Ask The Expert
Eating Well

Like type 1 diabetes, celiac disease is an autoimmune disease and has recently been found to be substantially more common in people with type 1 diabetes than in the general population. Also called celiac sprue, the genes that determine your risk of developing celiac disease are passed down from your parents. Eating foods that contain a protein known as gluten--found in cereal grains like wheat, barley, and rye-- causes damage to the lining of the small intestines in people with a genetic immune response. This damage to the intestines reduces absorption of many nutrients that can result in weight loss, anemia, osteoporosis, and certain vitamin deficiencies. The majority of people diagnosed with celiac disease are unaware of any symptoms. Others may experience diarrhea, vomiting, gas, abdominal pain, or other symptoms.

Eating Gluten-free

Doctors advise people with celiac disease to eat a gluten-free diet to allow the intestines to heal and to continue this way of eating throughout your lifetime to prevent further damage. As you have likely discovered, that is easier said than done.

• The first step is to avoid eating foods that contain wheat, barley, and rye. Foods like corn, rice, beans, legumes, potatoes, and soy can be substituted for foods containing gluten.
• Many regular grocery stores now carry gluten-free products such as gluten-free bread and pasta and a variety of types of gluten-free flour. Though you can try to avoid the offending foods, you'll need to do some reading and educate yourself on the hidden sources of gluten that can be found in other grains that have shared similar equipment in processing, storage, or preparation.
  • Cross-contamination of foods can occur even in your own kitchen from sharing toasters, cooking utensils, storage containers, and kitchen counters with offending foods.
  • You'll also learn that gluten can be found in unlikely products like food additives, certain spices, seasonings, toothpaste, the adhesive on stamps and envelopes, vitamins and medications.
• If you haven't already done so, be sure to make an appointment to talk with a dietitian with expertise in celiac disease who can help you with the gluten-free diet and provide you with an extensive list of foods containing gluten and reputable resources for buying gluten-free foods and products.
• Going back to the basics of eating fresh food instead of packaged foods and eating at home more often makes it easier to eat gluten-free.
• Otherwise, learn which types of foods may contain gluten, read labels carefully, and /or purchase special gluten-free foods to help keep you symptom-free. Fortunately, there are more sources of gluten-free foods and products now than ever before.

Other Grains

There is currently some difference in opinion regarding the use of certain grains such as oats, amaranth, and buckwheat in a gluten-free diet. Some studies suggest that these grains are not harmful, yet some doctors recommend avoiding these. In recent years, the American Dietetic Association has stated that oats are safe for people with celiac disease to eat in limited amounts if they use only oats tested and found to be free of contamination. Be sure to talk with your doctor and dietitian to get their advice on whether these foods can be safely eaten.

Dining Out

Eating gluten-free in restaurants is challenging. Not only do you need to be aware of the ingredients in your food choices, but also it is important to know how foods are prepared.

• Ask detailed questions about ingredients including spices and flavoring enhancers.
• Inquire if pans or grills are cleaned between use with other gluten-containing foods.
• Avoid fried foods that may have become cross-contaminated from other items that share the same deep-fat fryer.

Blood Glucose Control

Some studies suggest that celiac disease may affect blood glucose control, but other studies do not confirm this. Hypoglycemia (low blood glucose) may occur more frequently when a gluten-free diet is not followed due to decreased absorption. Some people have found that it is easier to control their blood glucose when they follow a gluten-free diet.

Conclusion:

Many people with celiac disease and diabetes, despite their resistance to the diet, find they feel better, have more energy, and better overall health when their diets are gluten-free.

You can still live a healthy, normal life with celiac disease if you continue to follow the advice of your doctor and dietitian. Many people find it helpful to join national and local support groups for access to the latest information, educational materials and support.

Sources:

• Schwarzenberg SJ and Brunzell C. Type 1 diabetes and celiac disease: overview and medical nutrition therapy. Diabetes Spectrum 15:197-210, 2002
• Thompson T. Contaminated oats and other gluten-free foods in the United States. Journal of the American Dietetic Association, Volume 105, Issue 3, Pages 348-348, 2005
• Thompson T. Celiac disease nutrition guide, 2nd ed. Chicago: American Dietetic Association; 2006