Diabetes Forecast

A Tricky Diagnosis

Why you should learn about celiac disease

By Shauna S. Roberts, Phd ,

If you have type 1 diabetes, you're more likely to have the digestive disorder celiac disease, too. That's because type 1 and celiac disease are both autoimmune disorders, and people who have one autoimmune disease often develop others. Overall, about 1 percent of Americans have celiac disease, but among people with type 1 diabetes that figure is 3 to 8 percent. Unfortunately, celiac disease can be very hard to diagnose, and some people go for years without knowing what is causing their symptoms.

In celiac disease (also known as celiac sprue and gluten- sensitive enteropathy), the immune system attacks gluten, a protein found in wheat, barley, rye, and other foods, damaging the small intestine in the process. The body loses the ability to absorb nutrients from food, and you may become deficient in iron, calcium, and vitamins. Celiac disease can develop at any age; relatives of people with celiac disease have an increased risk of getting it.


Celiac disease is divided into three categories based on symptoms.

Classic celiac disease.

In the classic version of the disease, the symptoms occur in the gastrointestinal tract or reflect poor absorption of food. They include diarrhea that doesn't go away; constipation; abdominal pain; weight loss; poor growth (in children); bloating; flatulence; vitamin and mineral deficiencies; osteoporosis; and malnutrition.

Atypical celiac disease.

In atypical disease, gastrointestinal symptoms may be mild or not be present at all. Some people get a particular kind of rash (dermatitis herpetiformis) which tends to appear on the face, elbows, knees, or buttocks; other symptoms can include anything from tooth enamel problems to joint pain to infertility. Although labeled "atypical," this form may, in fact, be the most common. Its signs and symptoms can also be present in the classic form.

Silent celiac disease.

In silent disease, the person has no symptoms. Diagnosis occurs only when the bowel is examined or biopsied for some other reason, or if a person at high risk is screened for celiac disease.


Diagnosis starts with blood tests that look for two particular antibodies usually found only in people with celiac disease. If someone has the antibodies, doctors do several biopsies (removal of tissue samples) of the small intestine to look for specific changes in the tissue. This is done using a scope through the mouth and stomach into the small intestine. The final step is for the person to try a gluten-free diet. If the symptoms go away, the diagnosis is confirmed.


No matter what form of celiac disease you have, the treatment is the same: Give up all foods that contain gluten. You should meet with a dietitian to learn how to get the nutrients you need and to develop a healthy meal plan of gluten-free foods. People with diabetes and celiac disease need to monitor their blood glucose levels often after starting a gluten-free diet.

The table above lists some of the foods that contain gluten and should be avoided by people with celiac disease, plus other grains that can be eaten. Because grains find their way into all kinds of products, always read labels on foods, over-the-counter medicines, and supplements. Ask your doctor or pharmacist about the ingredients in prescribed medicines.

On the plus side, now that celiac disease is more widely known, there are many manufacturers who produce gluten-free food products.

Shauna S. Roberts, PhD, is a writer in Riverside, Calif.

Breaking down the grains:

Grains and grain products that contain gluten

  • Wheat
  • Barley
  • Rye
  • Oats*
  • Kamut
  • Spelt
  • Triticale
  • Beer
  • Breading
  • Graham flour
  • Whiskey
  • Communion wafers
  • Malt flavoring
  • Malt vinegar
  • Matzoh
  • Pasta
  • Play-Doh: modeling or compound

Products that may contain gluten
(check labels for substances listed above)

  • Breakfast cereal
  • Broth and soup bases
  • Brown rice syrup
  • Candy
  • Cookies
  • Artificial bacon
  • Gravies and sauces
  • Lunch meat
  • Medicines
  • Soy sauce
  • Stuffing
  • Vitamins and supplements

Grains safe for people with celiac disease to eat

  • Rice
  • Corn
  • Quinoa
  • Millet
  • Buckwheat
  • Amaranth
  • Tef
  • Sorghum
  • Arrowroot flour
  • Nut flour

*Oats themselves don't contain gluten, but some doctors recommend
avoiding them because oats often are contaminated with other grains.

For More Information

Organizations that specialize in celiac disease include:

  • Celiac Disease Foundation: (818) 990-2354, www.celiac.org
  • Celiac Sprue Association: 1-877-272-4272, www.csaceliacs.org
  • Gluten Intolerance Group: (253) 833-6655, www.gluten.net
  • National Foundation for Celiac Awareness: (215) 692-2639, www.celiaccentral.org


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