coeliac disease and diabetes

want to know more about coeliac disease and diabetes?

What is coeliac disease?

Coeliac disease is a lifelong intolerance to gluten, a protein found in wheat, rye, barley and possibly oats. When people with coeliac disease eat these foods, the gluten damages the lining of the bowel and the body can no longer absorb the nutrients in food properly.

Symptoms vary, but adults typically feel very tired, suffer from anaemia and bowel upsets, and lose weight. Other signs may be mouth ulcers, infertility and having never felt truly well. Infants and children usually become lethargic and miserable, pass pale, bulky stools and fail to grow properly.

Once coeliac disease has been confirmed by a gastroenterologist, treatment is with a strict life-long gluten-free diet. This is vital for good health and to avoid possible long term complications such as osteoporosis (brittle bones) or certain cancers. Regular medical and dietetic review is recommended.

What is diabetes mellitus?

Diabetes is also a lifelong condition where there is too much glucose in the blood. Diabetes develops because the body's way of converting blood glucose into fuel, a process that relies on a hormone called insulin, is not working properly. There are two main types of diabetes: Type 1 diabetes when there is a severe lack of insulin in the body and Type 2 diabetes when the body produces some insulin but not enough for its needs, or when the insulin is not properly used by the body. Type 2 is the most common form of diabetes and usually affects people over 40 years of age. Typical symptoms include extreme tiredness, increased thirst, passing large amounts of urine, weight loss and blurred vision.

Type 1 diabetes is treated by insulin injections and a healthy, balanced diet. Type 2 diabetes can be treated in several ways: by diet alone, or by diet and tablets, or by diet and insulin injections. Keeping to a healthy weight is also important.

Both types of diabetes are serious and the aim of treatment is to control blood glucose levels and reduce the risk of long term complications such as eye or kidney problems and heart disease. Regular medical and dietetic review is recommended.

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Is there a link between the two conditions?

Both conditions tend to run in families, and research shows that there is also a genetic link between coeliac disease and Type 1 diabetes. This means that people with Type 1 diabetes have a greater chance of developing coeliac disease than the general population (or vice versa). Many experts now recommend that everyone with Type 1 diabetes should be tested for coeliac disease (initially with a specific blood test), especially those with bowel problems or unexplained anaemia.

What is the diet like if you have both conditions?

A healthy, balanced diet with regular meals based on starchy foods is recommended for everyone, including people with these conditions. But when people have coeliac disease the diet must also be gluten-free. This means avoiding all foods containing wheat, rye, barley and possibly oats (oats may be allowed for some people undergoing personal medical and dietetic supervision. They are still not recommended for children). Less obvious sources of gluten include sausages, confectionery, sauces and ready meals.

Special gluten-free foods

As gluten is found in everyday starchy foods like flour, bread, pasta and breakfast cereal, a range of specially manufactured gluten-free alternatives is available on prescription to help keep the diet balanced and varied. These are also suitable for people with diabetes, who must take particular care to base meals and snacks on starchy foods to help control blood glucose levels. Remember too that many foods are naturally gluten-free, for example, rice, pulses, fruit, vegetables, plain meat and fish, dairy products and soya.

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Where can I get more information from?

Following diagnosis, you should be referred to a local state registered dietitian. If you are not, ask your GP or consultant to refer you. The dietitian will give practical advice tailored to the specific needs of the individual on how to follow a healthy gluten-free diet that is also suitable for diabetes. Diabetes UK produces a range of literature on all aspects of diabetes and Coeliac UK provides information on following a gluten-free diet.

Manufacturers of special gluten-free foods also provide a range of information and services including recipes, starter packs and special events. For further details please refer to the contact page at the back of this leaflet.

How can gluten-free foods be obtained?

For people with medically diagnosed coeliac disease, a range of specially manufactured gluten-free products is available on prescription. If you pay for your prescription you might consider buying a prescription “season ticket”. Ask your pharmacist for details. In addition, some items can be bought from health food shops, supermarkets and via mail order.

Enjoying a healthy gluten-free diet

A healthy diet is vital for everybody. Click here to download The Wheel of Good Health, which shows the 5
groups of food needed for a balanced diet in the healthiest proportions (under fives will have different needs).

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Points to remember

Always check food labels and ensure that the food you are about to eat is gluten-free. Please refer to Coeliac UK's Gluten-Free Food & Drink Directory

Planning ahead

When eating away from home always check in advance the availability of gluten-free food, or take along a suitable meal and/or snack.

Snacks

These can be tricky as common snacks for people with diabetes usually contain gluten e.g. biscuits, toast, scones. Try gluten-free alternatives such as gluten-free biscuits, gluten-free bread, home baked gluten-free items, glutenfree cereal or rice cakes.

To add variety to snacks why not try fresh fruit, dried fruit, a pot of low fat fruit yogurt (check it's gluten-free) or gluten-free dips and crudities.

Fibre

A gluten-free diet can be low in fibre, as a lot of the fibre we eat comes from wholegrain breads and cereals. To help keep the bowel healthy everyone is encouraged to include foods naturally high in fibre. However, some people with coeliac disease find that too much fibre upsets them and they have to limit the amount of fibre-rich food eaten. If you are concerned about your fibre intake please consult your dietitian.

To increase your fibre intake why not try pulses (peas, beans or lentils), or dried fruit which are also good for blood glucose control.

Alcohol

Wine, spirits and cider are gluten-free, but real ales, beer, lager and stout need to be avoided.

Keep to healthy daily alcohol limits - up to 3-4 units for men and 2-3 units for women (a unit is half a pint of standard cider, a small glass of wine, pub measure of spirits).

Sweeteners

Artificial sweeteners are gluten-free. People with diabetes can still use a moderate amount of sugar in baking.

Experiment

Healthy cooking and baking with gluten-free flours, mixes and ingredients requires some experimentation. Do follow the guidelines issued by the manufacturers of gluten-free products. Then enjoy the tasty results.

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