Glossary Term Name
This is a placeholder for glossary term definitions.
Celiac disease is an autoimmune disease that affects the digestive system and is commonly found in people with other autoimmune diseases, like type 1 diabetes. Celiac disease occurs in 1 in every 10 people with type 1 diabetes, as compared with the 1 in 100 cases in the general population.
People with celiac disease cannot tolerate gluten, a protein found in all forms of wheat, rye, barley and triticale. It damages the intestine and its ability to absorb nutrients. Many people with untreated celiac disease can have anemia or a vitamin B deficiency, which leads to numbness or joint pain. Its main symptoms are abdominal pain, gas and bloating and diarrhea, among many others. However, many people are diagnosed asymptomatically, which means there is no recognizable sign that one has the disease.
Living a life with celiac disease is challenging and affects people with diabetes in different ways, especially when a diagnosis is initially made. Because of the damage to the intestines, people with celiac disease cannot have any gluten. There is no other treatment except for removing all gluten from the diet.
When Robin's eight-year-old daughter, Samantha, complained of stomach aches soon after her diagnosis with diabetes, she asked her doctor if there was a correlation between stomach pains and diabetes. He said no, and added celiac disease to a list of tests to run. When the test results came back, Samantha was diagnosed with celiac disease.
Unlike Samantha, Naomi's son Daniel, who was also diagnosed with celiac shortly after his diagnosis with diabetes, had absolutely no symptoms. After his diagnosis, his hospital ran standard follow-up tests on other autoimmune diseases linked to type 1 diabetes, which include celiac disease and hypothyroidism. Follow-up tests showed that he had the antibodies for the disease and after a confirmation biopsy, Daniel was diagnosed with celiac disease.
Adjusting to food can be very challenging because many favorites like bread, pasta, pizza, and cookies must be completely avoided in order to prevent any cross-contamination and damage to the intestines. Gluten is also found in breakfast cereals and many processed foods like canned soup, lunch meat, gravy, and seasonings.
"The adjustment to gluten-free foods took time," Robin says. "The taste was terrible in the beginning and we had to find the brands and products that our daughter liked. My recollection is that the rice flours used in the gluten-free pasta had a tendency to raise blood sugars."
Anne, a 36-year-old who was diagnosed with celiac disease six years after her diabetes diagnosis, describes her diet as being naturally non-gluten, instead of incorporating a lot of gluten-free substitutes. She says her typical breakfast is a yogurt with berries and some Nutty Flax cereal, her lunch is a mix of veggies and protein, like tofu, beans, or chicken, along with soup or a gluten-free sauce, and her dinner is mostly Asian, such as Thai, Indian, or sushi, but without the soy sauce (which has gluten).
Naomi, on the other hand, mixes both naturally gluten-free food with the gluten-free alternatives. Some of Daniel's choices include the EnviroKids brand of cereal, "Against the Grain", tapioca buns for sandwiches, and empanadas made with Chebe brand mix. She uses gluten-free bread crumbs and buys gluten-free pasta, chips, and pretzels, though she says gluten-free pizza tends to run Daniel's blood sugars a little too high.
In addition to the carbohydrate differences in gluten-free food, blood sugars are also impacted as the intestine heals itself and more nutrients are absorbed into the body.
Anne says that as she changed to a gluten-free diet, she started needing more insulin. Thirty-year-old Catherine also noticed similar changes in her blood sugar when she switched to a gluten-free diet after her diagnosis in 2004.
"Initially [managing diabetes] was more difficult because my food absorption was changing and gluten-free crackers and breads tend to have different carb/fat/protein ratios than their gluten-filled counterparts," she says.
Another challenge is making sure to have gluten-free snacks on hand in case of a low blood sugar. Ann explains that she always brings a gluten-free snack with her in case she needs it. If a person ingests food contaminated with gluten, it can have disastrous effect, both for the celiac disease and for the diabetes.
"People with celiac react differently when they are exposed to gluten," Naomi explains. While most have stomach pains or diarrhea, vomiting or the inability to take food can have serious consequences for someone with diabetes. "Daniel vomits. This has caused our biggest problem because if Daniel ate, then he bolused to lower his blood sugar. He then loses his food, and his stomach hurts so much that it is difficult for him to take in any more carbs to prevent hypoglycemia."
This is another reason why switching to a completely gluten-free diet is absolutely crucial.
When switching to a gluten-free lifestyle, Robin recommends taking your time.
"The best advice we got was to change one food item each week," Robins says. "Unless you are very sick and need to go completely gluten-free immediately, gradual changes for kids (and adults probably) work better. The gluten-free diet is an adjustment and until there is a cure, it is for life. Allow yourself the time to find food substitutes that you enjoy.
Catherine adds that living gluten-free will get easier each year as awareness grows and more products become available in stores and in restaurants.
"Living gluten-free takes planning," Naomi says. "When traveling or going out to eat, you have to look for restaurants with GF menus, and carry food so that you are safe in places that don't have anything for you to eat. Most places are happy to let you know if they can provide a gluten-free menu or, if they don't have a GF menu, whether they can prepare something special. When in doubt, we just don't trust the food."
Catherine decided to help others with the process of finding gluten-free food by starting her blog, A Gluten-Free Guide. On her blog, Catherine shares her favorite recipes and her gluten-free friendly restaurants in New York City, where she lives. "I spent the first six months after my diagnosis buying practically every available gluten-free alternative to mainstream products," Catherine says, adding that she tested and changed recipes again and again until she found ones that tasted as good as the original gluten-filled items. "I decided to start the blog to share what I have learned and continue to discover. It has turned out to be one of the biggest blessings of a less than ideal condition."
Additional Resources:
Celiac Disease Foundation: http://www.celiac.org/
Gluten-Free Restaurant Awareness Program: http://www.glutenfreerestaurants.org/
ChildrenWithDiabetes.com Celiac and Type 1 Diabetes Mailing List: http://mail.castleweb.com:81/guest/RemoteListSummary/cwd_celiac
Gluten-Free Diet: A Comprehensive Resource Guide: http://www.glutenfreediet.ca/
