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Diabetes & Celiac Disease
Understanding the connection
In celiac disease, the lining of the small intestine is damaged by gluten, a protein in grains like wheat, rye, barley, triticale and oats. When these are eaten, the body’s immune (defence) system reacts, damaging cells in the intestine that help absorb food. Since food passing through the intestine is not well absorbed, a variety of symptoms usually appear (see below). Some people with celiac disease may have no symptoms if they still have enough undamaged cells to absorb food.
According to the Canadian Celiac Association, almost one percent of Canadians have celiac disease. Celiac disease can affect anyone of any age, ethnic background and sex. You may be at higher risk if someone in your family, such as a parent, brother, sister or child, has celiac disease.
Type 1 diabetes also increases the risk. It is thought that between four and nine percent of children with type 1 diabetes have celiac disease.
What is the connection between celiac disease and type 1 diabetes?
Type 1 diabetes and celiac disease appear to have a common genetic link found on several of the body’s chromosomes (the structures that carry genes). In people who are at risk, the immune system damages cells after being exposed to something in the environment. Researchers are working to identify the role the environment plays, but we do not yet know the trigger.
Symptoms of celiac disease
- diarrhea
- weight loss
- tiredness
- cramps
- bloating
- lactose intolerance (trouble digesting the lactose in milk)
- irritability
- children may not put on weight or grow well
- unexplained hypoglycemia (low blood glucose)
- poor diabetes control.
Blood tests may show:
- anemia (a low number of red blood cells)
- low levels of certain vitamins.
A similar process happens in both type 1 diabetes and celiac disease. With type 1 diabetes, the immune system damages the islet cells in the pancreas that make insulin. In celiac disease, the immune system harms cells of the small intestine. It is possible that for some people, gluten alone or with another factor may affect the immunity of the body and increase the risk of type 1 diabetes.
How do I know if I have celiac disease?
In celiac disease, the immune system makes antibodies when the body is exposed to gluten. If you have symptoms or family members with the condition, your doctor will order blood tests to check for these antibodies.
If blood tests show them, you should have a small sample of tissue from the intestine removed to check for damage. You will be referred to a doctor who does this type of procedure.
How is celiac disease treated?
Staying healthy with celiac disease and diabetes means avoiding all foods that contain gluten. Most breads, pasta and cereals contain gluten. Following a gluten-free diet relieves symptoms, heals the intestine and prevents further damage. Some people with diabetes and celiac disease may notice improved blood glucose control and less hypoglycemia on a gluten-free diet.
For those with diabetes who are diagnosed with celiac disease but have no symptoms, it is uncertain how much following a gluten-free diet will help. Researchers are working to identify the best treatment for people without symptoms. It is possible that even though you have no symptoms, damage still occurs. For this reason, gluten may be worth avoiding.
Carefully check ingredients on all food labels for grains and other ingredients that may contain gluten. Do this even with products you use often, as ingredients in a processed food may change. To be certain a product is still gluten-free, check food labels regularly and monitor the Canadian Celiac Association website for notices on food products and recalls.
Grains containing gluten |
Ingredients containing gluten |
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I have celiac disease and diabetes – What Can I Eat?
Vegetables
Choose vegetables prepared with no added sauces. Avoid breaded coatings and batters.
Milk and alternatives
Milk, evaporated milk, milk powder and cereal cream are gluten free.
Fats
Butter, margarine and vegetable oils do not contain gluten. Avoid salad dressings and cooking sprays that include wheat flour or wheat starch.
Fruits
Fruits prepared with no added sauces or toppings are a good choice.
Grains and starches
Breads, crackers, pasta and cereal made with rice, corn, soy, nut, pulse (lentil, pea, bean) and potato flours are generally safe choices. These foods are found in some grocery stores and specialty food shops, or can be made at home. Quinoa and plain rice (black, brown, and wild rice) are also gluten-free starches.
Meat and alternatives
Plain meat, fish, chicken, eggs, dried peas, beans (black, kidney, navy, pinto, soy beans), lentils, aged cheese, cottage cheeses and tofu are all safe choices on a gluten-free diet. Be aware that meat substitutes, cheese spreads and sauces, processed meats, imitation fish products (such as imitation crab), seasoned and dry roasted nuts, nut butters and seeds may contain hydrolyzed wheat protein, wheat starch and other fillers containing gluten.
Milk and Extras
Foods in this group, such as coffee, tea, diet drinks, spices, seasonings and condiments, are low in carbohydrate and calories. Check food labels carefully as some products, such as curry paste, seasoning mixtures, flavoured teas and coffees, and specialty mustards, may contain ingredients with gluten.
Other choices
This food group includes sugars and snack foods like plain popcorn, soy nuts and gluten-free corn chips. Brown and white sugar, corn syrup, molasses, maple syrup, honey and jam are all gluten-free. Check food labels carefully to ensure there are no ingredients that contain gluten. Remember to talk with your dietitian about using snack foods.
Additional help
Many other foods are safe for people with celiac disease. Contact your dietitian for more information about celiac disease and foods included in the celiac diet. By caring properly for both your diabetes and celiac disease, you can feel better and avoid the risk of complications.
The Canadian Celiac Association provides information on celiac disease, gluten-free foods and recipe books through newsletters and meetings. Check to see if there is a branch near you, or contact The Canadian Celiac Association: 1-800-363-7296 or *celiac.ca.
