I read a very interesting article recently from one of my all time favorite nutrition newsletters, “Nutrition Action Healthletter” written by The Center for Science in the Public Interest. I have been a subscriber for over 20 years and love their timely non-biased articles about food and health. In the September 2011 issue, “Gluten-Free Confusion, Separating fact from fiction,” interviews Dr. Joseph Murray, a gastroenterologist and professor of medicine at the Mayo clinic in Rochester Minnesota. We all know there is a link between diabetes and celiac disease and most educators I talk to want learn more about celiac disease.
Here a few things from the article that I found interesting:
- Celiac is on the rise. We are getting better at detecting it, but it’s actually increasing too. Dr. Murray suggested that it may have something to do with how we grow and process wheat. Genetically breeding wheat to have higher yield or have higher gluten content could be associated with the increase in celiac.
-There is a genetic component to celiac that is triggered by intestinal injury, infection, etc. (similar to type 1 diabetes). Thirty percent of the population carries one of two versions of the gene for the disease (HLA DQ2 or DQ8). Of course most people eat gluten, but only some of us get celiac disease.
-In someone with celiac disease, their body sees gluten as antigenic and begins to attack. This sets off an immune response. If someone with celiac continues to eat gluten, this results in chronic inflammation. Cytokines are then released from the inflammation and can make the patient with undiagnosed celiac disease feel bad and not initially know gluten is the culprit. Long term, someone with celiac who continues to ingest gluten will damage the lining of their intestine. This damage can cut down on nutrient absorption.
-Because the patient with undiagnosed celiac disease just generally ‘feels bad’ without necessarily having other symptoms, it can be very hard to diagnose. Patients are typically tested using a blood test for Anti-tissue transglutaminase antibody (tTG – IgA and IgG). If that test is positive, then they will most likely need a biopsy of the lining of the small intestine.
-If you think there is a chance your patient may have celiac disease and you recommend they go to their doctor to be tested, they must currently have gluten in their diet for the testing to be accurate.
-When Dr. Murray was asked who should be tested for celiac, he suggested “anyone who has a family member with celiac disease or symptoms that are suggestive of celiac disease--like iron deficiency anemia, chronic diarrhea, bloating, gas, or abdominal pain. So should people with type 1 diabetes or autoimmune diseases like lupus or rheumatoid arthritis in the family.”
Celiac.org and the NIDDK website provide excellent information about celiac disease.
Are you recommending your patients with type 1 diabetes to be tested for celiac? Why or why not? When you refer them to be tested, how complicated has the process been from suspicion of celiac to diagnosis?