Gluten-Free Diet for Type 1 Diabetes: Trend or Must?

It can be difficult to keep up with diet trends. There are so many of them, and they often don’t last very long. 

Although the gluten-free diet has gained in popularity over the past few years, there are still a lot of misconceptions. It’s not always easy to understand what gluten is and to know whether we can benefit from cutting it off.

At any rate, there are still a lot of gluten-free enthusiasts around the world. In Canada, the BETTER registry estimates that about 9% of people with type 1 diabetes (T1D) eat a gluten-free diet.

So, is it just a trend or is it a must? Let’s take a look.

What is gluten?

Gluten is a group of proteins found in wheat, spelt, barley, rye and sometimes oats. When mixed with water, the proteins form a sticky network that makes the dough elastic, chewy and more cohesive. The word “gluten” derives from the Latin word for “glue.” 

Gluten has always been a part of the foods we eat, but it can sometimes cause gastrointestinal discomfort. 

How are celiac disease and type 1 diabetes related? 

While sometimes called “gluten intolerance,” celiac disease is a disease all the same, rather than a form of intolerance. It is an autoimmune chronic condition, just like T1D, in which the consumption of gluten triggers an atypical attack of the intestinal walls by the immune system. The resulting lesions prevent the proper absorption of nutrients such as iron, calcium and certain vitamins. Recent studies have shown that people with T1D are at a higher risk of developing this disease, but it is not yet clear why. 

An estimated 4% to 9% of people with T1D also have celiac disease. These numbers are reflected in the BETTER registry, where close to 5% of participants reported having received a diagnosis of celiac disease.

Although celiac disease can develop asymptomatically in some rare cases, it usually manifests with the following symptoms:

• • Bloating, gas
  • Frequent diarrhea
  • Constipation
  • Major weakness/fatigue
  • Indigestion
  • Weight loss
  • Delayed growth or puberty (children)
  • Anemia
  • Frequent and unexplained hypoglycemia (people with T1D) 

If you have T1D and experience symptoms or believe you might have celiac disease, Diabetes Canada recommends getting a blood test and a biopsy (using removed small intestine tissue) to determine whether you have celiac disease.

Over time, celiac disease can cause nutrient deficiencies and lead to other health problems such as anemia (iron, folic acid or vitamin B12 deficiency), osteoporosis (calcium and vitamin D deficiency), reduced fertility and a higher risk of developing certain cancers.

The only solution: gluten-free diet 

Once the diagnosis is confirmed, the only way to completely eliminate symptoms and heal the intestine is to follow a gluten-free diet. This diet is strict and more complicated than it seems, especially when T1D is involved. And just like T1D, celiac disease is a chronic condition; treating it is a lifelong undertaking. That’s why you absolutely need an official diagnosis by a doctor and the help of a specialized nutritionist before you start following a gluten-free diet. 

Because gluten is found in a lot of cereal grains such as wheat, oats, barley and rye—as well as processed foods containing these grains, e.g., bread, pastries, breakfast cereal—this diet is all the more challenging.

It’s even more challenging when you also have to take diabetes into account. An unbalanced diet can cause nutrient deficiencies and hyperglycemia. Here are a few tips to tackle this dual challenge: 

• Consume carbs that are naturally gluten-free and high in fibre (e. g., brown rice, quinoa, buckwheat, potatoes, fruit with skin on).
• Add protein to your meal to reduce post-meal blood sugar spikes (e.g., an egg with your breakfast, nuts in your salad, a slice of cheese in your sandwich).
• If you eat gluten-free foods that have a higher glycemic index, make sure to inject your rapid-acting insulin before your meal, so that the insulin starts acting at the same time as the carbs reach your bloodstream.
• Discuss any insulin dose adjustment with your healthcare team.

“Gluten-free” food products 

In commercial “gluten-free” products, whole grains are often swapped with potato or rice starch, taking out a source of dietary fibre that helps regulate blood sugar levels, among other benefits. Gluten-free products are often processed foods loaded with carbs and low in protein.

While eliminating gluten can have the added benefit of also eliminating certain sources of refined sugar, going for gluten-free products is not necessarily the right solution. The “gluten-free” label does not guarantee a good nutritional value. 

Are there any benefits to following a gluten-free diet if you don’t have celiac disease?

There are people who haven’t received a diagnosis of celiac disease, but still choose to follow a gluten-free diet, claiming it’s better for their health. The condition where gluten causes intestinal discomfort in the absence of celiac disease, although not scientifically acknowledged, is referred to as “non-celiac gluten sensitivity.” The improvement of symptoms could be due to the absence of gluten, but also to the reduction or elimination of processed and unhealthy foods.

Each person’s body is different, and there is more than one way to eat healthy. Managing type 1 diabetes and celiac disease can be a real challenge, but it is absolutely possible to follow a gluten-free diet while aiming for optimal blood sugar control. 

Références :

• Diabète Québec, La maladie cœliaque et le diabète, consulté le 28 novembre 2022, https://www.diabete.qc.ca/fr/vivre-avec-le-diabete/alimentation/trucs-et-conseils/la-maladie-coeliaque-et-le-diabete/
• Cours Comprendre et traiter la maladie cœliaque lorsqu’on vit avec le diabète de type 1, Plateforme Support
• Diabetes Canada, Celiac disease and diabetes, consulté le 28 novembre 2022, https://diabetes.ca/managing-my-diabetes/preventing-complications/celiac-disease