Celiac disease is a digestive disorder that appears to be more common in people with type 1 diabetes than in the general population.

Celiac disease is found in 4 to 9% of children with type 1 diabetes but, in 60 to 70% of these children, the disease is asymptomatic (‘silent’ celiac disease). Children with type 1 diabetes are at increased risk for celiac disease during the first 10 years of diabetes. 

What is celiac disease?

Celiac disease is an autoimmune condition in which the body cannot tolerate gluten – a protein found in wheat, rye, barley and triticale. It is the gluten in the flour that helps bread and other baked goods bind and prevents crumbling. This feature has made gluten widely used in the production of many processed and packaged foods.

If you have celiac disease and eat food with gluten, your immune system responds by damaging the small intestine and preventing the body from properly absorbing nutrients in your food, including protein, fat, carbohydrates, vitamins and minerals. 

Celiac disease is an inherited condition. First degree relatives (parents, brothers, sisters and children) of people with celiac disease are at the highest risk of having unrecognized celiac disease (5-15%). It can appear at any time in the life of a person with a hereditary predisposition to it. Environmental factors such as emotional stress, pregnancy, surgery, or an infection (e.g., travellers’ diarrhea, pneumonia) can sometimes trigger the onset of symptoms. 

For more information, please visit the Canadian Celiac Association.

What are the symptoms of celiac disease?

Many people with celiac disease don’t have any symptoms at all, which is why the disease is often undiagnosed. In people who do experience symptoms, they can vary from obvious digestive problems such as severe diarrhea to more vague emotional or behavioural symptoms (the latter are especially common in children). 

These are some of the more common symptoms: 

  • Recurring gastrointestinal symptoms such as:
    • Gas
    • Abdominal pain, cramps, bloating
    • Indigestion and nausea
    • Chronic diarrhea
    • Foul-smelling stool
  • Poor weight gain
  • Anemia – iron, folate or B12 deficiency
  • Extreme weakness and fatigue
  • In people with type 1 diabetes, unexplained frequent low blood glucose (hypoglycemia)
  • In some people, the development of an intense burning and itching rash (dermatitis herpetiformis)
  • Chronic  constipation 
  • Diarrhea and/or constipation 
  • Canker sores

Additional symptoms in children: 

  • Delayed growth
  • Irritability and behavioural changes
  • Vomiting
  • Delayed puberty
  • Dental enamel abnormalities

How is celiac disease diagnosed?

Excellent blood tests to detect endomysial (EMA) and tissue transglutaminase (tTG) antibodies are now available to screen for celiac disease in people with mild or atypical symptoms and those in high risk groups. Such tests may suggest that a person has celiac disease, but they do not replace the need for an intestinal biopsy. 

Small intestinal biopsies are the ONLY definitive means of diagnosing celiac disease. A gluten-free diet should not be started before the blood tests and biopsies are done, since it can interfere with making an accurate diagnosis. 

How is celiac disease treated?

Without treatment, celiac disease can lead to malnutrition, anemia, osteoporosis, infertility and, in people with type 1 diabetes, recurrent episodes of low blood glucose. 

The only treatment for celiac disease is a strict adherence to a gluten-free diet for life. This means completely avoiding products that contain gluten, including bread, pasta and most baked goods. Some medications also include gluten; be sure to tell your pharmacist if you have celiac disease. You may also need to take a daily vitamin supplement. 

A dietitian can help you learn how to select food, read labels and create a healthy meal plan. If possible, ask to see a dietitian who also specializes in diabetes. A gluten-free diet will affect your choice of carbohydrates, which may impact your blood glucose levels. You may need to carefully monitor your blood glucose levels and adjust your insulin doses as you change your eating habits. 

If you have diabetes, you are probably already very aware of what you eat. Adjusting your meal plan for celiac disease may initially seem like a double burden, but you will soon notice an improvement to your overall health.