Patients And Study Design
The study was conducted at the University of Tampere and Tampere University Hospital. The celiac disease cohort comprised of 1358 adults collected from our regularly updated research database. The patient information was gathered from the medical records and, when inadequate, supplemented with personal interviews by a physician or study nurse. Following information at celiac disease diagnosis was collected from each subject: demographic, clinical and histological data, blood hemoglobin and celiac disease serology, presence of concomitant other chronic medical conditions, family history of celiac disease, and adherence to the gluten-free diet. The diagnosis of celiac disease was based on the demonstration of small-bowel mucosal villous atrophy and crypt hyperplasia in duodenal biopsies taken upon gastroscopy . After the analyses, the patients were divided into three groups based on the presence of celiac disease and either concomitant DM1 , DM2 , or no diabetes . The diagnoses of DM1 and DM2 were set by the hospital physicians according to the national guidelines .
The Regional Ethics Committee of the Tampere University Hospital District approved the study protocol, and all subjects participating to the personal interviews gave written informed consent.
Possible Risks Of Eating Gluten
A 2015 study that reviewed records of patients presenting for evaluation in celiac disease clinics found that 11% had at some point avoided gluten without a diagnosis of celiac disease. Reasons given for adopting the gluten-free diet included lactose intolerance and irritable bowel syndrome . A 2012 study of 579 children and adolescents found that 7.4% were avoiding gluten without a celiac disease diagnosis. The study found that the strongest predictors of participants following the gluten-free diet included irritability, family history of celiac disease, bowel movement changes, diarrhea, and autism .
Some evidence indicates that there are significant drawbacks to following the gluten-free diet. For example, gluten-free processed grain products are often lower in fiber, iron, zinc, and potassium . The gluten-free diet also may increase the risks for nutritional deficiencies, especially in B vitamins, iron, and trace minerals . In addition, gluten-free products continue to be significantly more expensive. A 2015 study found that gluten-free bread and bakery products were on average 267% more expensive than gluten-containing breads, and gluten-free cereals were found to be 205% more expensive than gluten-containing cereals .
Gf Diet And The Intestine
Thus, a GF diet may improve the intestinal microbiota and permeability , but more studies are needed in order to gain knowledge about mechanisms and causality.
Gluten free diet and the development of type 1 diabetes a hypothesis. A GF diet decreases the intestinal permeability and increases the villus-to-crypt ratio, thereby preventing food particles such as gliadin peptides from crossing the intestinal barrier and reacting the pancreas. A GF diet increases the number of Akkermansia bacteria, among other changes, and the amount of short-chain fatty acids such as butyrate. A GF diet modulates the innate and adaptive immune system resulting in reduced interferon gamma secretion from CD4+ T helper cells, reduced interleukin 22 secretion from gamma delta T cell receptor + T cells, and lower numbers of activated natural killer cells, among other things. TH17 cell numbers are reduced and immunosuppressant M2 macrophage numbers and forkhead box P3 + regulatory T cell numbers are increased. A GF diet reduces beta-cell stress by reducing the insulin secretion. This may preserve the number of islets, reduce insulitis, and ameliorate T1D.
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What Does Science Say
At this time, there is no strong scientific evidence that a gluten-free diet is good for people with diabetes. While some primary studies suggest that a gluten-free diet may decrease the risk of developing diabetes, more research still needs to be done to confirm or deny these findings.
On the flip side, some scientists have evidence that a gluten-free diet can actually increase your risk of diabetes type 2. The only thing confirmed is an increased risk of Celiac disease if you already have type 1 diabetes. This is thought to be a genetic link, but scientists need to do more research in this regard.
What Is Type 2 Diabetes And Gluten Intolerance
Every where I look these days I see the words gluten free. A good deal of people I speak to tell me they are gluten intolerant or have opted to go gluten free due to their wellbeing. So I decided Id look into why there appears to be this enormous increase in both the gluten free community and the type 2 diabetes. There was a time not that long ago when only people with celiac disease or gluten intolerance were advised by their physicians to remove gluten from their diets.There was also a time when most people who had diabetes had type one diabetes and were often born with it.
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Can Gluten Protect You From Type 2 Diabetes
Article Date: August 20, 2018
After spending years eating rice-flour cookies and pasta, health-conscious consumers believe theyve found a reason to put gluten back on the menu.
A 2017 study linked low-gluten diets to type 2 diabetes. Flipping that on its headcould that mean eating more gluten will protect you from diabetes, people wondered?
Not so fast.
The average person should neither increase nor decrease gluten as a means to a healthier diet, said Jonathan Gonzalez, MD. Consuming more gluten as a protective factor against diabetes is simply an overreach.
When the study came out, I got a lot of questions from patients asking me about this, said Dr. Gonzalez, a family physician with Baptist Primary care at 900 Beach Blvd. who specializes in wellness and also, Type 2 diabetes. But, I think they should take this out of their heads, the idea that theyre going to eat more gluten and theyre not going to get diabetes. I would focus more on exercise and maintaining a balanced diet.
On the other hand, many people who eliminate gluten from their diets arent really getting health benefits either, he said.
The march towards gluten-free
Gluten is a protein found in cereal grains such as wheat, rye and barley. Its the substance that gives dough its elasticity. Most people associate gluten with bread and other baked goods, but gluten may also show up in some not-so-obvious places such as bouillon cubes, hot dogs and beer.
Dr. Gonzalez said thats unnecessary.
A fad diet
Managing Celiac Disease And Diabetes
The gluten-free diet may improve glycemic control for diabetic patients, although that is still controversial, as some studies support the idea and others suggest there is no difference in glycemic control between normal diabetic patients and diabetic patients with celiac disease on a gluten-free diet.
Untreated celiac disease, leading to a damaged small intestine, can increase risk of hypoglycemia because the small intestine may no longer be able to absorb nutrients, such as sugars, properly, making diagnosis even more imperative.
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Coexisting Diabetes And Celiac Disease: Special Challenges
For patients with concurrent diabetes and celiac disease, the gluten-free diet must be carefully planned to meet nutritional needs while controlling blood glucose. This is best accomplished through consultation with a registered dietitian nutritionist who is experienced in treating celiac disease and diabetes. The carbohydrate and fat content of gluten-free foods often is higher than in gluten-containing foods . In addition, the fiber content is typically lower, particularly if individuals eat the majority of grain servings in the form of rice-based, refined, and processed foods. Early studies in this area found that gluten-free foods may have a higher glycemic index than comparable gluten-containing foods, but more recent research does not support this conclusion . It is important for patients to read the labels of gluten-free foods for carbohydrate content and because serving sizes may differ from those of similar gluten-containing foods.
Gluten And Diabetes: Should People With Diabetes Avoid Gluten
While going gluten-free is a bit of a fad these days, there can be good reasons for doing so especially if you live with type 1 or type 2 diabetes.
Could following a gluten-free diet improve yourinsulin sensitivity? Could it help you lose weight, feel more energized, improve your thyroid function, and eliminate your stomach woes?
Lets look at what the science says!
In this article, well look at what gluten is, the signs and symptoms of gluten intolerance or sensitivity, and what research says about gluten and diabetes.
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Low Gluten Diets Linked To Higher Risk Of Type 2 Diabetes
- American Heart Association
- Diets higher in gluten were associated with a lower risk of developing type 2 diabetes. Study participants who ate less gluten tended to eat less cereal fiber, a known protective factor for developing type 2 diabetes.
Eating more gluten may be associated with a lower risk of developing Type 2 diabetes, according to research presented at the American Heart Association’s Epidemiology and Prevention / Lifestyle and Cardiometabolic Health 2017 Scientific Sessions.
Gluten, a protein found in wheat, rye and barley, gives bread and other baked goods elasticity during the baking process and a chewy texture in finished products. A small percentage of the population cannot tolerate gluten due to Celiac disease or gluten sensitivity, but gluten-free diets have become popular for people without these conditions, even though there is lack of evidence that reducing gluten consumption provides long-term health benefits.
Micronutrients are dietary components such as vitamins and minerals.
In this long-term observational study, researchers found that most participants had gluten intake below 12 grams/day, and within this range, those who ate the most gluten had lower Type 2 diabetes risk during thirty years of follow-up. Study participants who ate less gluten also tended to eat less cereal fiber, a known protective factor for Type 2 diabetes development.
What Is Type 1 Diabetes
Type 1 diabetes is an autoimmune disease where the bodys immune system attacks insulin-producing cells in the pancreas.2 Insulin works to help transform sugar into energy, so when insulin levels are low, blood sugar levels rise. People with type 1 diabetes have little to no insulin of their own so they need to take insulin injections to survive.
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Coeliac Disease And Type 1 Diabetes
As well as the symptoms mentioned above, recurrent hypos can also be a sign of coeliac disease in people with type 1 diabetes because their body is not able to use the carbohydrate for energy.
If you have coeliac disease and type 1 diabetes, you need to be referred to a dietitian by your GP or your gastroenterologist for individual advice on how to manage your diet.
Clinical Presentation Serology And Adherence To Gluten
The main mode of presentation at celiac disease diagnosis was categorized into three groups: 1. Classical gastrointestinal celiac disease comprising subjects with for example diarrhea and malabsorption 2. non-classical presentations such as dermatitis herpetiformis, infertility, joint pains and neurological symptoms and 3. apparently silent/asymptomatic subjects detected by screening in at-risk groups. From the concomitant chronic diseases, particular attention was paid to the presence of autoimmune and gastrointestinal disorders, osteoporosis or osteopenia, asthma, malignancies, hypercholesterolemia and cardiovascular diseases. Anemia at diagnosis was defined as a hemoglobin value < 13.4 g/dL in men and < 11.7 g/dL in women .
Adherence to the gluten-free diet was considered strict if the patient reported no dietary lapses. A few minor lapses less than once per a month was regarded as occasional lapses, and lapses more often than that as no gluten-free diet. Furthermore, the strictness of the diet was estimated on the basis of the positivity to endomysial antibodies after a minimum of one year on gluten-free diet. The antibodies were measured by a well-validated in-house test that uses human umbilical cord as substrate .
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Gf Diet Early Evidence And Timing
In summary, the studies suggest that a GF diet may have the potential to reduce the risk of T1D. Interestingly, a GF diet seems to be most effective when applied in utero, and timing of the introduction of gluten is apparently critical. Moreover, a few studies indicate that a GF diet, when applied to older children with T1D, may preserve the beta cells to some extent.
Can Gluten Be Linked To Diabetes
A considerable amount of published research has looked at the potential links between coeliac disease and type 1 diabetes . This has led to the discovery that they often share similar genetic markers linked to the immune system.
Another recent study found that although coeliac disease was more common in people with type 1 diabetes there were no more cases of coeliac disease in people with type 2 diabetes than the general population.
However, while studies in animals suggest gluten may increase risk of developing type 1 diabetes, human studies do not. A large review investigating when infants are first given gluten and their risk of developing type 1 diabetes found no link, unless infants were fed solids in their first three months, which is much younger than the six months recommended by the World Health Organisation.
And in animal studies of type 2 diabetes, it has been suggested gluten may increase the risk of developing diabetes.
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Gf Diet Risk Of T1d And Cd
CD is a chronic autoimmune disease that results in inflammation of the intestinal submucosa and destruction of the intestinal epithelium. The following clinical signs are typically observed: increased numbers of intraepithelial lymphocytes, villus atrophy, and crypt hyperplasia. The treatment consists of a strict GF diet and if not initiated it will lead to undernourishment. The pathogenesis is thought to start with binding of gliadin to the chemokine receptor CXCR3 on enterocytes, which results in increased intestinal permeability by myeloid differentiation primary response 88 -dependent zonulin release and crossing of the lamina propria by gliadin . At this site, tissue transglutaminase deamidates glutamine residues in gliadin to glutamate, which mediates high affinity of gliadin to HLA-DQ2/DQ8 on APCs and thus activation of CD4+ T cells specific for gliadin . Next, production of proinflammatory cytokines and activation of CD8+ T cells specific for gliadin are thought to further worsen the damage to the intestine .
Hence, studies in animals and humans with T1D indicate that a GF diet may reduce the signs of CD and that the prenatal period may be of special importance .
Diabetes And Celiac Disease
The link between type 1 diabetes and celiac disease was first established in the 1960s. The estimated prevalence of celiac disease in patients with type 1 diabetes is approximately 6%, and about 1% in the general population. Due to the significantly higher prevalence of celiac disease in diabetes patients, many doctors recommend getting screened for celiac disease after a diagnosis of type 1 diabetes, and vice versa.
There is no established link between type 2 diabetes and celiac disease.
A 2013 study found that there were no standard uniform practices for screening type 1 diabetes patients for celiac disease. Of the facilities in the study that did screen for celiac disease, 60% only did so if there were symptoms present. The authors of the study suggested a uniform screening protocol be in place. Additionally, dietitians should acquire further education on the gluten-free diet for patients with type 1 diabetes and celiac disease.
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Type 2 Diabetes And Gluten
Since type 2 diabetes is not an autoimmune disease, it has absolutely no links with celiac disease. There have been no studies that show that gluten free diets help prevent the development of type 2 diabetes or manage it.4 Because of this, there are no recommendations to avoid gluten if you have type 2 diabetes.
Type 1 Diabetes Vs Type 2 Diabetes
Type 2 diabetes is characterized by insulin resistance, which means some cells donât respond to insulin to convert blood sugar to energy. Itâs worth noting that people with type 2 diabetes have beta cells, but they donât make enough insulin.
In both type 1 and type 2 diabetes, the blood sugar concentration becomes chronically high, damaging blood vessels and nerves.
Even though the exact cause of type 2 diabetes is not well understood, some risk factors include being obese/overweight, inactive lifestyle, 45+, and if you have a family member or close relative who has been diagnosed with the condition.
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What Side Effects Might I Need To Be Aware Of On A Gluten Free Diet
Nutrient deficiencies can be a potential side effect when observing a gluten-free diet. As a result, your doctor may need to prescribe supplements to you or prescribe specialist gluten-free products to help avoid deficiencies.
Whilst nutrient deficiencies are possible on a gluten-free diet, it should be noted that deficiencies of not following a gluten-free diet will be much greater if you have coeliac disease.
How Is Gluten Related To Type 1 And Type 2 Diabetes
Diabetes might seem far removed from gluten, but research has demonstrated a link between the two, beginning over 50 years ago in the late 1960s. We know that at least 10% of patients with type 1 diabetes develop celiac disease at some point in their lives . The comorbidity of type 1 diabetes with celiac has been attributed to an overlap in the genetic susceptibility to both diseases caused by the existence of the gene sequence HLA-DR3-DQ2. This particular set of genes is present in over 90% of individuals with celiac disease and 55% of those with type 1 diabetes. Interestingly, type 1 diabetes rarely develops after diagnosed celiac disease. This may indicate a protective role of a gluten free diet for diabetes.
Other studies have linked intake of a gluten-free diet to reduced incidence of obesity and type 2 diabetes, suggesting that a gluten free diet may have a role in reducing leptin- and insulin-resistance and increasing beta-cell volume, all factors in reducing diabetes risk. In addition, research has pointed to the beneficial effects of gluten-free diets in reducing adiposity gain and inflammation.
This protective effect may extend beyond just individuals. Animal and human studies have demonstrated that a gluten-free diet during pregnancy reduces the risk of type 1 diabetes in the developing child.
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