People with type 1 diabetes (T1D) are at an increased risk of developing other autoimmune diseases, the most common being celiac disease. In fact, more than 10% of people with T1D also have celiac disease. Here, we explore what celiac disease is, how to treat it, and its connection to T1D.

What is Celiac Disease?

In celiac disease, a person’s body is not able to digest foods that contain gluten, a protein found in wheat, rye, barley, and some oats. If a person with celiac disease consumes gluten, their immune system reacts by attacking the lining of the small intestine (part of the gastrointestinal tract).

Because absorption of most nutrients in food occurs in the small intestine, the damage caused by celiac disease can result in decreased absorption of these essential nutrients. Over time, this can cause nutritional deficiencies and lead to secondary issues including slow growth, anemia, and osteoporosis.

What are the Symptoms of Celiac Disease?

Symptoms of celiac disease include:

• gas and bloating
• diarrhea
• vomiting
• stomach pain
• fatigue
• joint pain
• weight loss
• dermatitis herpetiformis (skin rash)

How is Celiac Disease Diagnosed?

Celiac disease diagnosis requires a medical review of symptoms. Diagnosing the disease may also require a blood test to show elevated levels of certain autoantibodies and a biopsy of tissue from the small intestine to check for damage to the lining, usually performed via endoscopy.

What is the Connection Between Celiac Disease and Type 1 Diabetes?

Celiac disease and T1D share a common genetic background found in the human leukocyte antigen (HLA) genotype. The presence of HLA class II genes DQ2 and DQ8 are present in 95% of patients with T1D and almost 99% of patients with celiac disease. But most people with these high-risk genes do not develop T1D or celiac disease.

“The reasons why some people with type 1 diabetes develop celiac disease while others do not, despite the common genetic background, is an area of active research,” says Farid Mahmud, MD, from the Hospital for Sick Children in Toronto. “The T1D population is also unique when it comes to celiac disease because they are largely asymptomatic.”

Because of their close genetic relationship, screening for celiac disease is often recommended in T1D patients, regardless of age. “There is often an incorrect perception of celiac disease with type 1 diabetes as a largely pediatric condition,” Mahmud said. “In reality, autoimmune comorbidities increase with age, and data from our large screening study showed that adults with T1D had higher celiac disease-seropositivity rates than children.”

Autoimmunity Screening for Kids (ASK) Program

T1D and celiac disease are the two most common autoimmune diseases of childhood. JDRF supports the Autoimmunity Screening for Kids (ASK) Program, based at the Barbara Davis Center for Diabetes in Denver, CO. The program offers free screening to all U.S. children to detect T1D or celiac disease.

The goals of ASK are:

• Find early signs of T1D or celiac disease in children before they get very sick
• Offer close monitoring, education, and early treatment when needed
• Offer participation in studies of new interventions that might stop or slow the progression of the disease
• Increase public awareness of T1D and celiac disease

Learn more at the ASK website.

How is Celiac Disease Treated?

Although there is no cure for celiac disease, it can be successfully managed through proper treatment, which requires strict compliance with a gluten-free diet. Removing gluten (wheat, rye, barley, and some oats) from the diet allows the small intestine to heal, which improves nutrient absorption.

There are plenty of foods that are naturally gluten-free, including:

• fruits
• vegetables
• beef
• poultry
• fish
• nuts
• eggs

Gluten-free breads, pastas, and even pizza crusts are easily found in most grocery stores these days. Restaurants are also becoming more accommodating to gluten-free diets. FindMeGlutenFree.com is a good resource to find restaurants in your area with gluten-free options.

Going Gluten Free with T1D

People with T1D may notice a change in their blood glucose control after starting a gluten-free diet. Removing gluten allows the lining of the gut to heal, so absorption of nutrients—including carbohydrates—will improve. Pay special attention to blood glucose levels until the body becomes more efficient at absorbing nutrients. Some people may need more insulin, therefore it is important to keep your T1D healthcare team informed about how you are managing your gluten-free diet and the impact on your blood glucose levels.

Editor’s note: How you manage your type 1 diabetes is a personal decision between you and your healthcare team. JDRF content is for informational purposes only and is not a substitute for professional medical advice. Please contact your doctor or other qualified health provider with any questions you may have regarding type 1 diabetes or any medical condition.