April 25, 2002
Research: Causes and Prevention
Question from Jackson, Wisconsin, USA:
I have read several reports that suggest that gluten may have a possible role in the induction of thyroid and pancreatic antibodies, and when the patients are placed on a gluten-free diet, the autoantibodies disappear. If further studies conclude what these initial findings, I suspect diabetes could possibly be avoided in certain cases. Is further research being done on this front? Are any places thinking of checking this out further?
As I understand it, you are proposing that starting a gluten-free diet in children with prediabetes might avert insulin dependence in the way that oral insulin is being used as part of DPT-1. The idea may have stemmed from an earlier observation that diabetes could be prevented in the NOD mouse by giving protein hydrolysates instead of whole milk. Your particular idea has in fact been tried both in the US and Italy and was not a success. Moreover, I think it doubtful that any Institutional Review Committee would now allow it because of the burden of a gluten-free diet.
Since you seem to have access to scientific journals, you might be interested in the article by Outi Vaarala in Pediatric Diabetes 2000, 1:217 on ‘The Role of the gut in beta cell autoimmunity and Type 1 Diabetes: a hypothesis”.
I think that it is also important to realise that antibodies themselves do no seem to damage the target organ in autoimmunity, rather it is the cytokines from the specially activated T-lymphocytes.
Additional comments from Dr. Stuart Brink:
There has been a lot of interest in celiac disease and the overlap with diabetes as well as other autoimmunopathies, and there continues to be lots of research. There will actually be a symposium about celiac disease and type�1 diabetes at the upcoming American Diabetes Association meeting.
At our center, we routinely screen for celiac disease at diagnosis and annually and are finding about a 6-8% prevalence.