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People with type 1 diabetes have a higher risk of coeliac disease. Both conditions are autoimmune disorders. According to Coeliac UK between 2 and 10% of people with coeliac disease will also have type 1 diabetes. Some people with type 1 diabetes have silent coeliac disease, which means that no symptoms are apparent. It can also be easily missed because symptoms of feeling unwell may be attributed to the diabetes. Experts agree that all people who suffer from diabetes 1 should be screened for coeliac disease.
Type 1 diabetes is usually diagnosed in children and young adults. It is not the diabetes your grandpa developed when he turned 80. In type 1 diabetes, the body does not produce insulin. Insulin is a hormone that is needed to convert sugar, starches and other food into energy needed for daily life.
1. People with coeliac disease have an increased risk of diabetes 2.
Diabetes 2 is non insulin dependent diabetes. It is the most common type of diabetes and is the type of diabetes that is diagnosed in late adulthood. The bodies of people with diabetes 2 do still produce insulin. But either their pancreas does not make enough insulin or the body cannot use the insulin well enough. This is insulin resistance. There is no link between coeliac disease and type 2 diabetes. The risk of diabetes 2 in people with coeliac disease is the same as for the general population. The risk factors for diabetes 2 are being overweight, lack of exercise, high blood pressure, family history, age, and others. These risks are the same for coeliacs and non coeliacs.
2. Sugar in gluten free foods causes diabetes 2 in people with coeliac disease.
This might be partially true. A diet that is high in sugar can contribute to weight gain, which combined with other risk factors increases the likelihood of developing diabetes 2. But this is not limited to people with coeliac disease. It is the same for the general population. If a person with coeliac disease does not have diabetes 1, the international health recommendations apply. Eat a healthy balanced diet and increase your activity levels to avoid health problems. Just make sure your diet is gluten free.
3. People with coeliac disease and diabetes 1 should follow a sugar free diet.
When a person with diabetes 1 and coeliac disease is established on a gluten free diet, absorption of nutrients from food will increase as the intestine heals. This will affect blood sugar control. It is important to follow advice from a healthcare team regarding possible changes in insulin requirements. However, many people think that they can eat all gluten free food as long as it is sugar free. This is a myth. In reality sugar can be consumed by people with diabetes as part of a healthy diet in cooking and baking. High sugar foods are not healthy for anybody and will not help with glucose control, but sugars are not prohibited. Sadly, many gluten free products are high in sugars. Try to limit the consumption of high sugar foods, but that is not enough.
If a person has diabetes and coeliac disease these points are important to remember:
- Eat regularly and do not skip meals. Try to include a starchy carbohydrtae with every meal. Carbohydrates are important to control blood sugar levels. Follow the advice of a dietitian with regards to how much carbohydrates to include in your diet as this varies depending on age, activity level and weight.
- Include foods with a lower glycaemic index. The glycemic index, or GI, measures how a carbohydrate-containing food raises blood glucose levels. Foods with a low or medium GI raises blood glucose less than foods with a high GI. Fat and fiber tend to lower the GI of a food. As a general rule, the more cooked or processed a food, the higher the GI (although there are exceptions). This means that gluten free highly processed packed products tend to have a high GI index and will raise blood glucose levels fast. Low GI foods that are gluten free include basmati rice, naturally gluten free grains, gluten free pasta, gluten free multigrain, wholegrain or seeded bread, sweet potato, corn, yam, beans, peas, legumes, lentils, most fruit, and non starchy vegetables.
- Eat a healthy diet and maintain a healthy weight.
- Aim for 5 servings of fruit and vegetables per day
- Avoid diabetic foods and drinks. The ‘suitable for diabetics’ label is a gimmick. These foods contain the same amounts of fats and calories and have a laxative effect that can affect blood glucose levels.
Include plenty of naturally gluten free foods in your diet. Do yourself a favour and limit the packaged highly processed gluten free junk. And don’t forget to exercise!
Sources and further reading:
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So here we go again.
It’s funny how I tend to forget what the pain of accidentally ingesting gluten is like every time. For me, symptoms are very specific and only occur with gluten exposure. So I am lucky enough to know that the cause is gluten beyond doubt.
As I was lying on my bed this afternoon, trying not to focus on the pain I got thinking. It is not all bad.
In most auto-immune conditions, the trigger is unknown, but thanks to the work of doctors and scientists in the last century, the trigger of coeliac disease has been identified as gluten. In my article titled A little history about coeliac disease, I explained that before the introduction of the famous banana diet by Sidney Haas in 1924, the only treatment was introducing food in stages to the coeliac patient over a period of months to years. Just think of the pain the patients with coeliac disease had to endure on a daily basis at the time. Not to mention the complications they suffered as a result of untreated coeliac disease. It wasn’t until the second world war that Dutch pediatrician Willem Karel Dicke, MD noted that his paediatric patients improved when wheat was excluded from the diet and replaced with rice and maize flours. The discovery was due to the shortage of wheat grain during the war years in Holland. These children deteriorated again when wheat was re-introduced post war.
We are lucky that we know that we should avoid gluten. Even an episode of accidental gluten exposure only causes temporary discomfort for people who have been diagnosed with coeliac disease. By knowing our trigger to ill health, we have a chance to prevent complications and to improve our life expectancy to the same as the general population. We also have the chance to reverse some of the damage that occurred from years of gluten exposure. I say some, because although the intestine will eventually heal, the systemic effects of years of malabsorbtion might not all be fully reversible depending on the age of diagnosis.
Even people with silent coeliac disease are now being diagnosed, something that was impossible in the past due to lack of awareness that coeliac disease can manifest with atypical or no symptoms, and due to the fact that it was still unknown that certain groups of people are at a higher risk of developing the condition. Thanks to screening programmes whereby people with a family history of coeliac disease, other autoimmune conditions, type 1 diabetes, IBS, anaemia of unknown cause and symptoms of coeliac disease amongst others are tested, more cases are being diagnosed. There still remains a high percentage of undiagnosed people who suffer from coeliac disease, but this is improving with greater awareness and diagnostic criteria.
With regards to diagnosis, antibody blood tests have become more specific and sensitive. An endoscopy is a much milder and easier way of viewing one’s insides and taking a biopsy than previous methods that caused much more discomfort and were not as accurate. We also now know the genes that are associated with coeliac disease. Genetic tests are available, and are useful to rule out coeliac disease or to know if one has the gene/s that give them the potential to develop coeliac disease.
As I am typing this out I am already feeling a little better about myself. At least I know that I will feel better soon because I know what it is that makes me ill. And although complex, expensive and at many times inconvenient, a gluten free diet is just that. A diet. Not too bad as a treatment for a serious auto-immune condition.
The power of positivity….
How do you feel about this?
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