with AT-1001 support the salvaging of beta cell function in pre-diabetics or in new-onset diabetes, giving us the impetus to rapidly move through the development process, bringing this dream to a reality for treatment in the diabetes community. T1D is an autoimmune disease that results in the destruction of the insulin producing cells of the pancreas, the islet beta cells. Current treatment of T1D is limited to the administration of insulin and other medications to treat the consequence of diabetes, elevated blood sugar and the complications thereof. The inability to treat the cause of T1D - a process known as autoimmunity, in which the bodys immune system attacks the beta cells of the pancreas - has been the key obstacle to the freeing patients from the yoke of this disease. Autoimmune diseases are thought to occur in individuals with the genetic pre-disposition to attack and destroy various organ tissues by the bodys own immune system. This immune misrecognition is thought to be triggered by the presence of an environmental stimulus; in the case of T1D, the trigger is unknown. While the majority of research efforts have focused on identifying the trigger of T1D and modifying immune pathways, little is known about how such a trigger might enter the body and about how such an entry-way might serve as a target for the treatment of the disease. The discovery of zonulin - a gatekeeper of intestinal barrier function, and its involvement in celiac disease, led to the hypothesis that its malfunction could be involved in a series of other autoimmune diseases characterized by a leaky gut, including T1D. Previous work by Dr. Alessio Fasano has shown a close association of celiac disease in children at risk of developing T1D and led to the novel discovery research in support of AT-1001. About Alba: Alba Therapeutics is a Baltimore based biopharmaceutical company dedicated to commercializing disease-modifying therapeutics and drug delivery adjuvants based on the zonulin pathway. Albas lead molecule, AT-1001, is targeted towards the treatment of Celiac Disease and Type 1 Diabetes and is in the final stages of pre-human testing. Contact Alba Therapeutics Corporation, Baltimore Dr. Blake Paterson, 410-522-8708
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Diabetes Care 2004;27:1294-1298. Celiac.com 11/29/2004 - In an effort to determine the prevalence of biopsy-confirmed celiac disease in Italian children and adolescents with type 1 diabetes, and to determine whether age at onset of diabetes is independently associated with the diagnosis of celiac disease, Dr. Franco Cerutti and colleagues at the Universita di Torino, Italy looked at 4,322 children and adolescents (4-11 years old) who had type 1 diabetes. Yearly celiac disease screening was performed on them by using IgA/IgG anti-gliadin and IgA anti-endomysium antibodies, and those with positive antibody results were given a biopsy for confirmation. Out of 4,322 children screened 292 or 6.8% had celiac disease. In 89% of cases diabetes was diagnosed before celiac disease. Using logistic regression analyses the researchers determined that those diagnosed with diabetes at a younger age, those who are female, and those with a thyroid disorder are independently associated with the risk of having both diabetes and celiac disease. The researchers conclude: "We have provided evidence that 1) the prevalence of biopsy-confirmed celiac disease in children and adolescents with type 1 diabetes is high (6.8%); 2) the risk of having both diseases is threefold higher in children diagnosed with type 1 diabetes at age 9 years; and 3) girls have a higher risk of having both diseases than boys."
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Celiac.com 10/28/2004 - The following study demonstrates a connection between the length of time a celiac is exposed to gluten and the prevalence of anti-islet cell antibodies. This study supports many others that have shown that celiac patients are at high risk of developing insulin-dependent diabetes mellitus, which is a condition that has a long pre-diabetic period. It would be interesting to conduct a similar study on non-celiacs to determine if gluten has the same effect, which, if demonstrated, would mean that gluten has toxic, disease-causing properties in other people in addition to those with celiac disease. Rev Med Chil. 2004 Aug;132(8):979-84. BACKGROUND: Celiac patients are at high risk of developing insulin-dependent diabetes mellitus, a condition that has a long pre-diabetic period. During this lapse, anti-islet cell antibodies serve as markers for future disease. This may be related with the duration of the exposure to gluten. AIM: To test the hypothesis that long term adherence to a gluten free diet decreases the frequency of risk markers for insulin dependent diabetes mellitus during adolescence and early adulthood. PATIENTS AND METHODS: 158 celiac patients were classified as: G1, (n=30 patients) studied at the time of diagnosis; G2 (n=97 patients) exposed to gluten as a result of non compliance with the gluten free diet and, G3 (n=31 patients) who had maintained a long term, strict gluten free diet. Isotype IgG anti-islet cell antibodies were detected by indirect immunofluorescence using monkey pancreas, results were reported in Juvenile Diabetes Foundation (JDF) units. RESULTS: Celiac patients exposed to a gluten containing diet had a significantly higher prevalence of anti-islet cell antibodies than those who had been exposed only briefly (p CONCLUSIONS: Celiac patients long exposed to gluten have a significantly higher prevalence of anti-islet cell antibodies than those exposed for a short period. This fact supports the hypothesis that the development of these antibodies is associated with the length of the exposure to gluten. Verbeke S, Cruchet S, Gotteland M, Rios G, Hunter B, Chavez E, Brunser O, Araya M. Unidad de Gastroenterologia, Division de Nutricion Humana, Instituto de Nutricion y Tecnologia de los Alimentos, Universidad de Chile, Macul 5540, Santiago, Chile.
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Diabetes Care 2002;25:1111-1122. Celiac.com 08/08/2002 - A recent study conducted by Dr. David B. Dunger (Addenbrookes Hospital in Cambridge) and colleagues found that children with type 1 diabetes and latent celiac disease who were put on a gluten-free diet showed significant improvement in their metabolic control and growth. The study, which was published in the July issue of Diabetes Care, looked at 11 children with type 1 diabetes and who were diagnosed with celiac disease using anti-gliadin and anti-endomysial antibodies and a biopsy for confirmation. The group with celiac disease had a significantly lower mean BMI standard deviation score (SDS) than that of a control group of 22 age and sex-matched children with diabetes who did not have celiac disease. The mean height SDS and C-peptide levels in the two groups were similar, while the mean HbA-1-c was lower (better) in the group with celiac disease. After one year on a gluten-free diet the group with celiac disease improved its mean BMI score to that of the control group, and its HbA-1-c score went down (improved), while the control groups HbA-1-c score increased (worsened). The researchers conclude that more studies are needed to support their findings that a gluten-free diet significantly improves glycemic control in children with type 1 diabetes and celiac disease.
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Pediatrics 2002;109:833-838. Celiac.com 06/06/2002 - The results of a study conducted by Dr. Graziano Barera and colleagues from the Scientific Institute H San Raffaele, Milan, Italy and published in the May issue of Pediatrics indicate that those with type 1 diabetes are 20 times more likely to also have celiac disease. The researchers collected data on 274 consecutive newly diagnosed type 1 diabetes patients with a mean age of 8.28 years. These patients were studied for the following 6 years. At the time of their diagnosis 10 of them (3.6%) already had celiac disease, and over the next 4 years an additional 12 children tested positive for antiendomysial antibodies, and 7 underwent biopsies and were confirmed to have celiac disease. The overall prevalence of biopsy confirmed celiac disease in the group was 6.2%, and most of the cases were asymptomatic and the children showed no obvious signs of the disease. The researchers conclude that greater than 10% of children with newly-diagnosed type 1 diabetes had developed serological markers for celiac disease within the first 6 years of diagnosis, and they recommend that children in this category be screened annually for celiac disease for several years following their type 1 diabetes diagnosis.
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J Pediatr Gastroenterol Nutr 2001;33:462-465. Celiac.com 11/12/2001 - According to a recent report published in the October issue of the Journal of Pediatric Gastroenterology and Nutrition nearly 5% of US children with juvenile diabetes also have celiac disease. Dr. Steven L. Werlin of the Medical College of Wisconsin in Milwaukee and colleagues tested 218 patients with juvenile diabetes and 117 matched control subjects for the IgA endomysial antibody. Patients with positive results were offered a small bowel biopsy. The patients symptoms were assessed via a parent questionnaire. Results: Seventeen diabetic patients tested positive for the IgA endomysial antibody, while no positive results were found among control subjects. Fourteen of the 17 patients who tested positive underwent a follow-up small bowel biopsy. Villous atrophy was found in 11 of the patients. Two patients had increased intraepithelial lymphocytes without villous atrophy. Interestingly, more than half of the patients with biopsy-proven celiac disease were asymptomatic. According to Dr. Werlin, the results indicate that there is an association between asymptomatic celiac disease and juvenile diabetes. According to other research the treatment of the celiac disease in these patients will make the management of their diabetes easier. He further states that treating asymptomatic celiac disease will prevent many of its complications, and recommends that children with diabetes mellitus be screened for possible celiac disease with an antibody test and possible follow-up small bowel biopsy.
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Gluten-Free Diet Could Reduce Diabetes Risk
Scott Adams posted an article in Diabetes and Celiac Disease
Clin Immunol. 2004 Apr;111(1):108-18 According to German researchers, delaying the introduction of wheat and barley proteins could reduce the incidence of diabetes. The scientists looked at mice on diets that were modified according to protein source, and specifically looked at mice pups from female non-obese diabetic mice. Mice on lifelong wheat-free and barley-free diets (their protein source was poultry) had significantly reduced levels of diabetes (45% by age 32 weeks vs. 88% in control mice), and when they did develop diabetes, its onset was delayed. Interestingly the development of diabetes in these mice was not fully restored after adding wheat and barley proteins to their diets (58%). Further, insulin autoantibodies and insulitis scores were both reduced in the wheat and barley-free mice, and their intra-pancreatic IL-4 mRNA levels were increased. The researchers conclude: "These data support a link between dietary wheat and barley proteins and the development of autoimmune diabetes." -
Mdki M, Hupponen T; Holm K, Hallstrom O, _Gut_ 1995; Feb 3692) pgs. 239-42 In a study of 238 children and adolescents with insulin dependent diabetes mellitus (IDDM), serum IgA reticulin antibody tests were performed once a year. During the initial testing, within one year of the onset of IDDM, 5 children (2%) were positive. During follow up, 11 of the antibody-negative children (5%) became positive; of these 9 were shown to have silent celiac disease by jejunal biopsies. This study suggests that repeated serological screening and biopsies should be considered to detect late developing, clinically silent celiac disease among patients with IDDM.
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Diabetes and Celiac Disease - By Kemp Randolph
Scott Adams posted an article in Diabetes and Celiac Disease
Of the many immune related disorders linked with the celiac condition, the best established connection is with Type I diabetes (mellitus). Type I diabetes occurs at a rate of about 0.5% in the general population, but at a rate estimated at 5-10% among celiacs. Normally the diabetes is diagnosed first, both because this form of diabetes tends to strike early in life and its diagnosis is certain. No connection has been found with the more common form of diabetes (mellitus= honey , from the sugar laden urine when uncontrolled), Type II which occurs at a rate of 2-2.5% in the general population. In Type I diabetes, the insulin producing cells of the pancreas are destroyed by the immune system, perhaps in overreaction to some kind of infection (The incidence of Type I is highest in the winter.) Normally, insulin is released into the blood for distribution to nearly all cells in the body so glucose can be burned for energy. There are indirect connections with protein and fat metabolism as well which give rise to some of the poisons that build up in the absence of insulin. For glucose, cells have an insulin receptor on the surface: once insulin is bound there, glucose can enter and hence be metabolized. At diagnosis, the Type I presents itself with a better defined form of malnourishment than celiac disease: hyperglycemia (high blood sugar), weight loss, excessive thirst, excessive urination laden with (un-metabolized) sugar and protein, a fruity smell to the breath and little or no insulin in the blood. Treatment consists of 1-3 subcutaneous injections of insulin a day and control of carbohydrate intake. The recommended diet for diabetes, long before it was recommended for everyone, consisted of less fat and protein and more carbohydrate. Complex carbohydrates (less quickly metabolized) were recommended to cut down the peak in blood glucose that occurs about two hours after eating. It was, and is, a perfect Jane Brody diet - lots of fresh fruit and vegetables, hence with lots of fiber. The restriction on sugar is indirect: only the total carbohydrates must be controlled. So, if you have some sugar, you must eliminate something else (less carbohydrates probably), and have to put up with less on the plate. Control of Type I is certainly more of a nuisance than celiac disease, but also one with much better information readily available. Food labels are nearly adequate for controlling carbohydrate intake; the risks of the various long term complications versus average blood glucose are well known; relatively inexpensive, reliable home monitoring of blood glucose is possible to even out the daily peaks and valleys; a longer term blood test reliably measures average blood glucose for sufficient monitoring of longer term risks. Like celiac disease, Type I diabetes is more common in those of northern European extraction. Like celiac disease, it is highly linked to the so-called HLA markers of the immune system (those marking white blood cells). Celiacs are likely to be positive for both HLA-B8 and HLA-DR3; Type Is are most linked to HLA-B8 and either HLA-DR3 or HLA-DR4. An English study several months ago found that multiple genes were linked to Type I reflecting the fact that parents of a Type I are often diabetes free (the interpretation being that genes were required from both sides). The recent request for celiac siblings for a study of genetic typing intends to duplicate the study which looked for celiac genes. Reference: Gluten Intolerance Group of North America newsletter, V. 13, Issue 2, 1987; New York Times, Sept. 13, 1994, genetics study by Dr. John Todd at Oxford-
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