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I have diabetes. Should I avoid gluten?

Gluten isn't all bad, even if you have diabetes

Cue the imperial death march because I’m going to talk about everyone’s favorite villain, gluten. It seems no one is eating it this century, or at least no one is admitting to eating it. 

This is partly because gluten really IS dangerous for a segment of the population, including possibly some people with diabetes. But it’s also partly because there is a cloud of misinformation trailing this dietary protein.

As Seth Rogan says in this hilarious, totally inappropriate, and very not-safe-for-work video (seriously, I’m warning you), “Gluten’s a vague term. It’s used to categorize things that are bad. Calories — that’s a gluten. Fat — that’s a gluten…I’m not eating it.”

Is gluten really that bad? Let’s take a more informed look. 

First, what is gluten?

Gluten is a protein, basically a chain of amino acids folded into a complex shape. It’s found naturally in wheat, rye, barley, spelt, kamut and triticale. Because oats are often grown and shipped with other grains, oats also contain gluten unless they’re specifically produced and labeled gluten-free.

Gluten is valuable in part because it offers dietary protein and in part because it gives structure that allows baked goods to rise. Without gluten in bread, all you get is a sad little pancake. 

Why should I avoid gluten? 

There are a few clear cases in which you should avoid gluten. If you’re one of the 1% of people who inherited celiac disease, gluten causes intestinal damage, nutritional deficiencies and a host of painful symptoms. If you have celiac disease,  you should never consume gluten, not even small amounts. It’s important for my patients to know that celiac disease is more common among those with Type 1 diabetes than in the general population, so testing may be in order.

An additional group of people (it’s unclear how many) also have an immune reaction to gluten called Non-Celiac Gluten Sensitivity. They may have painful symptoms, but there is no sign of celiac’s hallmark damage to the intestinal lining. Even so, it is recommended that they avoid gluten as it is causing unnecessary inflammation in the body.

Should I avoid gluten if I have diabetes?

Like most areas of life, the answer isn’t 100% clear. The best thing about our human bodies is that we are all unique.  Because of that uniqueness, putting everyone on the same “diabetes diet” is completely inappropriate. It’s important to assess each person’s individual needs.  For example, you can use your blood sugar meter to tell you what food your body responds well to (and doesn’t), notice how you feel after a meal, pay attention to any other symptoms that you experience on a regular basis (skin problems, stomach/bowel issues, sinus issues). Ask yourself, “What feels off?” If you have a problem (or many), that doesn’t mean gluten is the culprit, but your food choices could play a role. Work with your dietitian to become a detective, and start figuring out the fuel that keeps your body functioning at its best!

Here are some reasons for avoiding gluten that I discuss with my clients with diabetes.

Inflammation:

Some people with the haptoglobin 2,2 gene produce an inflammatory by-product (zonulin) when they consume gluten. When these people have diabetes, it can increase their risk of heart attack. It can also up their chances of developing leaky gut. For those with the haptoglobin 2,2 gene and diabetes it may make sense to opt for a balanced gluten-free diet to decrease the risk of heart attack, inflammation and food sensitivities. Strict adherence is not necessary, but a general avoidance is good.

A healthier diet:

Gluten is found in many highly-processed foods. Some people find that when they cut gluten, they end up eating a healthier diet overall – sticking mainly to fruits, vegetables, lean proteins, and healthy fats.

Symptoms:

Many of my clients, with or without diabetes find, during testing or elimination diets, that gluten-containing foods give them uncomfortable symptoms. Whether this comes from wheat, gluten, or other fermentable carbohydrates found in the same foods, cutting gluten often helps address their bloating, gas, eczema, rosacea, headaches, rashes and other challenges.

And here are some of the reasons not to avoid gluten if you have diabetes:

Slower carbohydrate absorption:

The replacement flours used in gluten-free foods are often nothing more than puffs of starch without the fiber contained in whole wheat and other whole grain products. Cutting this fiber can lead to spikes in blood sugar as well as, shall we say, reluctant, bowels. 

One recent study found that, in three large cohorts of Americans, going gluten-free was associated with an increased risk of Type 2 diabetes. The researchers speculated that this was because of the lack of fiber and nutrients in many gluten-free diets.

Again, a healthier diet:

Often people see the “gluten free” label and assume that means a food is healthy, regardless of what it is. It could be a box of cookies, but it has a seal of approval on it. In reality, gluten-free means it contains less than 20 parts-per-million of gluten and nothing more. People with diabetes tend to do best when they focus on the overall nutritional quality of their diet, rather than stressing about gluten, especially if they are not overly sensitive to it.

Also, gluten-containing whole grains offer many nutrients including B-vitamins, magnesium and iron. If people don’t take care to choose a diverse range of foods when going gluten-free, they may not get all of the vitamins and nutrients they need for efficient metabolism and overall health. Keeping gluten on the table increases your options for a range of healthy — and tasty — whole-grain foods. 

So, how do I know if I should avoid gluten?

Here’s what I tell my patients:

  1. Do you have Type 1 diabetes? If so, your risk of celiac disease is increased and you may want to consider testing before going gluten free. If you do not have celiac, but feel that gluten free may help reduce inflammation, then take care to include enough fiber through fruits and vegetables.
  2. Are you interested in genetic testing? If you have diabetes and find you carry the haptoglobin 2,2 gene, you may want to avoid gluten to reduce risk of leaky gut.
  3. Do you have bothersome symptoms that may be related to any food? If so, screening for celiac disease, allergies and sensitivities may help us discern what diet is best for you.
  4. Very Important: Always talk to a health professional before eliminating gluten. If you cut it before you are tested, your results won’t be accurate. There’s nothing worse than eliminating gluten, feeling better, then having to go back on it for 3-6 months to get sick enough for it to show on a biopsy!

So there you have it. Gluten, like most characters, is neither all good nor all bad. If you have diabetes and any physical symptoms that might be diet-related, talk to your doctor or nutritionist. Your health is too important to trust to misinformation, hype and “informative” videos, no matter how funny.

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Even though diabetes is present in your life, there is hope. Hope that harmony between you and diabetes can be attained.

Angela Manderfeld, RD

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