Two Diets, One Life: Managing Celiac Disease and Type 1 Diabetes
By Kate Morin, Delight Contributor
Imagine planning out each of your daily meals and snacks, counting every gram of carbohydrate, and balancing this intake with medication. Now, combine that task with managing a nutritionally balanced and completely safe gluten-free diet. For one segment of the celiac disease population, this balancing act is reality, as they juggle living gluten-free with managing Type 1 Diabetes.
Although Type 1 Diabetes occurs in only 0.05 percent of the general population, within the celiac disease community that number grows to between five and ten percent. Why?
Researchers from the University of Cambridge in England recently discovered a genetic link between the two autoimmune conditions. The research team found that the two diseases share at least seven chromosome regions, or specific locations of gene or DNA sequences on chromosomes.
Type 1 Diabetes occurs when a person’s immune system mistakenly attacks healthy cells in the pancreas which produce insulin, a hormone needed to convert sugar (carbohydrate) into energy. While the intestinal lining that is destroyed by consuming gluten in those with celiac disease can repair itself, pancreatic cells cannot. This means that people with Type 1 Diabetes must inject themselves with insulin in order to process carbohydrates. A balanced, stable, and nutritionally dense diet is essential in managing both diseases.
Because of the findings coming out of England, screening for celiac disease has become routine protocol among diabetic patients in the United States. According to Pam Cureton, R.D., LDN, at the Center for Celiac Research at the University of Maryland, this step is critical because the vast majority of patients with both conditions don’t show classic celiac disease symptoms.
So how does a patient keep up with the demands of both diseases? Here are three major tips for a happy and healthy gluten-free and diabetic-friendly lifestyle:
Maintain Consistent Carbohydrate Intake
For a diabetic-friendly diet, maintaining consistent carbohydrate intake from meal to meal is key. This will vary depending on weight and caloric needs, but a good estimate is between 210 and 240 grams per day, spread evenly across meals and snacks to avoid fluctuations in blood sugar. The amount of insulin prescribed for Type 1 Diabetes is based on the number of grams of carbohydrate consumed. The more refined the food, the higher it will raise your blood sugar, and the more insulin you will need in order to process the food. Because many gluten-free foods are made with rice flours and other low-fiber, highly refined starches like potato, corn, and tapioca, many gluten-free alternatives tend to raise blood sugar more than their gluten-containing counterparts. Whereas simple carbohydrates like cookies and other refined products turn into sugar quickly, lean proteins, healthy fats, and whole grains stay in your stomach longer, allowing nutrients and carbohydrates to be released more slowly, helping to stabilize blood sugar, Cureton explains.
Learn to Pay Attention and Read Labels
Pay close attention to the carbohydrate content per serving of food and learn how to read labels. Diabetes patients should check blood sugar levels before meals and snacks to determine correct insulin dosages. However, when also adjusting to a gluten-free diet with diabetes, it can help to check levels after meals as well to determine how specific gluten-free substitutes affect your blood sugar. While adjusting to both of these diets, look at the amount of gluten-containing foods you normally consume per meal. Then, look at the content of your new alternative and adjust insulin doses to better match the new amount of carbohydrate. Note that the carbohydrate count of the specific gluten-free products you choose will vary from brand to brand.
“The key is to find healthy, high fiber, gluten-free alternatives,” says Cureton. “If you are used to having whole wheat toast with fruit for breakfast, don’t feel the need to change your routine. Find a whole grain gluten-free bread alternative, look at its carbohydrate content, and adjust medication to compensate.”
Consider Changes to Your Body
Before switching your diet, it’s important to consult with a skilled dietitian to consider how some side effects of celiac disease, such as malabsorption caused by damaged intestinal cells, could change as you switch to a gluten-free diet. As the intestine heals and the body is better able to absorb nutrients, insulin needs may change. In the first few months of a new gluten-free diet, closely monitoring blood glucose levels and adjusting medication accordingly can help produce a successful transition to a gluten-free lifestyle.
Pam Cureton, RD, LDN, Center for Celiac Research, U. Maryland
John Todd, Ph.D., Cambridge Institute for Medical Research, University of Cambridge, U.K.; Robert Goldstein, M.D., Ph.D., chief scientific officer, Juvenile Diabetes Research Foundation, New York City; Weimin He, Ph.D., assistant professor, Center for Environmental and Genetic Medicine, Texas A&M Health Science Center Institute of Biosciences and Technology, Houston; Dec. 25, 2008, New England Journal of Medicine