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:
- Wheat and
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.
Coeliac disease is a condition that affects about 1 in every 100 people in the UK. Coeliac disease is an autoimmune disease and has links with type 1 diabetes, which is also an autoimmune disease.
About 1 in 10 people with type 1 diabetes have coeliac disease as well so it is not uncommon to have both diabetes and coeliac disease.
Coeliac disease is an autoimmune disease which causes inflammation in the lining of the small intestine when gluten is eaten. Gluten is a protein found in wheat, barley and rye and is therefore found in a wide range of products including:
- Tinned soups
- Packaged foods containing sauces
Inflammation of the small intestine can mean that the body struggles to absorb nutrients properly. The symptoms of coeliac disease can vary from being very mild to severe. The classic symptoms of coeliac disease are:
- Stomach pain
- Diarrhoea or constipation
Other symptoms that may be present include:
- Delayed growth
- Bone and joint pain
- Weight loss
- Skin rash
- Nerve damage (neuropathy)
Some people with coeliac disease may be diagnosed without noticing symptoms. People with the following conditions may be recommended to undergo screening for coeliac disease:
- Type 1 diabetes
- Irritable bowel syndrome
- Underactive or overactive thyroid
- Dermatitis herpetiformis -a skin condition
Diagnosis of coeliac disease initially involves a blood test to check for specific antibodies. If these antibodies are present, a biopsy of your small intestine will be taken.
Both diabetes and coeliac disease means care needs to be taken when choosing what to eat.
Having coeliac disease means you need to avoid foods containing gluten. Whilst diabetes means you need to consider the carbohydrate quantity in what you eat
People with coeliac disease need to keep to a gluten free diet. Many prepared foods contain gluten but there are a growing number of foods available which are specifically gluten free. You should be referred to a dietician who will help you to choose a diet that is well balanced and free from gluten.
People with coeliac disease can also get prescriptions for gluten free foods such as flour and breads.
The JDRF, a charity for people with type 1 diabetes, notes that people with type 1 diabetes and coeliac disease may have a higher tendency to experience unexplained episodes of low or high blood sugar levels.
Coeliac disease in children
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% 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% 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.
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 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
- Tel: 01494 437278
- Help line: 0870 4448804