Primer: Managing Diabetes and Celiac Disease (Part 3)


This week, I’ll wrap up my three-part series on celiac. So far, we’ve looked at symptoms of celiac, how it’s diagnosed, and the beginnings of what the gluten-free diet consists of.  I’d like to share some more information on the gluten-free diet, since this is really the crux of the treatment of celiac, as well as some tips for managing both diabetes and celiac at the same time.

I’m also curious to know how many of you have celiac. If you have celiac and you have some helpful hints or tips that could help others, please share!

Gluten-Free Diet Tips
Last week, I listed the grains that are “forbidden” when following a gluten-free diet. And while things can seem pretty restrictive, it’s good to know that there are a lot of foods that you can still eat.

I attended a session at AADE (the diabetes educators’[1] conference) back in August on celiac, given by a dietitian who has both diabetes and celiac (and who knows her stuff, I might add!). Something she mentioned was new to me: A “safe” amount of gluten is about 50 milligrams (mg) of gluten per day. That may not mean anything to you. However, to keep things in context, a one-ounce slice of wheat bread contains about 4,800 mg of gluten. So, if you want to splurge on wheat bread yet still be safe, you could eat a 100th of a slice of bread!

My point is that while it’s impossible to totally avoid gluten altogether, it’s important to do your best to avoid gluten-containing foods as much as possible if you have celiac disease. Some people may think, “I feel fine—what can it hurt to eat a slice of bread/a small dish of pasta/a piece of pizza, etc.?” Herein lies the danger. You may feel great, but when you have celiac, even very small amounts of gluten can wreak havoc on your intestinal villi, causing damage.

We’ve already reviewed some of the complications associated with untreated or poorly treated celiac. This list of complications, unfortunately, includes a higher risk of cancer. So, don’t be lulled into a false sense of security. If you have celiac disease, stay as gluten-free as possible!

About 90% of processed foods contain gluten, so become an astute label reader. Watch out for these ingredients, as they often indicate that the food contains gluten:

Distilled vinegar is okay to use, but malt vinegar isn’t. That means, too, that malt beverages (e.g., beer) are not okay. Good news—Redbridge beer is gluten-free. Oatmeal may be safe, but you need to be sure that it is not contaminated with other grains.

There are a lot of intricacies to the gluten-free diet, and they’re beyond the scope of this post, so it’s a good idea to work with a dietitian who ideally has some experience with celiac and to read as much as you can about it.

Celiac and Diabetes
If you have diabetes and are wondering if you might have celiac, please get tested. Besides the more “traditional” symptoms, you may notice unpredictable or unexplainable swings in your blood glucose; hypoglycemia[2] a couple hours after a meal; hypoglycemia that is hard to treat; and lack of improvement in your HbA1c[3] level. Of course, these diabetes symptoms can be due to other causes, but, they could be linked to celiac.

Finally, know that there are a lot of resources out there for folks who have celiac. Here are a few to get you started:

There are also many food companies that specialize in gluten-free products. The above Web sites will give you names and links to these companies. And don’t forget to check out your local grocery store/health food store for gluten-free products, too.

  1. diabetes educators’:
  2. hypoglycemia:
  3. HbA1c:

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Amy Campbell: Amy Campbell is the author of Staying Healthy with Diabetes: Nutrition and Meal Planning and a frequent contributor to Diabetes Self-Management and Diabetes & You. She has co-authored several books, including the The Joslin Guide to Diabetes and the American Diabetes Association’s 16 Myths of a “Diabetic Diet,” for which she received a Will Solimene Award of Excellence in Medical Communication and a National Health Information Award in 2000. Amy also developed menus for Fit Not Fat at Forty Plus and co-authored Eat Carbs, Lose Weight with fitness expert Denise Austin. Amy earned a bachelor’s degree in nutrition from Simmons College and a master’s degree in nutrition education from Boston University. In addition to being a Registered Dietitian, she is a Certified Diabetes Educator and a member of the American Dietetic Association, the American Diabetes Association, and the American Association of Diabetes Educators. Amy was formerly a Diabetes and Nutrition Educator at Joslin Diabetes Center, where she was responsible for the development, implementation, and evaluation of disease management programs, including clinical guideline and educational material development, and the development, testing, and implementation of disease management applications. She is currently the Director of Clinical Education Content Development and Training at Good Measures. Amy has developed and conducted training sessions for various disease and case management programs and is a frequent presenter at disease management events.

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