Sugar Matters
March 13, 2009
The long road to the end: Diabetes and your Intestines

Our trek through your gastrointestinal system continues today. As with last week, some of this will not be the most pleasant dinnertime conversation: you have been warned!

The topic this week is actually more specific to those with Type 1 diabetes, but it is still important to keep in mind for those with Type 2 as well.{{more}} The two disease to be discussed today, Pernicious Anemia and Celiac Disease, are not true complications of diabetes per se, but can be associated with it therefore I thought it best that we at least mention them briefly.

The intestines, a several-foot long rope of bowel tucked neatly inside all of us, is where the magic of absorption happens. When it does not work well, many aspects of our health suffer. Type 1 diabetes is an autoimmune disease, meaning that certain cells in your body attack other cells, leading to damage. When one autoimmune disease is present, you are at risk for having another one pop up in future because they often like to travel in groups.

In the case of Type 1 diabetes, there are two specific diseases in the small intestine that are also autoimmune diseases: a specific kind of B12 deficiency (pernicious anemia), and Celiac Disease.

In pernicious anemia, certain cells in the gut that are needed to help make Vitamin B12 are damaged or missing, so you wind up having very low levels of B12, and then a low blood count. Because the cells are damaged, no amount of food containing B12 will work. The only way to bring those levels up is with B12 injections, often given monthly. If your doctor is suspicious about this possibility, certain tests will need to be done to ensure the diagnosis and treatment started.

Celiac disease is becoming more common now that we know to look for it. This can actually have several grades of severity, from mild to quite serious. In this disease, the cells in your intestine that absorb certain carbohydrates are again damaged or missing. Symptoms include diarrhea, bloating, belly pain and weight loss. Most people find these symptoms are worse after eating specific type of starches that contain flour: bread, cookies, rotis, bakes etc. I can hear you now: “please tell me there is a treatment since I can’t avoid flour.” Sorry, bad news. The best and really only treatment for this is dietary, meaning avoidance of foods that make the symptoms worse and learning to eat healthy without using foods that contain flour. Yes, it IS difficult, but it can be done and in fact many people do this just as a choice and not even related to Celiac Disease. This disease also needs some specific testing to be sure of the diagnosis, although some people simply cut flour out of their diets and see if symptoms improve. If they feel better, it is a good sign this may be the cause, so they just continue to try to limit flour in their diets.

Until next week, stay safe and healthy Vincies! We move on to the liver next week, so stay with me. Yes indeed, diabetes can even affect your liver. We have SO much to talk about!

Anita Ramsetty, MD
[email protected]
Medical Director Endocrine Care Group
Tel: 843-798-4227