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Celiac.com 01/25/2023 - Studies that have tried to measure the effects of a gluten-free diet on the clinical, biochemical and psychological condition of youths with both type 1 diabetes and celiac disease have delivered mixed results. A team of researchers recently set out to evaluate the impact of gluten-free diet on growth, metabolic control and quality of life in children and adolescents with type 1 diabetes and celiac disease. The research team included Enza Mozzillo, Roberto Franceschi, Francesca Di Candia, Francesco Maria Rosanio, Letizia Leonardi, Ludovica Fedi, Valentina Rosà, Vittoria Cauvin, Adriana Franzese, and M. Loredana Marcovecchio. They are variously affiliated with theDepartment of Translational Medical Science, Section of Pediatrics, Regional Center of Pediatric Diabetes, Federico II University of Naples, Naples, Italy; the Department of Pediatrics, S. Chiara Hospital in Trento, Italy; the Pediatric Diabetology Unit, Pediatric Department, S. Chiara General Hospital inTrento, Italy; and the Department of Paediatrics, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK. The team first performed a systematic search of studies published in the last 15 years. They used PICOS framework to inform the selection process, and assessed evidence using the GRADE system. Their systematic review included only studies of moderate-high evidence quality level and reporting data on objectively assessed adherence to a gluten-free diet. Their findings highlight pre-adult adherence to a gluten-free diet in youth with type 1 diabetes and celiac disease leads to regular growth, stable BMI, without any negative effect on HbA1c and insulin requirements. Their main finding was that patients who followed a gluten-free diet experienced regular growth without any adverse increase in BMI. Moreover, the gluten-free diet does not negatively affect HbA1c and insulin, but is associated with higher post-meal glucose levels. Evidence from several studies indicate that a gluten-free diet is associated with better lipid profile and major quality of life and the psychological condition of juveniles with both type 1 diabetes and celiac disease. This study offers strong evidence that a gluten-free diet offers major benefits to juveniles with both type 1 diabetes and celiac disease. Read more at Diabetes Research and Clinical Practice.
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Hi everyone! Hopefully this is the right place to post this! Just wanted to post my story on here for anyone who needs some reassurance/anyone who can give me some tips! I’m 22 and from the UK, I’ve been type 1 diabetic since I was 13 and have always taken it in my stride. This year the pandemic hit and I was fortunate enough to be placed on furlough so I just spent my time at home with my family. At the beginning of the pandemic I was exercising a lot as I am very active, I liked to take the dogs out for long walks just so I could get out of the house! One morning in June I woke up in the middle of the night and my stomach was making crazy noises just like trapped wind, I got up and used the bathroom and tried to go back to sleep but the pain in my stomach would not subside and I started to get dizzy, pale and nauseous and ultimately was sick. I had just assumed it was something that I had eaten although my diet was completely unrestricted I have always eaten the same foods. The next day I had stomach pains but not too badly and carried on as normal. (Also throughout this whole summer I had been eating ryvita for lunch every day to be ‘healthy’ which is soooo laughable now) Throughout the summer I then started to have strange dizzy spells which I always put down to the heat or anxiety - although I’m thankful enough to not have any anxiety with work/home etc I just thought it was maybe underlying?! I also have suffered with travel sickness since I was younger and was becoming travel sick on journeys that lasted 5 minutes. Once I was able to go back to work I would walk to work and start to feel like I was about to pass out, I always tried to talk myself out of it using anxiety techniques but nothing seemed to work. I also used to get to work and start to feel really shaky and I would get hypoglycaemia symptoms but would go to check my blood sugars and they would be normal! Fast forward to the 11th of December and the sickness that I had previously happened again in exactly the same order although this time it didn’t go away. I did a 24 hour fast incase it was a sickness bug and felt completely fine from not eating. I booked a doctors appointment anyway and he did blood and urine tests and checked my stomach and decided to get me a pelvic scan to make sure everything down there was okay and I didn’t have any growths etc. I went back to work but had to keep leaving early because I had really awful pains in my chest it felt sort of tight and hot and every time I tried to eat it was like my body would not let me swallow it! On the way to the scan I was so unwell, I was shaking and had tingly hands, I could barely drink enough water to have it done! On the way home I seriously thought I was going to die, it felt like my body was completely shutting down. I asked my mum to go to Tesco and pick me up some bananas as I know they’re filling and I got home and had a banana and some glasses of milk just so I had something in my body. I looked into celiac and the next day we went and bought some gluten free foods. I told my doctor about this and he told me not to go gluten free as they need to do tests and he would try and add a celiac test onto my previous blood test. Also during this time I was rapidly losing weight, I lost 1 stone in 7 days. This is when all chaos ensued. I won’t go into huge details but I’ll give you a basic idea about what happened. I had to visit A&E 4 separate times. 1st time - the doctor essentially laughed in my face. He sent me home with omeprazole for heartburn. I went home and took these and had no relief in the slightest. 2nd time - I was taken through to a bed and I was placed on a drip and seen by a doctor, she was horrendous. I told her that it feels like my body was shutting itself down and she told me I needed to ‘stop speaking in third person’ I told her I keep my blood sugars under really tight control and she tested them and they were high (OBVIOUSLY because of stress and illness) and she told me that I did not have good blood sugar control. I was so upset by this as I wasn’t being listened to and two more nurses came over and tried to tell me that I was just having mood swings. I was completely livid. 3rd time - I was taken into a triage ward where they did some tests on me, everything came back fine and a doctor came in and felt my stomach. He (without any doubt in his mind) told me that I had gastroparesis. I was shocked, I was asking questions etc and he just told me it will go away and come back from time to time. I was in hospital alone due to Covid restrictions so I was Googling everything so I could to get a crumb of information and was so scared it was horrific. I was given anti nausea tablets and was told I was staying the night. My diabetes nurse came in in the evening and made them do a test for low cortisol just to rule some more things out. She said she did not think it was gastroparesis but it could either be this or celiac as obviously being type 1 diabetic makes this a fairly good candidate. It gave me some relief and the next day I was out of hospital and back home. My diabetes nurse called me and told me they think it’s low cortisol so put me on hydrocortisone and fludrocortisone tablets and said she would be in touch. This was the 24th of December so I rushed to pick up my prescription and started them on Christmas Day. As soon as I started them it felt like I was having a panic attack but I’m not sure if this was a side effect or nerves or even because it’s to do with the adrenal glands maybe my body was in fight or flight mode?! Anyway, due to the fact that it was Christmas and New Years my diabetes team and doctors were all closed because of bank holidays and weekends etc. I did not think the tablets were helping me although I still took them when I was supposed to. 4th time- I then felt so unwell again, shaking, nausea, unable to sleep, my stomach was making the most insane noises. I would be asleep and then jolt myself awake after an hour. I really thought my body was shutting itself down and that I was going to die. I went back up to A&E and was put on a drip again, I talked to a doctor and this is no word of a lie, he told me that I should get myself a personal trainer to reverse my diabetes? Like I could just grow myself a new pancreas!! I asked him to do an endocrine test and he said he couldn’t, nothing is wrong and that my blood pressure was fine - I literally felt like I was talking to a brick wall so I asked to take the cannula out of my arm and to go home. They said that I had to stay, some of the nurses were really supportive and couldn’t believe the doctor had said that and that I should contact my diabetes clinic as soon as they reopened. They gave me a tuna sandwich on wholemeal bread which after eating I felt shaky and weird again. I went home and had an awful nights sleep again, woke up and tried to call my clinic but they didn’t answer, I was getting more and more frustrated and more and more unwell. I was also told that they hadn’t received the blood test so I phoned my doctor and told him I need a celiac blood test ASAP and he told me he was free in 10 minutes so I grabbed my things and headed down. He took the blood from my arm and I told him from this point forward I’m going to be eating gluten free. He told me that the blood test is very temperamental and that it might come back negative and they would want to do a endoscopy. I told him in the nicest way possible that it won’t be happening as I’m going to be gluten free from this day forward no matter what the test says, I will not compromise my health just for the sake of a positive test and I won’t be doing the gluten challenge so if it comes back negative that he will have to manually type in that I have celiac disease. So far I am now 5 days gluten free and wow I can honestly say I am feeling 80% better than I did before. Obviously it takes time to get better but I’d say after 3 days the weird digestion feeling I was getting had stopped. I am still taking the steroids but have an endocrine test on the 15th so fingers crossed it won’t be a cortisol issue and I can come off of them. We went out and bought a new toaster and all sorts of kitchenware and have sectioned a space in the kitchen for all of my things. At first it was overwhelming but I used this platform to read positive stories and it really settled my mind. I’m going to list my symptoms in the hope it may help/reassure somebody else?! -nausea -shaking/internal tremors -tight chest/extreme acid reflux feeling -muscle weakness -stomach noises/extreme intestinal movement -heart palpitations -loss of appetite -dry mouth -mild diarrhoea -lightheaded when standing up -lower abdominal cramps -unable to sleep I don’t have my appetite back yet all though I’m still eating on schedule and I am still getting the shakes/tremors and very mild heartburn from time to time but I think this could be from the tablets that I’m taking. Also for anyone new who may be reading this, food wise simple things like boiled eggs, tuna, gluten free toast and Nutella, mashed potato have really been a good start to help my stomach. I have also decided to cut out lactose for the first 3 months as I read somewhere that this is meant to help with healing as your villi cannot absorb it?! Also I bought some of the Alive multivitamin gummies from Holland and Barrett (they say gluten free on the back of the packaging) and these have been helping me also!! I’ve got a really positive mindset on this now and I think I’m going to be okay!! Obviously I still have to have my endocrine test and will post an update on that but I just wanted to share my story in the hopes that someone who is maybe going through something similar can get some reassurance that everything is going to be okay and the supermarkets have so many good food options that you’ll be spoilt for choice!! Sorry it’s so long!! Thanks for reading and if you have any tips/ tricks let me know Ellis
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Celiac.com 10/10/2012 - Celiac disease is associated with type 1 diabetes (T1D), but little is known about the connection between celiac disease and diabetic retinopathy (DRP) in patients with T1D. A research team recently set out to determine whether celiac disease is associated with a higher risk of diabetic retinopathy (DRP) in patients with T1D. The researchers included Kaziwe Mollazadegan, MD; Maria Kugelberg, MD, PHD; Scott M. Montgomery, PHD; David S. Sanders, MB, CHB, FRCP, MD, FACG; Johnny Ludvigsson; MD, PHD; and Jonas F. Ludvigsson, MD, PHD. They are affiliated with the Pediatric Clinic, and the Department of Clinical and Experimental Medicine in the Division of Pediatrics at Linköping University in Linköping, Sweden, with St. Erik Eye Hospital, and the Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; the Department of Pediatrics, and the Clinical Research Centre at Örebro University Hospital in Örebro, Sweden, Gastroenterology and Liver Unit, Royal Hallamshire Hospital and University of Sheffield, Sheffield, U.K. Their study shows that longstanding celiac disease is associated with an increased risk of diabetic retinopathy in patients with type 1 diabetes. The team conducted a population-based cohort study, in which they used the Swedish National Patient Register to identify 41,566 patients diagnosed with diabetes from 1964 to 2009, and who were 30 years of age or younger at the time of diagnosis. The team defined celiac disease as the presence of villous atrophy (Marsh stage 3) according to small intestinal biopsies performed between 1969 and 2008, with biopsy reports obtained from Sweden’s 28 pathology departments. During follow-up, the team found 947 T1D patients with celiac disease. They used Cox regression analysis with celiac disease as a time-dependent covariate to estimate adjusted hazard ratios (aHRs) for DRP in patients with T1D and celiac disease, and to compare them with patients with T1D but no celiac disease. The results showed that the longer the patients had celiac disease, the higher their risk of DRP. Once the team adjusted the results by time from celiac disease diagnosis, people with T1D and celiac disease showed a lower risk of DRP in the first 5 years after celiac disease diagnosis (aHR 0.57 [95% CI 0.36–0.91]), followed by a neutral risk in years 5 to Between 10 and 15 years after diagnosis, patients with coexisting celiac disease showed a risk of 2.83 for DRP [95% CI 1.95–4.11. More than 15 years after follow-up, that higher risk rate went up to 3.01 [1.43–6.32]). So, having celiac disease for more than 10 years is a risk factor for the development of DRP in patients with T1D. Therefore, the researchers note, physicians should conduct intense DRP monitoring in patients with long-standing celiac disease and T1D. Source: Diabetes Care
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Celiac.com 11/03/2010 - Children who have both type 1 diabetes and celiac disease, and who also delay a gluten-free diet are about as healthy as kids with type 1 diabetes alone, according to a report in the Journal of Pediatrics. A two year prospective longitudinal review comparing factors including glycemic control, celiac symptoms, or z-scores for weight, body mass index, or height found no significant differences between children who eat a gluten free diet and children who eat to a regular diet. About one of every eight children with type 1 diabetes also suffers from celiac disease. However, this high rate was noted after the development of blood screening for celiac autoimmunity via immunoglobulin A transglutaminase autoantibody (TG); a TG index > 0.05 is considered positive. Currently, doctors don't fully understand the implications of a positive TG index in the absence of symptoms. Whether or not to screen diabetic kids for celiac disease remains controversial. Numerous pediatric diabetes and gastroenterology associations currently recommend screening diabetic kids for celiac disease, while the National Institutes of Health consensus statement does not recommend such screening. Dr. Jill H. Simmons, from Vanderbilt Children's Hospital, Nashville, Tennessee, led a team of researchers that examined the natural history of celiac autoimmunity in children with type 1 diabetes, and explored the benefit of an early gluten-free diet. For the study, the team compared 79 diabetic children with celiac disease antibodies and 56 diabetic children without celiac disease who averaged 10 years old, duration of diabetes (4 years) and gender (56% male). Of the 79 children with positive TG tests, 36 continued eating a regular diet, while 43 followed a gluten-free diet. The team was logistically unable to conduct a two-year follow-up on all participants, and ultimately analyzed complete results for 26 gluten-eating kids, and 37 following a gluten-free diet. Even though the gluten-free diet group showed a higher TG index at the start of the study (0.66 vs. 0.45, p = 0.03), the two groups evened out after 24 months (0.31 vs. 0.35). The groups had about the same overall HbA1c, with the gluten-free group coming in at 8.1% compared with 8.2% for the regular diet group. The team found that 16.2% of gluten-free kids experienced episodes of severe hypoglycemia, compared to 8% of the kids who ate gluten, but the difference was not statistically significant. One year into the study, percentages of patients reporting celiac-associated symptoms, such as diarrhea, abdominal pain, constipation, and abdominal distention were 71% in the gluten-free group, compared with 58% with the gluten-free diet vs. 71%). However, by the two-year mark, these numbers had also evened out. This is interesting, because both groups still report what seem like relatively high rates of celiac-associated symptoms. One important difference at two-year mark was insulin-like growth factor binding protein 3 z-score (-0.23 vs. -1.16, p = 0.002). Therefore, the team concludes, this study "did not demonstrate significant adverse outcome in those children who delayed" a gluten-free diet. Dr. Simmons' group also compared characteristics between TG-positive and -negative children. At baseline, TG-positive subjects had lower z-scores for weight and mid-arm circumference, lower free T4 and insulin/kg values, higher intact parathyroid hormone level, and higher urinary cross-linked N-telopeptides of type 1 collagen (NTX). After 2 years, the only remaining differences were higher urinary NTX and lower weight and BMI z-scores. TG status had no influence on glycemic control. Whatever the case, due to the study's small size, and numerous other factors, the question of whether to screen diabetic children for celiac disease, and how soon to start them on a gluten-free diet, remains unanswered. Also, focus of the study seems a it off the mark. The study does not seem to address the basic complications of celiac disease in general. Rather, it looks at celiac disease purely through the lens of whether or not there are substantial physiological differences in diabetic children with celiac disease who eat gluten-free versus those who do not; or in those who delay the diet versus those who begin immediately. A better question to examine might be: At what point does the damage from celiac disease begin to occur in children with celiac disease who continue to eat a diet that includes gluten? We know the damage from untreated celiac disease starts at some point, and is cumulative in its effect. Clearly, at some point a gluten-free diet will be necessary for diabetic children with celiac disease, so what advantage is there to not putting the child on a gluten-free diet as soon as possible? To their credit, the research team notes that further research is needed to determine the optimal timing of celiac screening in diabetic children, and how soon to begin treatment with a gluten-free diet, weighing cost vs. benefits and effects on quality of life. However, they don't have much to say about what quality of life issues for untreated celiac disease. The team does not examine any aspect of behavioral changes or improvements that may occur when gluten is eliminated; or other factors. They do not address the fact that celiac disease is an auto-immune disease, or the wisdom of permitting an auto-immune disease that is so easily treated as celiac disease to go untreated while trying to treat diabetes. I would say take this study with a grain of salt and keep an eye out for more studies that further elucidate the associations between diabetes and celiac disease, and which provide clearer answers to the question of how soon diabetic children with celiac disease should begin a gluten-free diet. Source: The Journal of Pediatrics. doi:10.1016/j.jpeds.2010.07.025
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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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