Diabetes and Coeliac Disease (coeliac sprue or gluten allergy)
Coeliac disease (also known as celiac disease) is a condition that occurs when the lining of the small intestine is damaged by gluten. Gluten has an adverse reaction that causes the immune system to attack the lining of the bowel.
Gluten is a common protein that is found in rye, wheat, and barley. The damaged lining of the small intestine means that foods are not absorbed properly. Several groups are more at risk from developing celiac disease, and these include type 1 diabetics.
What symptoms are common in coeliac disease?
Like diabetes itself, coeliac disease can be diagnosed with no symptoms, and the symptoms can be extremely subtle. However, often people who have it will lose weight because of their inability to absorb food. Vomiting and diarrhoea may occur, as well as more seemingly minor symptoms such as lethargy and breathlessness. In some cases, the patient will have had a history of abdominal pain or discomfort, but in others coeliac disease can develop at any time.
In babies and young children, coeliac disease can cause them to gain weight, become paler, and be lethargic and unhappy. In children, Coeliac disease often starts manifesting itself when cereals are introduced into the diet.
All of the symptoms of coeliac disease can also be indicative of other conditions, so it is essential to seek professional diagnosis before jumping to any conclusions. However, if left untreated, coeliac disease can lead to bone disease, anaemia and even cancer.
How large is the risk of coeliac disease in the UK?
Recent research has found that coeliac disease affects approximately 1 in 300 people throughout the UK and Europe. In some areas of the world, coeliac disease is more prevalent. For instance, the West coast of Ireland has a high coeliac concentration with approximately 1 in 100 people affected by the condition. Coeliac condition occurs equally in men and women.
What are the causes of coeliac disease?
Gluten is a combination of the proteins gliadin and glutenin. When Gluten is mixed with water it becomes sticky and forms dough. When gluten reaches the lining of the small bowel it causes a reaction. The immune system attacks villi on the lining of the bowel as if it were an external organism. In coeliac disease, the villi are attacked and eventually may be destroyed.
Henceforth, nutrients are not properly absorbed, leading to a host of problems.
Many coeliacs inherit the condition from a member of their family, although having a coeliac family member means only a 10 per cent higher chance of developing the condition.
I am worried that I may have coeliac disease, who can diagnose me and how does this work?
To obtain an accurate diagnosis of coeliac disease, it is usually necessary to see a gastroenterologist. A new method of testing involving measuring the anti-gliaden antibodies that only persist in people with coeliac disease is considerably easier than the old method of intestinal biopsy. However, the tests are still not 100 per cent accurate.
How will being coeliac affect my diabetes?
Considerable volumes of research have linked diabetes and coeliac disease in adults, children and adolescents. Many experts now agree that more attention should be given to this link, and that all patients diagnosed with diabetes should be screened for coeliac disease.
Coeliac disease can sometimes cause abdominal symptoms that lead to a diabetes diagnosis, and it may also cause hypoglycaemia due to impaired carbohydrate absorption in the gut.
What diet should I use if I have coeliac disease and diabetes?
To return the intestine to a normal pre-coeliac state it is necessary to adhere to a strict gluten-free diet. Diet is essential to manage diabetes, but when combined with coeliac disease this needs careful attention. Carbohydrates are essential for diabetics, but when coeliac disease is also diagnosed many of the staple carbohydrate sources must be avoided. These can include bread, pasta, cereal, biscuits and cakes.
Although these can be replaced with gluten-free alternatives, these often lack the taste of the original food.
There are several key difficulties to be considered when combining a coeliac and diabetes-friendly diet:
- Little choice of what to eat
- Few pre-prepared foods without gluten
- Gluten can easily be ‘hidden’ in some products
- Buying gluten-free food is expensive
There are many books available about living gluten-free.
What are the real effects of living with both diabetes and coeliac disease?
The actual effects of living with diabetes and coeliac disease can be extremely harrowing, both for the individual and the family. In the case of children it can cause them to be ostracised by their peers and less able to enjoy normal social situations where food is present.
Coeliac disease often causes emotional and behavioural problems as a child comes to terms with their disease. Many restaurants will be able to help you if you reveal that you are a coeliac.
Who can I turn to for help and advice about diabetes and coeliac disease?
These numbers and addresses could provide further useful information:
The Coeliac Society,
PO Box 220,
High Wycombe,
Bucks.
Tel: 01494 437278
Help line: 0870 4448804
