Diabetes Self-Management Blog

When I began writing this blog entry last Friday, the mouth-watering smell of hot, fudgy brownies baking in the oven was wafting throughout the house.

Gluten-free hot, fudgy brownies.

That was followed by the equally mouth-watering smell of a lemon ricotta-almond cake.

Also gluten-free.

I was baking gluten-free goodies because I was in charge of dessert and coffee after religious services on Friday night, and one of the women in the congregation was just diagnosed with celiac disease. When she told me a few days earlier when she came to pick up her children from religious school, I saw the same look in her eyes as I imagine most of us had when we were told we had a chronic condition that was going to change our lives.

The other women on my committee and I wanted her to be able to enjoy the fellowship of her friends without looking at the dessert table and mourning what she could no longer have. Joining the gluten-free brownies and cake was fresh fruit, chocolate-dipped dried apricots, and a selection of cheeses and gluten-free rice and caraway crackers.

I’d never deliberately baked anything gluten-free in my life. It must have been OK, however, because her eyes lit up when she bit into a brownie and immediately asked me what brand mix I’d used.

Mix? Although gluten-free mixes do exist, I ground almonds and found rice flour to make those brownies, I’ll have you know! Where I live, gluten-free mixes are unheard of, except at the privately-owned grocery near my house with the very responsive owner. The specialty flours needed also can be hard to find, but I’m persistent. And I like to cook.

But why am I talking about celiac on a diabetes blog? In case you haven’t heard, according to the American Diabetes Association, the overall incidence of celiac disease worldwide is estimated to be 1 person in 250, but as high as 1 in 20 for people with Type 1 diabetes. The Juvenile Diabetes Research Foundation, on the other hand, gives figures for the United States: 1 in 100 people in the general population and 1 in 10 people who have Type 1 diabetes. In either case, yikes!

Like Type 1 diabetes, celiac disease is an autoimmune disease, meaning that your body basically attacks itself. The American Celiac Disease Alliance (ACDA) defines celiac as “a permanent intolerance to the gliadin fraction of wheat protein and related alcohol-soluble proteins (called prolamines) found in rye and barley.” According to several other sources, oats also may be culpable.

When any form of wheat, rye, barley, and, perhaps, oats is eaten, small, finger-like projections in the small intestine called villi are damaged or destroyed. “The resulting inflammation and atrophy…results in the malabsorption of critical vitamins, minerals, and calories,” says the ACDA.

People with celiac disease must completely avoid ingesting all products containing the triggers. It’s more involved than just avoiding the obvious, such as breads, pastas, and such that have gluten-containing grains in them. Some medications—both prescription and over-the-counter drugs—contain gluten. My can of baking powder advertises that it is gluten-free. Soy sauce generally contains gluten. Even Play-Doh has it. (I’m not suggesting you eat Play-Doh—not that there’s anything wrong with that; but if you need to avoid gluten, be sure to wash your hands after handling it and before putting your fingers in your mouth.)

One ad I ran across in my research touted gluten-free lipstick, which seems to indicate that the cosmetic may contain gluten.

Cross-contamination is another factor if, for example, you use the same toaster for standard bread and for gluten-free bread. Even using the same knife you used to spread peanut butter on your child’s sandwich made with standard bread to make your own peanut-butter sandwich could cause problems.

Just to be on the safe side, I went to the discount big-box store and got an inexpensive bowl, a rolling pin, and sets of measuring cups and spoons and mixing spoons to use. In an attempt on Sunday to make gluten-free matzah, I covered the food preparation area with plastic wrap before beginning and used parchment paper on the baking sheet.

You may be diagnosed with celiac if you experience symptoms that “include diarrhea, short stature, iron-deficiency anemia and lactose intolerance,” says the ACDA. Nonclassic symptoms may include abdominal pain, irritable bowel, and osteoporosis. My friend was diagnosed after complaining of ongoing stomach pain.

On the other hand, you may have no symptoms at all.

If you suspect that you have celiac disease, it’s best to be tested before eliminating gluten from your diet, several sources say. Diagnosis includes tests for antibodies and/or a small-intestine biopsy plus elimination of gluten from your diet.

Another reason to find out if you have celiac—in addition to the permanent organ damage and malnutrition part—is that people with celiac disease are at higher risk for gastrointestinal cancers.

Luckily, in the United States, food manufacturers are required to list the top eight food allergens, which includes wheat, on food labels, says the ACDA. The U.S. Food and Drug Administration has until August 2008 to “develop and finalize rules for the use of the term ‘gluten-free’ on product labels.”

My friend now knows that Rice Chex are gluten-free because it says so on the box. But she won’t touch Rice Krispies, even though I told her it didn’t appear that any of the ingredients contained gluten, because it didn’t say “gluten-free.” Good thing, because a friend who has celiac and read through this blog entry before it was posted told me it contains malt, which is made from barley. I imagine that my friend will have an easier time after the new food-labeling laws take effect—just as those of us with diabetes benefited from nutrition labels on foods.

Can you still eat out? Sure! Just ask your favorite sit-down or fast-food restaurant if it has a gluten-free menu. You might be pleasantly surprised.

And don’t forget those old standbys: fresh fruits, veggies, and meats, none of which contain gluten.

As for the “goodies,” my friend found out last Friday, there are some pretty “yummy” (as she told me in an e-mail) recipes out there. Just key in “gluten-free (whatever) recipe” into your search engine and go for it.

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Comments
  1. About 36 years ago I was having some of these problems and ended up in the hospital. After multiple tests failed to give any results the MD. said you have “non-tropical spru” which is now apparently called celiac disease.
    I was placed on a gluten free diet and for two years we read labels. There wasn’t as much on them as there is now. As I remember bread was the most difficult food to find.
    By the end of the two years I went off the diet slowly and seemed to be OK. No more problems, however, was diagnosed in 1994 with Type II. Am now about 70 with no recurrance of “spru” or celic. Just wondered if others had celic go away after a time or maybe the diagnosis was incorrect in my case.

    Posted by Reed |
  2. Jan -
    Thanks for the blog info. I have a friend who was just diagnosed with celiac. She has 4 kids, has had 2 of them tested, they turned out positive for celiac spru and will be testing the other two, more then likely they have it too. So 5 in her household will have this disease. It’s so overwhelming at times for her. You gave some great insight and included a good blog, all of which I have passed along to her.

    I love the fact that you were so thoughtful to your friend and made gluten free goodies for her. I’m hoping I can do the same for my friend too!!

    Posted by Jan |
  3. Reed, celiac is an autoimmune condition and - like Type 1 diabetes - does not go away. However, people with celiac sometimes have no symptoms and, on top of that, I’ve read that the symptoms of wheat allergies and wheat intolerance can be confused with those of celiac. Remember, however, that I’m hardly an expert: The best person to ask would be your health care professional.

    Posted by Jan Chait |
  4. I have been celiac for 31 years, (now 71) I was diagnosed with type 2 diabetes, 3 years ago. Yes, it is a challenge. Gluten is in medications, cosmetics, candies, and even the glue on envelopes. I contend that having been celiac for so long, and eating so many potatoes and rice, that it probably contributed to diabetes diagnosis.
    I get a lot of my baking ingredients (just within the last 10 yrs–did without before) from Miss Robens in Maryland [mail-order]. But I find it so hard to use rice, because, as a diabetic, 1/3 c of rice is 15 grams of carb.
    I applaud you for learning what you can to help your friend to adjust to celiac disease. I too often hear; “I can’t or couldn’t cook for you”. On the other hand i have an 87 yr, sister-in-law who confesses to keeping notes of things I can eat so that when we visit her,about once a year. she has some things for me eat. I also pack plenty to take with me.
    The only way celiac will go away, is strict adherence to a gluten-free diet. It will always be there. Even though you think you are getting by with it, some day you will realize that you aren’t

    Posted by P. Heffner |
  5. Jan,
    Thank you so much for your very well researched and written gluten-free blog. A couple of points of clarification: You seemed to be fuzzy on the status of oats. Oats are gluten free when they are not cross contaminated. However, most oats are grown in wheat fields, which results in contamination. Oats grown in their own field will be labeled GF and cost about 3-4 times as much as contaminated oats.
    I was suprised to read that Rice Chex are now GF, I checked their website and found “General Mills has replaced barley malt with molasses resulting in a Gluten Free Cereal. General Mills has taken the requisite steps to prevent cross contamination.” Hurray! Thank you SO MUCH for spreading the word!
    Lastly, meats are often processed or preserved with gluten-containing ingredients. (Ex: Many whole turkeys are injected with gluten ingredients.) But you are correct that unprocessed meat is gluten free.
    Thank you again for the great information!

    Posted by A.K. |
  6. Hi I am Rudy Barroso. I am 14 years old and my sister and I have created a board game that teaches families about diabetes, and its called Future Focus. Future Focus is a fun educational tool that helps people comprehended the terminology for both type1 and type 2 diabetes. People can use this tool to educate themselves and the people around them in a fun educational way. My sister is the Juvenal Diabetes Research Foundation Youth Ambassador and we both publicly speak in large conventions to help get out our game. If you would like further information on our game see our website at . We are great speakers and have been interviewed on Television by ABC 7, Kcal 9, CBS 2, and KVCR. Our goal is to give every newly diagnosed diabetic a free Future Focus game, but we don’t have any sponsors yet. If you can help us in any why please contact me. Recently we have been directing and producing our own TV show in Riverside California! It’s called Exploring Diabetes with Rudy and Martha. It’s a reality drama that visually explains the consequences a diabetic can go through if you don’t take care of yourself. Every month there’s a new episode of a different person. If you have a case to share e -mail me at rudy_barroso@sbcglobal.net
    Thank you,
    Rudy Barroso

    Posted by Rudy Barroso |
  7. My husband was diagnosed with celiac disease several years ago. Last week, he was diagnosed with type II diabetes. We will be attending a diabetes education class, but in the meantime, I am totally confused as to what he can and can’t eat. It seems that we are left with so few choices. Does anyone have any suggestions?

    Posted by Kathy Robertson |
  8. Hi Kathy

    I’m sorry your husband has joined the (diabetes) “club.” He is fortunate to have a supportive wife.

    I don’t have celiac and none of my friends who do have diabetes. In addition, I may have Type 2 diabetes, but I take insulin which means I can pretty much eat what I want.

    That said, since you’re more familiar with celiac than I, since it’s been living in your home for several years, I would remind you that unadulterated foods — meats, fruits, and vegetables — don’t have gluten in them. They’re also recommended for diabetes.

    The dietitian should be able to determine what kind of meal plan is best for you, but it will focus on the amount of carbohydrates that are being eaten. One easy meal plan to follow in the meantime is to mentally divide the plate into quarters. One quarter is for meat; one quarter is for a starch (i.e., rice, potato, bread…), and the remaining two-quarters is for non-starchy vegetables. Outside the plate is a small fruit and some form of dairy, i.e., a cup or milk or half a cup of ice cream. Try to keep the foods as close to natural as possible — i.e., a baked potato rather than mashed potatoes.

    Good luck to you both. There’s a learning curve, which may seem unsurmountable to you at first, but you’ll get there.

    Jan

    Posted by Jan Chait |
  9. Hi Kathy,

    If it’s at all possible, I’d suggest that you and your husband meet with a dieitian specifically for his celiac. The diabetes meal plan can be planned around the foods he will need to eat for his celiac, and it’s important that both of you are very comfortable and knowledgeable about what he can/can’t eat. Maybe your husband’s physician can refer you to a “celiac savvy” dietitian. If not, go to to find a dietitian in your area. In the meantime, if you haven’t already, check out these two Web sites:

    http://www.celiac.com

    http://www.glutenfreeeasy.com

    These two Web sites can at least get you started until you’re able to meet with a dietitian.

    Posted by acampbell |
  10. My husband is a type 1 diabetic. We have always had trouble controlling his blood sugar. It left me scratching my head in confusion. After all, he’s had it most of his life, why is he so BAD at it? In the last couple of years, we have had to call out the ambulance more and more often due to low blood sugar comas. The last couple of months, they were coming out once a week. I knew there was a pattern, and had a sneaking suspicion that he was a celiac. I finally convinced him a couple of weeks ago, and since then cooking and eating has become a nightmare! But, being gluten free has eliminated the need to call for help, to force feed him sugars to bring his levels back up, as well as a significant improvement with other, ahhh, unpleasantries.
    The biggest challenge is making sure he gets all the sugars and carbs that he needs to maintain his blood sugar. I have also discovered that this disease is expensive. I am having a difficult time balancing proper nutrition for a celiac with diabetes. What can we do for snacks that are appetizing, as well as meet the carb intake, for two very fussy eaters?
    Thank you,
    shannon

    Posted by Shannon |
  11. Hi,

    I’ve had type 1 diabetes for 36 years, under very good control with intensive insulin therapy. I’ve developed a gluten intolerance. I’m finding all of the gluten-free alternatives shoot my sugar levels sky high! I had gluten-free pasta last night, and it was a nightmare all through the night with astronomical blood sugars.

    Anybody else have that issue, or have any suggestions of what flour substitutes don’t affect blood sugar as much as the rice flour?

    Thanks,
    Elizabeth

    Posted by Elizabeth |
  12. I started a gluten free diet 10 months ago and the last 6 months my glucose has been high. Just wondering if anyone knows why a gluten free diet would cause that to happen?

    Posted by Leigh |
  13. Hi Leigh,

    If it’s any comfort to you, know that many people with celiac and diabetes can find managing blood glucose to be challenging, at least initially. I suspect that the change in the types of foods you’ve been eating is responsible for your higher glucose readings. Gluten-free foods often contain more carbohydrate than non-GF foods (for example, rice pasta contains more carbohydrate than wheat pasta); also, gluten-free foods can have a higher glycemic index, which means, again, that glucose levels can be higher. You may need more insulin (or diabetes medicine) to compensate for these factors. Make sure you’re carefully reading the nutrition label for portion size and total carbohydrate. It’s not a bad idea to measure out your food portions to make sure you’re eating, say, 1 cup of rice and not actually 2 cups. Use a Web site such as Calorie King for nutrition information, and try out this site which lists additional resources:

    http://glutenfreecooking.about.com/od/nutritionmealplanning/Nutrition_and_Meal_Planning.htm

    Finally, learn how food affects your glucose.If at all possible, talk to your physician about wearing a continuous glucose monitor which can be invaluable for how foods and meals drive your glucose readings.

    Posted by acampbell |
  14. this is more of a question than a comment,
    is gluten free good foa a diabetic, is the
    gulten free flours good for diatetic?

    I have gluten and my husabnd has diabetic,would you help me understand if I can use the gluten pasta fpr him, I tried to find articles about this all it does is talk about glutin and diabetic as 2 different articles, I need to know if I can use gkuten pasta for him.
    Thank You
    God Bless You

    Posted by Mildred |
  15. Mildred, your husband can eat gluten-free flours, but will need to watch the carbohydrate count. For example, many gluten-free pastas are made from rice, which has a different carbohydrate count than pastas made with wheat.

    Consider meeting with a dietitian who is a certified diabetes educator (CDE). Because a higher percentage of people with diabetes have celiac than the general population, the dietitian should be familiar with gluten-free diets.

    Amy Campbell, a registered dietitian and CDE, recommended a Web site in her comment right above yours. It’s a good site. Here it is in shorter form: http://tinyurl.com/23hva32

    Good luck to you.

    Jan Chait

    Posted by Jan Chait |
  16. I was diagnosed with Celiac’s disease at the beginning of 2011. Before that I would eat anything and everything and still can’t seem to stop. I’ve been having very bad stomach pains and lots of other pain in my abdominal area for a long time. I try so hard to eat properly because of the fear the doctor has put into me, but get so darn mad. I try to bake bread but seem to mess it up. If I get it right then it goes bad fast. It’s like I can’t seem to keepa healthy diet and enjoy food. I have no patience for making “everything” that I eat and no will power. I’m 238 pounds and 5′4″ tall and way overweight according to the BMI index. Living in remote region in Northern Alaska makes it a bit incovenient to buy gluten-free products without paying a seal and a whale for shipping. So… I . I dont know how much longer I can keep this up. I constantly tell myself that I’ve been eating this way for 41 years and have been miserable for just about that long that why does it matter if I’m gluten free? It’s an everyday struggle with life and I really have no support groups except what’s online.

    Posted by Jacinta Coples |
  17. I have a question my mom was diagnosed with diabetes about 6 months ago, and I want to make sure I help her out with her new diet, eating healthy and so on. With baking cakes or buying the boxes at the stores, would you recommend buying sugar free or gluten free?

    Posted by Pixie |
  18. Pixie, what your mother needs to watch is total carbohydrates: Carbohydrates are what convert to sugar, which your body uses for energy.

    Gluten-free is not carbohydrate-free. In fact, it can be higher in carbohydrates than food that contains gluten.

    Also, believe it or not, so-called “sugar-free” food can contain more carbohydrates than “regular” food. Give it a try sometime: Check the nutrition labels on a food that is labeled “sugar-free” (or, more likely, “no added sugar”) and the same food that’s just the “regular” version. Try hard candy, for example. You’ll find that “sugar-free” is not carbohydrate free.

    Remember: Just check the “total carbohydrates” line on the nutrition label.

    Good luck to you!

    Jan Chait

    Posted by Jan |
  19. Hi,
    I was searching for information on the relationship between type 2 diabetes and wheat when I came across your blog. It is really interesting and informative. What studies I have read so far says that there is a connection between wheat/gulten and Type 1 but nothing much is said about Type 2. Some of the comments made on your blog refer to having celiac when younger and then becoming Type 2 later. Have you read anything about the link between wheat/gluten and Type 2 diabetes? I am Type 2 on insulin and I also have psiorsis which is suspected as being an autoimmune disease. Trying to get a handle on both.

    Thanks
    Ana (UK)

    Posted by Ana |
  20. I read a little of gluten free diet benefits for D type 1 at http://www.celebritiesdietplan.com/2012/04/benefits-of-gluten-free-diet-plan.html

    Posted by Jasmin |
  21. I called Kellogg’s to find out whether or not their malt was made from chemicals (and therefore might be gluten free) or made from barley. They stated that their malt was made from barley and therefore may contain gluten.

    Posted by Kerry |

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