The Link Between Diabetes and Celiac Disease

Nearly 10 percent of Type 1 diabetics also have celiac disease, an inflammatory condition of the small intestine that is brought on by eating gluten. Like Type 1 diabetes, celiac disease also is an autoimmune disease, explains Peter Green, MD, director of the Celiac Disease Center at Columbia University and co-author of "Celiac Disease (Revised and Updated Edition): A Hidden Epidemic." />
"Celiac disease is common, and those with diabetes are a high-risk group for getting it," Green says, adding that it's now recommended that individuals with newly diagnosed Type 1 diabetes be screened for celiac disease annually for several years.

The health risks for those with undiagnosed celiac disease are many and scary: anemia, osteoporosis, acquiring another autoimmune disease, and even a small but real risk of having a malignancy develop, Green says.

If you've got both celiac disease and Type 1 diabetes, meal planning can be tricky. "It definitely adds a degree of complexity," Green agrees. But once you get familiar with some of the foods you may not have cooked before, like amaranth or polenta, you can eat healthy, delicious meals that the whole family will love.

Devon Carlson, MS, RD, of the Naomi Berrie Diabetes Center at NewYork-Presbyterian Hospital/Columbia Medical Center, works with many patients who have both conditions.

"Some patients say that managing diabetes is easier than conforming to a gluten-free diet," Carlson says. "What makes it hard to do both is that a lot of the gluten-free foods are high in fat and/or sugar." Fats and sweeteners are added to increase the palatability of the food once the gluten is taken out, she explains.

To avoid consuming too many high-fat, high-sugar foods, she recommends focusing on foods that are naturally gluten-free, like fruits, vegetables, and yes, whole grains.

But don't grains contain gluten? Nope, says Carlson. Quinoa, millet, buckwheat and amaranth all are gluten-free, and they contain both fiber and protein. Here are some ideas for cooking deliciously.
Quinoa can be turned into a wonderful pilaf, millet can be eaten as a hot cereal, and buckwheat makes fantastic pancakes.

  • When baking with gluten-free flours, Carlson recommends using the higher-protein, higher-fiber flours like amaranth, millet and quinoa rather than rice and tapioca flours. "These two are not as nutritious," she says.
  • There's a tremendous variety of gluten-free baking mixes now available, and you can experiment by using small amounts of a mix in a recipe that calls for all-purpose flour.
  • Getting enough fiber can be hard for those with celiac disease, since high-fiber foods such as whole wheat are off-limits. For extra fiber, try adding ground flaxseed to your food, or incorporate millet and buckwheat into baked dishes.
  • Love oatmeal? Be sure to read the label and buy only oatmeal that is labeled gluten-free. Many oatmeals are processed in a plant that also processes products containing gluten, Carlson explains. "They could contain a small amount of gluten through cross contamination," she says.
  • If you're bored with naturally gluten-free foods like fruits and vegetables, get creative. Try baking apples instead of just serving them raw. Stir grated carrots or zucchini into a gluten-free muffin mix. Add dried plums or dates for extra fiber.
  • Make a fruit crisp using blueberries or raspberries, and prepare the topping by substituting a gluten-free baking mix for the flour. Add a little extra cinnamon and nutmeg to enhance the flavor.
  • Get acquainted with polenta, which is incredibly versatile. You can make a large pan of polenta, spread it in a thin layer on a baking sheet, and chill briefly. Use this in place of noodles in lasagna. And to make it even healthier, use lots of vegetables, lean ground turkey, and lowfat mozzarella cheese in place of the usual whole milk mozzarella and ground beef.