Tied to Inability to Digest Grains
By Ed Edelson, HealthScoutNews
(HealthScoutNews) -- The incidence of celiac
disease, a genetic inability to digest the gluten in grains, is
much more common among persons with insulin-dependent diabetes
than has been thought, a study finds.
Detailed tests found that 4.6 percent of 218 young patients
with diabetes had celiac disease, says a report in the latest
issue of the Journal of Pediatric Gastroenterology.
"Based on our work here, every one of our diabetic patients
now gets screened for celiac disease," says study leader
Dr. Steven Werlin, professor of pediatric gastroenterology at
the Medical College of Wisconsin.
Gluten is a protein in wheat, rye and barley. In celiac disease,
the body's immune system mistakenly identifies and attacks gluten
in the intestines. Damage to the intestinal lining leads to reduced
absorption of important nutrients, which can cause anemia, failure
to grow properly and other problems.
Many patients in the Wisconsin study did not have obvious symptoms,
Werlin says. Their celiac disease was diagnosed by taking samples
of tissue from the lining of the intestines and looking for inflammation
and cell damage.
It's important to detect even mild, symptomless cases of celiac
disease in diabetics, Werlin says. "For one thing, diabetes
with untreated celiac disease is harder to manage, and among other
complications, there is an increased risk of lymphoma (malignant
tumors) of the small bowel."
Until recently, doctors believed only about 1 percent of people
with diabetes in the United States had celiac disease, Werlin
says. European studies have found a much higher incidence there.
"Our findings are compatible with the European studies,"
Newer studies have raised the estimate of the incidence in the
United States, says Dr. Stefano Guandalini, professor of pediatrics
at the University of Chicago and a member of the medical board
of the Celiac-Sprue Association/United States of America.
"The estimates have been fluctuating between 2 and 6 percent,"
he says. "We have done similar studies and found similar
Celiac disease is more likely to go undetected in the United
States than in Europe, partly because the American diet is richer,
making the symptoms more difficult to detect, says Mary Schluckebeier,
president of the Celiac-Sprue Association. "In Europe, celiac
disease is considered the most frequent genetic disease. Physicians
are less likely to look for it in the United States, where it
is considered to be a rare disease," she says.
The incidence of celiac disease among the general American population
is unknown, with estimates ranging from one in 3,000 to as high
as one in 250. She says the incidence clearly is higher among
persons with insulin-dependent (Type I) diabetes and among patients
with other genetic diseases.
"It appears that if you look at the genetic marker for
celiac disease, it is a close neighbor of the marker for Type
I diabetes," she says. "Both are autoimmune diseases.
There is a greater possibility if you have one autoimmune disease,
you will have another."
The treatment for celiac disease is a gluten-free diet. Specially
manufactured substitute foods, including gluten-free bread, pasta
and flour, are available. Other foods, including rice, corn, meat,
fish, eggs, dairy products, fruits and vegetables can be eaten
without worry because they do not contain gluten.
What To Do
Parents of children with Type I diabetes should be alert for
the symptoms of celiac disease, which include bulky, unusually
smelly feces, failure to gain weight properly, excess intestinal
gas and sometimes acute diarrhea. Undetected celiac disease in
adults can cause fatigue, breathlessness, swelling of the legs
and abdominal pain.
Detailed information about celiac disease is available from the
Celiac-Sprue Association/United States of America and the
National Institute of Diabetes and Digestive and Kidney Diseases.
American Diabetes Association explains Type I diabetes.
Reference Source 101