Inspiration And Expert Advice: Expert Columns

Diabetes and Celiac Disease

By Lara Rondinelli RD, LDN, CDE

I’ve been asked by a few patients, “Do you have diabetes? If you don’t have it, how could you possibly know how it feels and why should you tell me what to eat?” My response has been that I don’t know how it feels to have diabetes, but I have the knowledge and the desire to help people eat and live healthier to best control their diabetes. My answer was always accepted by these people, who were probably just angry with their diagnosis.

Well, in the past couple of months, I’ve definitely gotten more familiar with being a patient versus being a health care provider. I didn’t get diagnosed with diabetes, but I did get diagnosed with celiac disease. Celiac disease is an autoimmune disorder triggered by gluten, a protein found in certain grains, which damages the small intestines and decreases its ability to absorb nutrients. People with type 1 diabetes, as well as those with other autoimmune conditions such as thyroid disease, are more at risk for celiac disease. It is estimated that 8-10% of people with type 1 diabetes also have celiac disease, with the diabetes diagnosis usually coming first1. Celiac disease is extremely underdiagnosed in the United States. Common symptoms include gas, bloating, diarrhea, weight loss, and fatigue, but some people do not experience any of the gastrointestinal symptoms. A delay in diagnosis of celiac disease can increase the chance of developing other autoimmune diseases, along with increasing risk of osteoporosis, anemia, peripheral neuropathies, and some cancers. If you have type 1 diabetes and have any of these symptoms listed above, it is probably best to discuss this with your doctor. Celiac disease is diagnosed by a blood test that measures specific antibodies in your blood and if those are positive, then an intestinal biopsy is conducted to examine the small intestine and determine if there has been any damage.

Gluten is the common name for proteins found in wheat, rye, and barley. People with celiac disease must avoid gluten for their whole life. Even a small amount of gluten is thought to be potential risk for the patient. Gluten is found in many common American foods, such as flour, therefore it is in cookies, crackers, cakes, bread (white or whole-wheat), bagels, and cereals. In addition, there are also hidden sources of gluten in foods like soy sauce, salad dressings, lunch meats, and many more foods. Label reading becomes very important for a person with celiac disease. Just as a person with diabetes is told to see a registered dietitian who specializes in diabetes (CDE), a person diagnosed with celiac disease should see a registered dietitian specializing in gastrointestinal diseases, including celiac disease.

When my doctor gave me the news that I had celiac disease, I remember sitting in my office thinking of how my life would change and what favorite foods I would never be able to eat again. But, I’ve come to learn that there are many gluten-free substitute foods, such as gluten-free crackers, bread, cereals, etc., that taste good and can be found in some local grocery stores. Just like diabetes, celiac disease definitely creates some challenges, hassles, and major changes in your life, and I’ve always been straightforward with my patients about that. But, I’ve often told my patients with diabetes – “Nobody wants diabetes, but you have it, it can be controlled and sometimes it makes you healthier. Many people start a living a healthier lifestyle that includes a healthier diet.” This healthy lifestyle change might not have been occurred if they didn’t get diabetes.

1. Peter Green. Celiac Disease, A Hidden Epidemic. HarperCollins Publishers, 2006.

Below is a recipe for a great tasting gluten-free dish that is also diabetes friendly.

Greek Lemon Chicken and Rice

Serving Size: 1 chicken breast and ½ cup brown rice

3 Tablespoons fresh lemon juice
2 teaspoons olive oil
3 cloves garlic, minced
1 teaspoon chopped fresh oregano (or ¼ teaspoon dry)
4 4-ounce boneless, skinless chicken breasts
Cooking spray
1/4 teaspoon salt
1/4 teaspoon ground black pepper
2 cups cooked brown rice

Directions:

1. In a medium bowl, whisk together lemon juice, olive oil, garlic and oregano. Add chicken breasts to marinade and turn to coat. Marinate chicken in refrigerator for 30 minutes.

2. Coat a large non-stick skillet with cooking spray. Remove chicken from marinade and season well with salt and pepper. Reserve marinade. Cook chicken over high heat for approximately 5-7 minutes on each side. Add reserved marinade to pan and bring to a boil for 1 minute.

3. Serve chicken breasts over brown rice.

Nutritional Information: 268 calories, 6g total fat, 1g saturated fat, 68mg cholesterol, 213mg sodium, 24g total carbohydrate, 2g dietary fiber, 28g protein

Copyright © American Diabetes Association from Healthy Calendar Diabetic Cooking. Reprinted with permission from The American Diabetes Association. To order this book, please call 1-800-232-6733 or order online at http://store.diabetes.org/.