There has been a significant increase in the incidence of autoimmune disorders over the past several decades. For every 1,000 Americans, approximately one in five people have type 1 diabetes (T1D). Type 1 diabetes typically develops when the body's own immune system attacks the pancreas and prevents the production of insulin.
There is increasing evidence of the correlation between the gut and T1D. Alessio Fasano, MD brought this to everyone’s attention in “Surprises from Celiac Disease” published in Scientific American, August 2009. In this article he discusses intestinal permeability and its role in many autoimmune diseases such as celiac disease, MS, rheumatoid arthritis and T1D.
New research just published in Diabetologia and presented at the Annual Meeting of the European Association for the Study of Diabetes (EASD) in Barcelona, Spain this September demonstrated that a child's intake of gluten at 18 months of age is associated with a 46% increased risk of developing T1D for each extra 10 grams of gluten consumed per day. There was no association between the maternal intake of gluten during pregnancy and T1D.
This new study included 86,306 children in The Norwegian Mother and Child Cohort Study born between 1999 and 2009, and followed up on until April 2018. The study investigated the association between the maternal gluten intake during pregnancy, the child's gluten intake at 18 months, and the risk of T1D. The clinical outcome was the diagnosis of T1D based upon a nationwide childhood diabetes registry. An increased risk was calculated using statistical modelling for maternal gluten intake during pregnancy and the child's gluten intake at 18 months. The research team estimated the amount of gluten intake from a food frequency questionnaire at week 22 of pregnancy and from a questionnaire completed when the child was 18 months old.
As a result, 346 children (0.4%) developed TID. The average gluten intake was 13.6 g per day for mothers during pregnancy and 8.8 g per day for the child at 18 months of age. Maternal gluten intake during pregnancy was not associated with the development of T1D; however, the child's gluten intake at 18 months demonstrated an increased risk of later developing T1D. This risk increased by 46% for each 10 g per day increase in gluten intake.
There is some evidence that gluten intake may influence the gut microbiota, induce inflammation and contribute to intestinal hyper-permeability. Since these results demonstrate the highest risk of developing T1D is in the group with the highest gluten consumption, simply reducing gluten intake may be enough to reduce risk, and complete avoidance may not be necessary.
Autoimmunity can occur a few different ways. First, there can be a mistaken identity and the body attacks itself. This can occur with a virus where there is tissue destruction and it appears to be foreign to the body. The second way is called molecular mimicry. This occurs when the body makes an antibody (a protein in the body that attacks objects in the body that appear to be foreign) to a specific antigen. These antigens can resemble certain proteins in the body and the antibodies attack the body’s own tissues. Third is the development of the T cells (the immune system). This can be affected by genetics, stress and environmental triggers.
Environmental triggers are what integrative doctors mainly work with in functional medicine. These can be food triggers such as gluten or food sensitivities that can trigger inflammation as well as anything coming in with the food such as toxins or molds. In addition, the nutrient status of the patient is important. This can be antioxidant status, vitamins, essential fatty acids, vitamin D, etc. Gut health is also a main focus. This includes “leaky gut” and dysbiosis. Finally, there are toxins that can affect the status of the immune system, including heavy metals and xenobiotics, as well as the total toxic burden in the body.
It has not been determined if T1D's signature effect on the gut is caused by or the result of the body's own attacks on the pancreas, but it is essential to investigate these factors for all patients with autoimmunity.
By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS
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