Celiac disease at a glance
Like type 1 diabetes, celiac disease is an autoimmune disease. In people with this disease, consuming gluten triggers an abnormal reaction of the immune system that damages the walls of the intestine. This damage interferes with the absorption of nutrients, such as iron, calcium and certain vitamins, found in food.
In the long term, the nutritional deficiencies caused by the disease can lead to anemia (deficiency of iron, folic acid or vitamin B12), osteoporosis (weakening of the bones due to a lack of calcium and vitamin D), fertility problems and increase the risk of developing certain cancers.
Although we do not yet understand all the inner workings, research in recent years clearly shows that people with type 1 diabetes are at greater risk of developing this disease.
The symptoms experienced may vary from one individual to another. The most common are:
- bloating, gas
- recurrent diarrhea
- extreme weakness / fatigue
- delayed growth and puberty (in children)
- frequent and inexplicable hypoglycaemia
In some cases, celiac disease is silent, that is, it has no symptoms. Other times, it manifests as dermatitis herpetiformis which is characterized by the appearance of blisters on the elbows, knees, buttocks and upper back, accompanied by a burning sensation and itching.
Certain genetic factors have been linked to celiac disease. Moreover, the probability of developing the disease climbs to 10% in people with a close family member (parent, brother, sister). People with another autoimmune disease (type 1 diabetes, thyroid disease) or Down’s syndrome are also at greater risk.
On the other hand, genes do not explain everything. The mechanisms that trigger the onset of symptoms are still poorly understood. In some cases, stress would have an important role to play. Indeed, the first symptoms often appear following severe physical or psychological stress such as infection, surgery, pregnancy or emotional shock.
Celiac disease can start at any age, but is most commonly diagnosed between the ages of 30 and 60. To detect it, we first do a test for the blood levels of antibodies specific to the disease. If this test is positive, a biopsy (tissue sample) of the small intestine is then taken. If the biopsy shows lesions, this confirms the diagnosis of celiac disease.
However, it is recommended that you do not start a gluten-free diet until you have taken the biopsy, as this could misdiagnose. In its 2018 guidelines, Diabetes Canada recommends that people with type 1 diabetes who experience symptoms related to celiac disease get screened.
Celiac disease is permanent, that is, it does not go away over the years. On the other hand, following a gluten-free diet for life allows the complete disappearance of the symptoms and the recovery of the intestine. Before starting this diet, it is essential for the person with diabetes to have received confirmation of the diagnosis by a doctor and to be monitored by a nutritionist specializing in celiac disease and diabetes. The nutritionist will first make sure that the diabetes is well controlled before starting the gluten-free diet.
Gluten-free diet and diabetes
Reconciling the gluten-free diet with diabetes can be a real food gymnastics! If the diet is not balanced, it can cause nutritional deficiencies and an increase in blood sugar.
The complexity comes from the fact that gluten is found in many foods consumed daily. In fact, this protein is found in cereals of wheat (including kamut, spelled and triticale), oats *, barley and rye. Thus, all products processed from these cereals (eg: breads, pastries, breakfast cereals, cereal bars, cookies, crackers, pasta, couscous, bulgur, etc.) contain gluten.
By removing all of these products from the diet, especially those made from whole wheat, we eliminate the main sources of dietary fiber, which helps in controlling blood sugar levels, among other things. Additionally, gluten-free alternatives are often low in fiber, higher in carbohydrates, and provide less protein.
Here are some tips that can help people with diabetes with celiac disease make healthy, gluten-free choices:
Eat foods that are as minimally processed as possible (vegetables, fruits, fish, poultry, eggs, nuts, milk, etc.)
Avoid fried or breaded foods (restaurant cooking oils are often contaminated with gluten, and breadcrumbs usually contain gluten)
Replace wheat products with naturally gluten-free starches (potatoes, rice, corn, quinoa, corn tortilla, rice cakes, rice vermicelli, etc.)
Opt for whole grains (brown rice, quinoa, amaranth and buckwheat) and legumes (chickpeas, beans, lentils, soybeans, etc.) to optimize your fiber and protein intake
Use your own toaster oven and have your own jars of jams and spreads (mayonnaise, mustard, etc.) to avoid cross contamination
Avoid hidden sources of gluten like oats *, soy sauce, imitations of seafood (pollock), grain-based alcohols (beer), certain store-bought soups and broths, sausages and cold cuts.
Note that the above list is not exhaustive and should in no way replace the personalized advice of a nutritionist specializing in celiac disease and diabetes.