Can Wheat Cause Type 1 Diabetes?

You might think so after reading this headline:

Type 1 diabetes linked to immune response to wheat

Press release headlines are designed to elicit a response, a desire to read the actual article. But most people never get passed the press release because the actual science is boring or difficult to understand in the manner it is published.

Here is the press release as published:
Scientists at the Ottawa Hospital Research Institute and the University of Ottawa have discovered what may be an important clue to the cause of type 1 diabetes. Dr. Fraser Scott and his team tested 42 people with type 1 diabetes and found that nearly half had an abnormal immune response to wheat proteins. The study is published in the August 2009 issue of the journal Diabetes.

Early in life, the immune system is supposed to learn to attack foreign invaders such as viruses and bacteria, while leaving the body's own tissues and harmless molecules in the environment alone (including food in the gut). When this process goes awry, autoimmune diseases and allergies can develop. Type 1 diabetes is an autoimmune disease that occurs when the immune system mistakenly attacks the pancreas, the organ that regulates blood sugar. Dr. Scott's research is the first to clearly show that immune cells called T cells from people with type 1 diabetes are also more likely to over-react to wheat. His research also shows that the over-reaction is linked to genes associated with type 1 diabetes.

"The immune system has to find the perfect balance to defend the body against foreign invaders without hurting itself or over-reacting to the environment and this can be particularly challenging in the gut, where there is an abundance of food and bacteria," said Dr. Scott, a Senior Scientist at the Ottawa Hospital Research Institute and Professor of Medicine at the University of Ottawa. "Our research suggests that people with certain genes may be more likely to develop an over-reaction to wheat and possibly other foods in the gut and this may tip the balance with the immune system and make the body more likely to develop other immune problems, such as type 1 diabetes."

In a commentary accompanying the paper, diabetes expert Dr. Mikael Knip of Finland said "These observations add to the accumulating concept that the gut is an active player in the diabetes disease process."

Dr. Scott's previous research has shown that a wheat-free diet can reduce the risk of developing diabetes in animal models, but he notes that more research will be required to confirm the link and determine possible effects of diet changes in humans. Research is also needed to investigate links with celiac disease, another autoimmune disease that has been linked to wheat.
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This research was funded by the Juvenile Diabetes Research Foundation and the Canadian Institutes of Health Research. The authors include Dr. Majid Mojibian, Dr. Habiba Chakir, Dr. David E. Lefebvre, Jennifer A. Crookshank, Brigitte Sonier and Dr. Erin Keely, as well as Dr. Scott. Patients were enrolled at The Ottawa Hospital and the Children's Hospital of Eastern Ontario.

An estimated 246 million people have diabetes worldwide. Type 1 diabetes is the most severe form, representing about 10 per cent of all cases. Insulin injections can help control blood sugar levels in those affected but there is no cure.

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Celiac is another autoimmune disorder. It has long been known if you have 1 autoimmune problem, your risk for another is much higher. In Type 1 diabetics about 5% or more have also been diagnosed with Celiac (I worked with one family who's daughter was diagnosed with BOTH at the same time). This study noted that the genetic subset for Celiac was not present in the tested patients (by the way, a very small number of test subjects) and this immune response was not the same as that for Celiac.

Here is an abstract of the actual article in the Journal of Diabetes (published by the American Diabetes Association). I'm a member of ADA but I was unable to access the full text of the article online.

Diabetes-Specific HLA-DR–Restricted Proinflammatory T-Cell Response to Wheat Polypeptides in Tissue Transglutaminase Antibody–Negative Patients With Type 1 Diabetes
Majid Mojibian, Habiba Chakir, David E. Lefebvre1, Jennifer A. Crookshank, Brigitte Sonier, Erin Keely and Fraser W. Scott

Abstract
OBJECTIVE There is evidence of gut barrier and immune system dysfunction in some patients with type 1 diabetes, possibly linked with exposure to dietary wheat polypeptides (WP). However, questions arise regarding the frequency of abnormal immune responses to wheat and their nature, and it remains unclear whether such responses are diabetes specific.

RESEARCH DESIGN AND METHODS In type 1 diabetic patients and healthy control subjects, the immune response of peripheral CD3+ T-cells to WPs, ovalbumin, gliadin, α-gliadin 33-mer peptide, tetanus toxoid, and phytohemagglutinin was measured using a carboxyfluorescein diacetate succinimidyl ester (CFSE) proliferation assay. T–helper cell type 1 (Th1), Th2, and Th17 cytokines were analyzed in WP-stimulated peripheral blood mononuclear cell (PBMNC) supernatants, and HLA was analyzed by PCR.

RESULTS Of 42 patients, 20 displayed increased CD3+ T-cell proliferation to WPs and were classified as responders; proliferative responses to other dietary antigens were less pronounced. WP-stimulated PBMNCs from patients showed a mixed proinflammatory cytokine response with large amounts of IFN-γ, IL-17A, and increased TNF. HLA-DQ2, the major celiac disease risk gene, was not significantly different. Nearly all responders carried the diabetes risk gene HLA-DR4. Anti-DR antibodies blocked the WP response and inhibited secretion of Th1 and Th17 cytokines. High amounts of WP-stimulated IL-6 were not blocked.

CONCLUSIONS T-cell reactivity to WPs was frequently present in type 1 diabetic patients and associated with HLA-DR4 but not HLA-DQ2. The presence of an HLA-DR–restricted Th1 and Th17 response to WPs in a subset of patients indicates a diabetes-related inflammatory state in the gut immune tissues associated with defective oral tolerance and possibly gut barrier dysfunction.

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What does that mean for regular people? There is a possibility that people with Type 1 diabetes show a autoimmune response to wheat that is NOT Celiac. But this is a correlation result, NOT cause & effect. The headlines could easily be misconstrued to suggest eating wheat causes Type 1 diabetes. Nothing could be further from the truth. While this might be one potential trigger in someone who is genetically susceptable, there are many folks with genetic potential who eat wheat and never develop Type 1 diabetes. I'd like to see what happens if they open up this screening to a larger number of people with Type 1 diabetes and include first degree relatives who do NOT have Type 1 diabetes.

Living With Celiac

I do not have Celiac, but as a Registered Dietitian I have worked with many families newly diagnosed. So I have an interest in related news and internet postings. Here is one that caught my eye today.

The Expense of Eating With Celiac Disease

By LESLEY ALDERMAN, NY Times. Posted Aug 15, 2009

YOU would think that after Kelly Oram broke more than 10 bones and experienced chronic stomach problems for most of his life, someone (a nurse? a doctor?) might have wondered if something fundamental was wrong with his health. But it wasn’t until Mr. Oram was in his early 40s that a doctor who was treating him for a neck injury became suspicious and ordered tests, including a bone scan.

It turned out that Mr. Oram, a music teacher who lives in White Plains, had celiac disease, an underdiagnosed immune disorder set off by eating foods containing gluten, a protein found in wheat, rye and barley.

Celiac disease damages the lining of the small intestine, making it difficult for the body to absorb nutrients. Victims may suffer from mild to serious malnutrition and a host of health problems, including anemia, low bone density and infertility. Celiac affects one out of 100 people in the United States, but a majority of those don’t know they have the disease, said Dr. Joseph A. Murray, a gastroenterologist at the Mayo Clinic in Minnesota who has been studying the disease for two decades. The disease can be detected by a simple blood test, followed by an endoscopy to check for damage to the small intestine.

Seven years after receiving his diagnosis, Mr. Oram, who is married and has one daughter, is symptom-free, but the cost of staying that way is high. That’s because the treatment for celiac does not come in the form of a pill that will be reimbursed or subsidized by an insurer. The treatment is to avoid eating products containing gluten. And gluten-free versions of products like bread, pizza and crackers are nearly three times as expensive as regular products, according to a study conducted by the Celiac Disease Center at Columbia University.

Unfortunately for celiac patients, the extra cost of a special diet is not reimbursed by health care plans. Nor do most policies pay for trips to a dietitian to receive nutritional guidance.

In Britain, by contrast, patients found to have celiac disease are prescribed gluten-free products. In Italy, sufferers are given a stipend to spend on gluten-free food.

Some doctors blame drug makers, in part, for the lack of awareness and the lack of support. “The drug makers have not been interested in celiac because, until very recently, there have been no medications to treat it,” said Dr. Peter Green, director of the Celiac Disease Center at Columbia University. “And since drug makers are responsible for so much of the education that doctors receive, the medical community is largely unaware of the disease.”

As awareness grows and the market expands, perhaps the prices of gluten-free products will come down. Meanwhile, if you suffer from the disease, here are some ways to keep your costs down.

When people first learn they have celiac disease, they tend to stock up on gluten-free versions of breads, crackers and pizza made from grains other than wheat, like rice, corn and buckwheat. But that can be expensive and might not even be that healthy, since most gluten-free products are not fortified with vitamins.

“The most important thing to do after being diagnosed is to get a dietary consultation,” Dr. Murray said. With planning, you can learn to base your diet on fruits, vegetables, rice and potatoes. “I have some patients who rarely use those special gluten-free products,” he said.

Get in the habit of reading labels, advises Elaine Monarch, executive director of the Celiac Disease Foundation, a nonprofit organization in Studio City, Calif. Soy sauce, for instance, often has wheat protein as a filler. But Ms. Monarch found a brand of light soy sauce at her local grocery with no wheat that cost much less than one specifically marked as gluten-free. “There are often alternatives to specialty products, but you have to look,” she said.

Gluten-free bread is more expensive than traditional bread and often less palatable. And that holds for many gluten-free items. Some people, including Mr. Oram, end up buying a bread machine and making their own loaves. Nicole Hunn, who cooks gluten-free meals for her family of five and just started the Web site glutenfreeonashoestring.com, avoids mixes, which she says are expensive and not that tasty, and instead bakes with an all-purpose gluten-free flour from a company called Bob’s Red Mill, which can be used in place of wheat flour in standard recipes.

If you’re too busy to cook, look for well-priced gluten-free food at large chains like Whole Foods Market and Trader Joe’s. “Trader Joe’s now carries fantastic brown rice pasta that is reasonably priced and brown rice flour tortillas that can sub for bread with a variety of things,” says Kelly Courson, co-founder of the advice site CeliacChicks.com. Ms. Courson put out a Twitter message to her followers and learned that many were fans of DeBoles gluten-free pastas, which can be bought in bulk on Amazon, and puffed brown rice cereal by Alf’s Natural Nutrition, just $1 a bag at Wal-Mart.

Finally, it may be worthwhile to join a celiac support group. You can swap cost-cutting tips, share recipes and learn about new products. Many groups invite vendors to bring gluten-free products to meetings for members to sample — members can buy items they like at a discount and skip the shipping charges. Support groups typically have meetings, as well as newsletters and Web sites where you can post questions. Groups to check out include the Celiac Disease Foundation and the Gluten Intolerance Group of North America.

Finally, if you itemize your tax return and your total medical expenses for the year exceed 7.5 percent of your adjusted gross income, you can write off certain expenses associated with celiac disease. You can deduct the excess cost of a gluten-free product over a comparable gluten-containing product.

Let’s say you spend $6.50 on a loaf of gluten-free bread, and a regular loaf costs $4; you can deduct $2.50. In addition, you can deduct the cost of products necessary to maintain a gluten-free diet, like xanthan gum for baking. If you mail order gluten-free products, the shipping costs may be deductible, too. If you have to travel extra miles to buy gluten-free goods, the mileage is also deductible. You’ll need a doctor’s letter to confirm your diagnosis and your need for a gluten-free diet, and you should save receipts in case of a tax audit.

Do you have a flexible spending account at work? Ask the plan administrator if you can use those flex spending dollars on the excess cost of gluten-free goods — many plans let you do this. For more on tax deductions, go to the tax section of the Celiac Disease Foundation’s Web site.

Yes, managing the disease is a hassle. But untreated celiac disease can wreak havoc with your health. A study published in the July issue of the journal Gastroenterology found that subjects who had undiagnosed celiac were nearly four times as likely to have died over a 45-year period than subjects who were celiac-free.

“Sometimes I resent how time-consuming it is to cook from scratch,” Ms. Courson of CeliacChicks.com said. “But I remind myself that my restrictions actually help keep me in line, more than the next person with unhealthy foods readily available.”
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Yes, if you are diagnosed with Celiac, the most important thing you can do is take the time to sit down with a Registered Dietitian (RD) to really learn about Gluten-free (GF) living. Make sure the RD is experienced and comfortable working with the GF diet and he/she will direct you to the proper books and websites for additional help. Physicians who just hand you a piece of paper or tell you to look it up on the internet are doing you a disservice. While there is a slew of good information available for self-motivators/self-studiers, there is also potential for misinformation.

The other issue I have noticed is a increase of 'self-diagnosed' folks beliving they are wheat-intolerant or that GF diet will change behavior. Wheat allergy is not the same thing as Celiac (although sometimes it's easier to explain the diet restriction to a layperson by using the term "food allergy"). Living GF isn't always easy, make sure you are properly diagnosed before you embark on the GF diet. Because once you are Celiac, you will always be Celiac and the GF diet is a lifetime (no cheating) committment to your health.

Some additional links:
University of Maryland Center for Celiac Research
Celiac Sprue Association
Gluten Free Living Magazine
Living Without Magazine
Whole Foods Market Gluten-Free Information
Trader Joe's Labels & Lists
The Gluten-Free Diet, by Shelley Case, RD

Should Someone Be Fired for Promoting Healthy Eating?

Fla. doc fired over 'doughnuts equal death' sign

By MELISSA NELSON, Associated Press Writer Melissa Nelson, Associated Press Writer Thu Aug 13, 4:41 pm ET
PENSACOLA, Fla. – Dr. Jason Newsom railed against burgers, french fries, fried chicken and sweet tea in his campaign to promote better eating in a part of the country known as the Redneck Riviera. He might still be leading the charge if he had only left the doughnuts alone.

A 38-year-old former Army doctor who served in Iraq, Newsom returned home to Panama City a few years ago to run the Bay County Health Department and launched a one-man war on obesity by posting sardonic warnings on an electronic sign outside:

"Sweet Tea (equals) Liquid Sugar."
"Hamburger (equals) Spare Tire."
"French Fries (equals) Thunder Thighs."

He also called out KFC by name to make people think twice about fried chicken.

Then he parodied "America Runs on Dunkin'," the doughnut chain's slogan, with: "America Dies on Dunkin'."

Some power players in the Gulf Coast tourist town decided they had had their fill.

A county commissioner who owns a doughnut shop and two lawyers who own a new Dunkin' Donuts on Panama City Beach turned against him, along with some of his own employees, Newsom says. After the lawyers threatened to sue, his bosses at the Florida Health Department made him remove the anti-fried dough rants and eventually forced him to resign, he says.

"I picked on doughnuts because those things are ubiquitous in this county. Everywhere I went, there were two dozen doughnuts on the back table. At church, there were always doughnuts on the back table at Sunday school. It is social expectation thing," says Newsom, a lean 6-foot, 167-pounder in a county where 39 percent of all adults were overweight in 2007 and one in four was considered obese.

Newsom was hired by the state Health Department to direct the county agency. His $140,000-a-year salary is paid jointly by the state and the county. His job primarily involves educating the public about health issues — swine flu, AIDS and the like — but he also decided to address the dangers of glazed, sprinkled and jelly-filled treats.

He angered staff members by barring doughnuts from department meetings and announcing he would throw the fat-laden sweets away if he saw them in the break room. He also banned candy bars in the vending machines, putting in peanuts instead.

In May, lawyers Bo Rivard and Michael Duncan, co-owners of a new Dunkin' Donuts, asked Newsom to take down the "America Dies on Dunkin'" message. Newsom already had run other anti-doughnut warnings, including "Doughnuts (equals) Diabetes," and "Dunkin' Donuts (equals) Death."

The businessmen had the backing of County Commissioner Mike Thomas, who owns a diner and a doughnut shop. Thomas called for Newsom's ouster, saying the doctor shouldn't have named businesses on the message board.

"I think he was somewhat of a zealot," Thomas says. "I don't have a problem with him pushing an agenda, it's the way he did it. People borrowed money to go into business and they are being attacked by the government."

A short time after Newsom's meeting with Rivard and Duncan, Newsom says, his bosses at the state Health Department told him that his leadership wasn't wanted and that he could be fired or resign. He chose to resign May 8 but has reapplied for the job.

"I have never been known for my subtlety. I don't have a knack for it. I speak the truth to people and just assume that that my data and purpose are so real and true that everyone will see the value of what I'm doing," says Newsom, who now works at a prison, doing exams of inmates.

Rivard and Duncan did not return numerous calls to their offices.

"Dunkin' Donuts is pleased that the signs have been removed," Andrew Mastrangelo, a spokesman for Canton, Mass.-based Dunkin' Donuts said in an e-mail.

The Florida Health Department has refused to talk about Newsom since he is considered a job applicant. "We will be happy to talk to you after the position has been filled," department spokeswoman Susan Smith said in an e-mail.

Newsom is hoping to get his job back so that he can resume his campaign against overeating.

"My method was a little provocative and controversial," he says, "but there wasn't a person in Bay County who wasn't talking about health and healthy eating."

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I guess if he had kept his signs 'generic' instead of mentioning brands by name, he wouldn't be in such hot water.

It's sad that health promotion is not supported. Instead, society/lawyers/insurance companies are so focused on disease treatment instead of prevention.

Healthy lifestyles saves health care dollars. Department of Defense and other entities have proven that. Worksite wellness programs save companies money with decreased sick days and insurance premiums. But there is still very little reimbursement or insurance coverage for wellness services (i.e. office visits with a Registered Dietitian to provide a personalized approach to healthier eating within the patient's lifestyle/preferences).

How Bad is a High Fat Diet?

High-Fat Diet May Make You Stupid and Lazy

Short-term memory getting worse? Exercise getting harder? Examine your diet. New research published online in The FASEB Journal (http://www.fasebj.org) showed that in less than 10 days of eating a high-fat diet, rats had a decreased ability to exercise and experienced significant short-term memory loss. These results show an important link between what we eat, how we think, and how our bodies perform.

"Western diets are typically high in fat and are associated with long-term complications, such as obesity, diabetes, and heart failure, yet the short-term consequences of such diets have been given relatively little attention," said Andrew Murray, co-author of the study and currently at the University of Cambridge in the United Kingdom. "We hope that the findings of our study will help people to think seriously about reducing the fat content of their daily food intake to the immediate benefit of their general health, well-being, and alertness."

Rodents are thought to be good analogues to humans for studies like this, but research in humans would be needed to confirm that the effects cross over. Also, because rats live much shorter lives, study effects may play out on significantly shorter time scales than in humans.

Murray and colleagues studied rats fed a low-fat diet (7.5 percent of calories as fat) and rats fed a high-fat diet (55 percent of calories as fat). Muscles of rats eating the high-fat diet for four days were less able to use oxygen to make the energy needed to exercise, causing their hearts to worker harder - and increase in size.

After nine days on a high-fat diet, the rats took longer to complete a maze and made more mistakes in the process than their low-fat-diet counterparts.

In the fat-laden rats the researchers found increased levels of a protein called uncoupling protein 3, which made them less efficient at using oxygen needed to make the energy required for running.

"It's nothing short of a high-fat hangover," said Dr. Gerald Weissmann, editor-in-chief of journal. "A long weekend spent eating hotdogs, French fries, and pizza in Orlando might be a great treat for our taste buds, but they might send our muscles and brains out to lunch."
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Andrew J. Murray, Nicholas S. Knight, Lowri E. Cochlin, Sara McAleese, Robert M. J. Deacon, J. Nicholas P. Rawlins, and Kieran Clarke
Deterioration of physical performance and cognitive function in rats with short-term high-fat feeding
FASEB J. first published on August 10, 2009 as doi:10.1096/fj.09-139691 Abstract

The full article is available online but only for FASEB members (which I am not).