Is gluten-free the way to be? There is certainly no lack of opinions on the subject, and more and more gluten-free options are popping up at grocery stores. Why the shift away from a traditionally wheat-heavy diet? Is it a fad? If so, should we be paying attention?
People living with diabetes, who already devote a lot of time to thinking about their diet, may want to take a closer look at their risk for celiac disease. Those with type 1 diabetes are at a higher risk for the condition than the general population. And, equally frustrating, having celiac can complicate your diabetes management.
Diabetes Self Management notes that celiac disease is present in 5-7% of people with type 1 diabetes; the American Diabetes Association estimates that 10% of those with type 1 have celiac. These numbers may not seem incredibly high until you consider that in the general population of the United States, only about 1% have celiac. Those with type 1 diabetes are at a significantly higher risk for celiac than those without.
Other risk factors for celiac disease include:
- Having an autoimmune disorder (in addition to or separate from type 1 diabetes)
- Having gastrointestinal complications
- Being of European descent
- Having thyroid disease
- Being female (women are twice as likely as men to have celiac!)
- Having a first-degree family member with celiac. If someone has celiac, 10-15% of their first-degree family members will likely also have the disease.
Type 2 diabetes is not a risk factor for celiac, and those with type 2 have the same risk as the general population.
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Symptoms of Celiac Disease
Celiac disease is often difficult to diagnose because the symptoms mimic those of other gastrointestinal complications and those of diabetes itself. Symptoms include gas, bloating, diarrhea, fatigue, low blood sugar, anemia, depression, and/or irritability (no kidding).
However, the disease may also be asymptomatic, and approximately 50% of those with celiac disease present without obvious symptoms. But that doesn’t mean there’s nothing to worry about—celiac disease may cause serious long-term complications with or without obvious symptoms.
But how does Celiac Disease Work?
Celiac disease is a hereditary autoimmune disease that causes the immune system to see gluten as a toxin. Gluten is a type of protein found in wheat, rye, and barley. When someone with celiac ingests gluten, the immune system attempts to keep it out of the blood stream. It does this by causing the villi to flatten. Villi are the fingerlike projections in the small intestine that provide surface area for nutrient absorption. When the villi flatten, the intestinal walls are smoother, and food slips through without being properly absorbed. The small intestine also stops making the digestive enzymes needed for proper absorption.
The inability to properly absorb the nutrients from food may lead to weight loss, vitamin deficiencies, stunted growth (in children), low blood sugar, and the previously mentioned gastrointestinal complications. Or, again, there may be no obvious symptoms at all.
Even if someone with celiac doesn’t have symptoms, the flattening action in the intestines in response to the presence of gluten may cause long-term damage. The disease puts people at risk for deficiencies in vitamins A, D, E, K, and B-12; folate, iron, and calcium. Over time, these deficiencies may contribute to osteoporosis, fertility problems, gynecological disorders, and tooth enamel defects. Because of intestinal damage, people with celiac may also develop lactose intolerance. Talk about adding insult to injury!