KEYSTONE, COLO. — Many type 1 diabetic patients with comorbid celiac disease say the celiac disease is actually the harder of the two to deal with, according to a presentation at a conference on the management of diabetes in youth.
The gluten-free diet is particularly challenging for such patients. Patients with celiac disease often are asymptomatic, and because they already have one demanding lifelong chronic disease in the form of diabetes, they and their families need to be persuaded of the importance of following the diet on a lifelong basis. A couple of educational visits with a dietitian having expertise in both diseases can be helpful, according to dietitian and diabetes educator Gail Spiegel, a registered dietitian at the Barbara Davis Center for Childhood Diabetes. The center cosponsored the conference with the University of Colorado and the Children's Diabetes Foundation at Denver.
Among the essential concerns in these patients are the following:
▸ Insulin needs might increase as a consequence of the improved carbohydrate absorption accompanying intestinal healing.
▸ Skill is needed to distinguish safe from unsafe grains and to decode confusing food product labeling.
▸ Avoiding cross-contamination, a common problem in families where not everyone has gone gluten-free, is essential.
▸ Eating out safely must be mastered.
▸ Tapping into resources including cookbooks, Web sites, sample menus and recipes, lists of gluten-free snacks, and support groups can be extremely valuable.
Ms. Spiegel noted that “gluten-free diet” is a misnomer. Gluten is found only in wheat, but prolamins harmful to patients with celiac disease are also present in rye, barley, spelt, and triticale. All must be avoided.
Many gluten-free food products are not fortified, so a gluten-free multivitamin is important. Also, gluten-free grains are often more carbohydrate-dense and lower in fiber. Relatively high-fiber, high-protein gluten-free grains include buckwheat, quinoa, amaranth, soy flour, and nut flours.
Oats are a kid-friendly source of dietary fiber. Oats are problematic, however, because most oats are contaminated, having been grown in the same field or processed in the same facility as gluten-containing grains. About one-half cup of dry uncontaminated oats per day has been shown to be safe in most children with celiac disease.
The Food and Drug Administration is in the process of finalizing language for a new, more informative gluten-free designation on food labels. Meanwhile the Gluten Intolerance Group of North America has attempted to fill the void by starting the Gluten-Free Certification Organization in 2005. Foods containing less than 10 ppm of gluten earn the group's gluten-free certification mark. Numerous food companies are participating.
The good news is that the food industry is responding to the needs of patients with celiac disease and their families.
“There are way more gluten-free foods available in the last few years than I've ever seen before,” Ms. Spiegl noted.