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Family Health Magazine
DIABETES

Celiac Disease and Diabetes
Understanding the connection

Celiac disease is an illness where the inside lining of the small intestine is damaged by eating wheat, rye, barley, oats and triticale. These grains contain a protein called gluten. When these grains are eaten, the body’s immune (defence) system over-reacts and damages the cells in the intestine that help the body to absorb food.

When food passes through the intestine and is not absorbed, symptoms may occur. These may include diarrhea, weight loss, tiredness, cramps, lactose intolerance (trouble digesting lactose found in milk), bloating and irritability. A blood test may show a low red blood cell count (anemia) or low levels of certain vitamins. Some people may not have any signs of celiac disease if their body has enough undamaged cells left to absorb food in the small intestine.

Celiac disease can be found at any age. According to the Canadian Celiac Association, about one in every 2000 Canadians has celiac disease. It is more common in some countries in Europe. You may be at higher risk if someone in your family has celiac disease (parent, brother, sister or child), or if you have Type 1 diabetes.

What’s the connection?

In celiac disease, the body’s own immune system causes the damage. In Type 1 diabetes, a similar kind of over-reaction of the immune system occurs. The islet cells in the pancreas, which produce insulin, are damaged, causing diabetes.

How do I know if I have celiac disease?

If you have family members with celiac disease or have symptoms, your doctor will order blood tests to check for levels of antibodies to gluten. These antibodies are made by the immune system when the body is exposed to gluten. If the blood tests show these antibodies, your doctor may remove a small sample of tissue from the intestine to check for any damage caused by the gluten.

How is celiac disease treated?

A special diet that is gluten-free usually stops the symptoms of celiac disease. This diet helps to heal the damage in the lining of the intestine and prevents further damage. Some people with diabetes may notice improved blood glucose control.

Staying healthy with celiac disease and diabetes means eating a gluten-free diet for life. This means avoiding foods that contain wheat, rye, barley, oats and triticale. Foods that contain these grains include most breads, pasta and cereals. It is important to carefully check the ingredients on food labels for any of these grains or other ingredients that may contain gluten. Some ingredients that contain gluten are malt, malt flavour, modified wheat starch, hydrolyzed vegetable protein, icing sugar and soy sauce. Sometimes the ingredients in food may change. To be certain a food is still gluten-free, check food labels regularly.

I have celiac disease and diabetes - what can I eat?

Starch foods
Breads, crackers, pasta and cereal made with rice, corn, soy and potato flours are safe choices. These foods are found in some grocery stores and specialty food shops, or can be made at home.

Fruits and vegetables
All fruits and vegetables with no added sauces are also a good choice.

Milk
Milk, evaporated milk, milk powder and cereal cream are gluten-free choices.

Protein foods
Plain meat, fish and chicken, eggs, dried peas, beans, lentils, aged cheese, cottage cheeses and tofu are all safe choices on a gluten-free diet. Avoid breaded coatings or batters.

Fats and oils
Butter, margarine and vegetable oils are fats that do not contain gluten.

Sugars
Brown and white sugar, corn syrup, molasses, maple syrup, honey and jam are all gluten-free.

Other foods
Many other foods are also safe for people with celiac disease. Contact your dietitian for more information about celiac disease and foods that are included in the celiac diet.