While playing, 14-year old Sunil struck his hand on a stick and suffered a fracture on his upper arm bone. During a regular check up at the endocrinology department at BYL Nair Hospital, his parents were told that he has celiac disease, which had in turn caused the fracture.
Celiac disease is an auto-immune disorder that damages that small intestine and interferes with the intestinal absorption of nutrients. Patients show zero tolerance for gluten which is contained in wheat, rye (millet), oats and barley. Though the prevalence of celiac disease is just 0.5% to 1% in the general population, in type 1 diabetics, the prevalence is 10 to15%.
Now, in research conducted by the endocrinology department of BYL Nair Hospital, people with both celiac disease and type 1 diabetes have been found to have poor bone mineral density, making them susceptible to fractures.
“For the purpose of research, we tested 80 type 1 diabetics, of which 11 patients had celiac disease. The control group had 22 patients who suffered from type 1 diabetes without celiac disease. The patients’ ages varied from 12 years to 40 years,” said Ameya Joshi, who conducted this research under the supervision of the head of department, Premlata Varthakavi.
“While many suffer from typical symptoms such as gastrointestinal problems, others suffer from fractures from unrecognised trauma,” said Dr Joshi, adding, “Simple dietary measures can reverse these symptoms and improve bone density.”
The research paper won second prize in the Annual Conference of the Endocrine Society of India (ESICON) 2010at Vellore last month.
While similar research has been done in the West, this is the first time a research paper in India has shown a direct co-relation between celiac disease and low bone mineral density in type 1 diabetics.
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Complications
Left untreated, celiac disease can lead to several complications:
- Malnutrition. Untreated celiac disease can lead to malabsorption, which in turn can lead to malnutrition. This occurs in spite of what appears to be an adequate diet. Because vital nutrients are lost in the stool rather than absorbed in the bloodstream, malabsorption can cause a deficiency in vitamins and minerals, vitamin D, folate and iron, resulting in anemia and weight loss. Malnutrition can cause stunted growth and delayed development in children.
- Loss of calcium and bone density. With continued loss of fat in the stool, calcium and vitamin D may be lost in excessive amounts. This may result in osteomalacia, a softening of the bone that in children is also known as rickets, and loss of bone density (osteoporosis), a condition that leaves your bones fragile and prone to fracture.
- Lactose intolerance. Because of damage to your small intestine from gluten, foods that don't contain gluten also may cause abdominal pain and diarrhea. Some people with celiac disease aren't able to tolerate milk sugar (lactose) found in dairy products, a condition called lactose intolerance. If this is the case, you need to limit food and beverages containing lactose as well as those containing gluten. Once your intestine has healed, you may be able to tolerate dairy products again. However, some people may continue to experience lactose intolerance despite successful management of celiac disease.
- Cancer. People with celiac disease who don't maintain a gluten-free diet also have a greater chance of getting one of several forms of cancer, including intestinal lymphoma and bowel cancer.
- Neurological complications. Celiac disease has also been associated with disorders of the nervous system, including seizures and nerve damage (peripheral neuropathy).
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