Dry Eye, Autoimmune (Keratoconjunctivitis Sicca)

What Are Gastro-Intestinal Complications Of Type 1 Diabetes?

[dropcap]G astrointestinal complications of type I diabetes mellitus are functional or organic changes that result from diabetes affecting every organ of the gastrointestinal tract.

Q: How do gastrointestinal tract complications affect diabetes?

A: Impaired function of individual digestive organs in diabetes can significantly influence level of diabetes compensation and vice versa. On the other side, unsatisfactory diabetes compensation can result in manifestation of digestive problems.

The most frequent (55 to 75%) and the most serious clinical complication is diabetic gastroparesis characterized by impaired evacuation and motility of the stomach and small intestine. Gastroparesis results in nausea, vomiting, early fullness after eating and constipation.

Treatment is with prokinetics. These oral medicines help motility and transport of food in the esophagus, stomach and intestines and improve sphincter function to keep food from going backwards.

Gastroesophageal reflux and heartburn are other complications in diabetes. These are treated with antacids and acid reducing medications.

Various autoimmune disease interfere with digestion. One connection between diabetes mellitus and the gastrointestinal tract can be celiac disease.¹

What Are Gastro-Intestinal Complications Of Diabetes In Celiac Disease and/or Gluten Sensitivity?

• Gastrointestinal complications of type I diabetes in celiac disease are associated disorders.
• Gluten enteropathy itself is a cause of gastroparesis, heartburn, gastroesophageal reflux, dysphagia and other similar gastrointestinal tract complications as diabetes.
• Malabsorption and inflammation in celiac disease increase risk for invasion by pathogens causing disease such as bacterial overgrowth and candidiasis which themselves cause gastrointestinal complications of type I diabetes.
• Deficiency of magnesium due to malabsorption in celiac disease impairs motility.

• A study investigating the short-term (12 months) clinical and metabolic effects of gluten free diet in a group of 23 children with Type 1 diabetes and confirmed celiac disease found that the gluten free diet showed short-term benefits by reducing gastrointestinal symptoms and severe hypoglycemia while the insulin requirement increased significantly. Ten out of 11 children showed improvement in their GI symptoms, while 6 out of 8 patients had no further severe hypoglycemic episodes.²

How Prevalent are Gastro-Intestinal Complications Of Diabetes In Celiac Disease and/or Gluten Sensitivity?

Gastrointestinal complications of type I diabetes are common in celiac disease.¹

What Are Symptoms Of Gastro-Intestinal Complications Of Diabetes?

Gastrointestinal complications in type I diabetes in celiac disease are marked by these symptoms:

• Early fullness when eating.
• Eructation or burping.
• Nausea.
• Vomiting.
• Abdominal pains that can be temporary or missing in some patients.

How Do Gastro-Intestinal Complications Of Diabetes Develop In Celiac Disease and/or Gluten Sensitivity?

• Gastrointestinal complications of type I diabetes in celiac disease result from gastric autonomous neuropathy, impaired sensory innervation, and a direct effect of chronic hyperglycemia (elevated blood sugar).¹

Do Gastro-Intestinal Complications Of Diabetes Respond To Gluten-Free Diet?

Yes. Achieving normal blood sugar usually improves diabetic gastroparesis but in up to 80% of cases simultaneous administration of prokinetics is necessary.³ Prokinetics are medicines that stimulate gastrointestinal muscular activity.

6 Steps To Improve Gastro-Intestinal Complications Of Diabetes In Celiac Disease and/or Gluten Sensitivity:

• [dropcap]1 Remove the Trigger. Maintain a Strict, Nutritious Gluten Free Diet:

[box type=”shadow” ]Treatment. This condition responds to the complete elimination of gluten, which is the required treatment that improves both gastrointestinal complications of type I diabetes and gut health.

• Gut health is the foundation to restore ALL health. Restored health will enable you to maintain a strict gluten free diet, just as other life tasks will be easier.
• A strict gluten free diet means removing 100% of wheat, barley, rye and oats from the diet.
• Cutting out bread and other obvious sources of gluten is not good enough for recovery. Even 1/8th teaspoon of flour or bread crumb is enough to sustain the inflammation that is damaging your small intestine, causing increased permeability (leaky gut) and allowing undigested gluten to enter your body where it can damage structures and function, and instigate immune inflammatory responses.

Correct Your Individual Nutritional Needs.

• Eat foods that can replenish missing nutrients. Find them under NUTRIENT DEFICIENCIES.
• Take nutritional supplements as needed. Find them under NUTRIENT DEFICIENCIES.

Recovery. You should begin to feel better within a week and notice more energy as inflammation subsides and the  absorbing cells that make up the surface lining of your small intestine are better able to function.

• Intestinal lining cells are replaced every 5 days. The healing process is like sunburn where the damaged surface layer of skin sloughs off and is replaced with new normal cells.
• Leaky gut normally resolves in two month after starting a gluten free diet and brings about a big improvement in health. Improvement in intestinal permeability precedes morphometric recovery (cell appearance and structure) of the small intestine in celiac disease.⁴
• The intestinal lining may take up to a year to heal.[/box]

• [dropcap]2  Reduce Inflammation. Foods to Eat and Foods Not to Eat:

Because gluten is inflammatory, eliminate OTHER inflammatory foods from your diet to reduce an additive effect to gluten. At the same time, try to eat foods that reduce inflammation (anti-inflammatory).

[box type=”shadow” ]Here Are Major Inflammatory Food Types That Reduce Healing:

• Damaging Foods. In susceptible persons, includes corn, dairy (cow), and soy. Lactose, the sugar in any animal milk disrupts intestinal permeability causing leaky gut.⁵
• Allergenic Foods. Includes foods that trigger the immune sytem to produce IgE antibodies. Allergy testing is the usual way to discover these offending foods.
• Shelf Stable Processed Foods. Includes any that contain additives and preservatives. Look for them on the nutrition label of the box or package. Additives and preservatives also disrupt intestinal permeability causing leaky gut.⁵
• Fats. Limit deep fried foods, trans-fats, saturated fats (animal fat/butter), and EXCESSIVE omega-6 fatty acid oils like corn oil. Rancid fats, sodium caprate (a medium chain fat), and sucrose monester fatty acid (a food grade surfactant) induce significant disruption of the intestinal barrier that causes leaky gut.⁵.
• Excessive Refined White Flours (bran layer removed). Includes products made from them such as cookies, bread, cakes, pies. Bran contains the vitamins and minerals that metabolize grains and slows the otherwise rapid entry of sugar from their digestion into the bloodstream. Also disrupt intestinal permeability causing leaky gut.⁵
• Refined Sugars.  Includes white sugar, corn fructose and high fructose corn syrup.
• Certain Spices. Includes paprika and cayenne pepper which disrupt intestinal permeability causing leaky gut.⁵
• Alcohol and Caffeine. Disrupt intestinal permeability causing leaky gut.⁵[/box]

[box type=”shadow” ]Here Are Important Anti-Inflammatory Food Types to Promote Health:

• Fruits. Contain ample amounts of vitamins, minerals and phytochemicals which are naturally occuring components in plants that detoxify toxins, carcinogens (reducing the risk by 50%) and mutagens.
• Non-Starchy Vegetables. Support intestinal integrity and provide ample amounts of vitamins, minerals and phytochemicals. Includes green leafy vegetables such as lettuce and kale, also onion, broccoli, garlic, and others.
• High Quality Complex Carbohydrates. Provide vitamins, minerals, and fiber while boosting serotonin levels to help you relax and feel calm. Includes whole grains, legumes, and root vegetables such as carrots, parsnips, sweet potatoes, turnips, red beets, and others.
• Antioxidants. Protect the body from inflammatory oxidant molecules that continually occur and help us handle stress and reduce irritability. Includes vitamin C-containing foods such as lemon, grapefruit, apricot, Brussels sprouts and strawberries, and others. Also, includes vitamin E-containing foods such as nuts, seeds, avocado, olive oil, and others. Cocoa is good, too.
• Omega-3 Fatty Acids. Balance opposing omega-6 fatty acids and bad fats. Fish sources includes tuna, salmon, cod, and others. Plants sources include flax, chia seeds, canola oil, and others.
• Probiotics. Supply normal microbes needed for colon health and health of the body such as these fermented foods: yogurt, kefir, and unpasteurized apple cider vinegar.
• Prebiotics/ High Fiber Foods.  Food with fiber keeps our population of colonic microbes healthy.
• Protective Herbs and Spices.  See below #6 below for examples.[/box]

• [dropcap]3  Information Sheet You Can Take to Your Doctor or Other Health Professional:

Click here.

• [dropcap]4  Manage Your Medications Safely:

[box type=”shadow” ]

Certain medications used to treat gastrointestinal complications promote nutritional deficiencies that may complicate celiac disease.  Ask your doctor or pharmacist about this possible adverse effect if you are taking any of the drugs listed below. Do not stop prescribed medications without supervision.

This is not a complete listing.

ANTACIDS / ULCER MEDICATIONS 

• Pepcid®, Tagamet®, Zantac® deplete Calcium, Chromium, Coenzyme Q10, Folic Acid, Iron, Vitamin A, Vitamin B12, Vitamin D, Zinc, Magnesium, Copper, Potassium.
• Magnesium and Aluminum Antacid preparations (Gaviscon®, Maalox®, Mylanta®) deplete Calcium, Chromium, Folic Acid, Iron, Vitamin A, Vitamin B12, Vitamin D, Zinc, Magnesium, Copper, Potassium, Phophorus.
• Prevacid®, Prilosec® deplete Coenzyme Q10,Vitamin B12.
• Alka Seltzer®, Baking Soda deplete Coenzyme Q10, Folic Acid, Magnesium, Proteins, Potassium.

PROTON PUMP INHIBITORS strengthen the lower esophageal sphincter and improve emptying of stomach.

• Bethanechol (Urecholine)
• Metoclopramide (Reglan)

[/box]

• [dropcap]5 Nutritional Supplements To Help Correct Deficiencies:

[box type=”shadow” ]

The type and quantity of nutritional supplements that may be needed depend on which nutrients are deficient.

• Multivitamin/mineral combination that provides 100% once a day is useful to improve overall nutrient levels. This is a safe dose, but always check with your doctor to avoid interactions with medications.
• Calcium citrate is the best absorbed of calcium supplements. Calcium carbonate is a poor choice.
• Vitamin D3 as prescribed following blood test for status.
• Chelated magnesium  as prescribed but do not take at same time as calcium because they compete for absorption.

Storage Note: Store container tightly sealed, away from heat, moisture and direct light to avoid loss of potency. That is, in a safe kitchen cabinet – not in the bathroom or on the kitchen table.[/box]

• [dropcap]6 Manage Natural Remedies: 

[box type=”shadow” ]Hydration:

• Eight glasses of water are recommended per day unless there is a contraindication such as kidney or heart disease. The Institute of Medicine recommends approximately 2.7 liters (91 ounces) of total water, from all beverages and foods, each day for women and 3.7 liters (125 ounces) daily of total water for men.
• If you are thirsty, drink water. Add fresh, squeezed lemon to water. Lemon is anti-inflammatory, alkalizing and provides vitamin C.
• Hydration Test: Urine should be pale yellow. Fingertips should be plump, without pruning but this may not be reliable when fingers are swollen with edema. Lips should be plump, without puckering. The feeling of thirst can be unreliable.
• What is wrong with soda, coffee, tea, and alcohol? These drinks are dehydrating, increase acid, and deplete nutrients.[/box]

[box type=”shadow” ]Carminatives. The following  anti-inflammatory plant sources called carminitives help heal the digestive tract. They also tone the digestive muscles which improves peristalsis, thus aiding in the expulsion of gas from the stomach and intestine to relieve digestive colic and gastric discomfort.

Carminative Food Remedies:

• Raspberry.
• Carrot is also a cleansing digestive tonic.
• Grape is also bile stimulating and a cleansing remedy for sluggish digestion and laxative.
• Redbeets also stimulate and improve digestion and are easily digested.
• Cabbage also stimulates and improves digestion and is also a liver decongestant.
• Lettuce also stimulates and improves digestion and is also an alterative, meaning it improves the function of organs involved with the digestion and excretion of waste products to bring about a gradual change.
• Potatoes are antispasmodic (due to atropine like properties) and a liver remedy.

Carminative Herb Remedies:

• Sage is also a digestive, astringent, bile stimulant and energy tonic that heals the mucosa.  Drink as tea or use in cooking.
• Chamomile, lemon balm, and fennel, (as a tea) also help relieve nervous tension.
• Parsley also relieves indigestion.
• Rosemary as a tea and in cooking also is a nervous system tonic for stress and fatigue, bile stimulant, and can relieve headaches and indigestion.
• Thyme is also soothing remedy useful for stimulating digestion of rich, fatty foods.

Carminative Spice Remedies:

• Cloves are also antispasmodic.
• Nutmeg is also useful for indigestion.
• Ginger.[/box]

[box type=”shadow” ]Exercise Helps:

Exercise improves circulation and rids the body of toxins.

• Walking is aerobic exercise that reconditions the whole body to improve stamina. Read more about Exercise and Fitness.
• Weight training builds muscle. Read more about Exercise and Fitness.
• Stretching improves flexibilty. Read more about Exercise and Fitness.

Note: Exercise is important, but the amount and type of exercise undertaken depends on your health. Your first priority is to heal. [/box]

What Do Medical Research Studies Tell About Gastro-Intestinal Complications Diabetes In Celiac Disease and/or Gluten Sensitivity?

RESEARCH STUDY SUMMARIES

“Clinical and metabolic effects of gluten free diet in children with type 1 diabetes and celiac disease.” This study investigating the short-term clinical and metabolic effects of gluten free diet in a group of children with Type1 diabetes and confirmed celiac disease found that the gluten free diet showed short-term benefits by reducing gastrointestinal symptoms and severe hypoglycemia while the insulin requirement increased significantly.

Data were collected on all children with Type1 diabetes and celiac disease between November 2000 and November 2007 before and 12 months after commencement of gluten free diet. Data included the presence of gastrointestinal (GI) symptoms, episodes of severe hypoglycemia, daily insulin requirements, height, weight, body mass index (BMI), glycosylated hemoglobin (HbA1c), hemoglobin, and persistence of autoantibodies. The effects of gluten free diet on these parameters were studied and compared with those from the revised ISPAD Guidelines in 2007.

Four hundred and sixty-eight children with Type1 diabetes were screened, of whom 23 patients were diagnosed with celiac disease. The mean age at diagnosis of Type1 diabetes and celiac disease was 6.8 years and 11.1 years, respectively. Ten out of 11 children showed improvement in their GI symptoms, while 6 out of 8 patients had no further severe hypoglycemic episodes. Nine patients remained positive for antiendomysial antibodies after gluten free diet. There was no significant change in the standard deviation score for height, weight, and BMI or the mean HbA1c and Hb before and after gluten free diet.  However the mean insulin requirement increased from 0.88 to 1.1 units/kg/day, which was statistically significant.²

Sources:

1. Perusicova J. Gastrointestinal complications in diabetes mellitus. Vnitri Lekarstvi. May 2004;50(5):338-43. [↩] [↩] [↩]
2. Abid N, McGlone O, Cardwell C, McCallion W, Carson D. Clinical and metabolic effects of gluten free diet in children with type 1 diabetes and coeliac disease. Pediatr Diabetes. 2011 Jun;12(4 Pt 1):322-5. doi: 10.1111/j.1399-5448.2010.00700.x. [↩] [↩]
3. Perusicova J. Gastrointestinal complications in diabetes mellitus. Vnitri Lekarstvi. May 2004;50(5):338-43. [↩]
4. Cummins AG, Thompson FM, Butler RN, et al. Improvement in intestinal permeability precedes morphometric recovery of the small intestine in coeliac disease. Clinical Science. Apr 2001;100(4):379-86. [↩]
5. Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease. Journal of Gastroenterology and Hepatology. 2003;18:479-91. [↩] [↩] [↩] [↩] [↩] [↩]