Author: Betsy A. Hornick, MS, RD, LDN
Source: Diabetic Cooking, May/June 2008
When people with celiac disease eat gluten-a protein in wheat, rye, barley, and sometimes oats-their immune system response damages the lining of the small intestine. Damaged areas can’t absorb nutrients properly, which leads to an array of problems. Symptoms vary from chronic diarrhea, gas and bloating to depression, weight loss, joint pain, infertility, headaches, and fatigue. In children, symptoms may also include irritability, unexplained anemia, delayed growth, or behavior changes.
Diagnosing. A link between diabetes and celiac disease, both autoimmune disorders, has been recognized for some time. People with type 1 diabetes have a greater risk for developing celiac disease, typically about 1 in 20. (In the general population, including people with type 2 diabetes, the rate may be as high as 1 in 133.) In most cases, diabetes is diagnosed first.
Developing one disease increases the risk of developing the other, so it’s becoming standard procedure for people with type 1 diabetes to be screened for celiac disease. Initial screening, via a simple blood test, should be done within 1 to 2 years of a diabetes diagnosis. A small-intestine biopsy may be done to confirm the diagnosis. Periodic follow-up screening is advised every few years for people at risk; testing normal does not rule out later development of the disease.
Treating with diet. The only treatment for celiac disease is lifetime avoidance of all gluten-containing foods. This includes breads, baked products, pastas and cereals made with wheat, rye, barley, and oats. People with celiac disease must read labels avidly to avoid all gluten-containing foods. Many other foods-luncheon meats, prepared soups, condiments, and sauces, for example-may contain “hidden” gluten in the form of fillers, stabilizers, and other ingredients.
Faithfully following a gluten-free diet stops celiac disease symptoms, prevents further damage, and enables the small intestine to heal. Combining a gluten-free diet with the diet imposed by diabetes may seem daunting, but the effects on overall health and well-being are substantial. A registered dietitian can provide resources and education on how to follow this complex diet.
A word of advice. If you think you may have celiac disease, talk to your doctor to be screened before trying a gluten-free diet. Self-diagnosis and self-treatment with a gluten-free diet may yield inaccurate blood test results.
Foods to be avoided on a gluten-free diet:
- Barley, bran, bulgur, couscous, durum, einkorn, farina, faro, hydrolyzed plant protein (HPP), hydrolyzed vegetable protein (HVP), kamut, malt and malt extract, tye, semolina, spelt, triticale, wheat bran, wheat germ, wheat starch
- Bread, baked goods, and pasta made with any grains above
- Processed meats and luncheon meats containing HPP or HVP
- Any sauces or gravies that may contain flour
- Instant coffee, instant tea, instant cocoa mixes, some root beer, grain alcohol, soy sauce, some vinegar
- Check the labels of prepared and processed foods for “hidden” gluten foods.
Grains and starches allowed on a gluten-free diet:
- Amaranth, arrowroot, beans/legumes, buckwheat, corn, millet, montina, nut flours, pea flour, potato and potato flour, sweet potato, quinoa, rice and wild rice, rice bran, rice flour, sorghum, soy, tapioca, teff
- Breads and pastas made from rice or nonglutious grains
*This is only a partial listing. Seek additional advice from a registered dietitian or from celiac organizations.