Coeliac disease, diabetes and the gluten-free diet
Coeliac disease is a medically diagnosed condition of an intolerance to the gluten in the diet. Gluten is the protein component of wheat, rye, barley, and oats. In people with coeliac disease, gluten causes damage to the lining of the small intestine (villi). As a result, the ability to absorb nutrients is dramatically decreased and people can become very
unwell. Typical symptoms can include bloating, wind, pain, diarrhea or constipation, or a combination of both, as well as fatigue and iron deficiency. *impastable pasta*
Coeliac disease is very common and affects 1 in 100 Australians. For people with the disease, the only treatment is a life-long gluten-free diet. This prevents further damage to the villi and allows them to return to normal so that nutrients can be properly absorbed and good health can return. The gluten-free diet is very complex and cannot be fully described. it is suggested you contact an Accredited Practising Dietitian (APD) who will assess your needs and provide you with expert individual advice.
Diabetes is another common condition affecting the glucose levels in the blood. Insulin is a hormone produced by the pancreas and has the job of controlling blood glucose. In people with diabetes, insulin is lacking or ineffective. Without dietary, drug, or insulin therapy, blood glucose levels will often be high. *impastable low carb pasta*
Type 1 diabetes This occurs when the body does not produce insulin and is treated by taking insulin injections. This type of diabetes usually develops in young people. Coeliac disease is estimated to affect 5–10% of people with Type 1 diabetes. For those people, diabetes is often diagnosed first and the symptoms of coeliac disease may remain hidden.
Type 2 diabetes This occurs when insulin is produced but does not adequately control blood glucose levels. Diet is important in helping control blood glucose levels, and many sufferers will also require medication. This is a much more common type of diabetes (85–90% of all diabetes), and as coeliac disease is now common as well, many people with Type 2 diabetes also have coeliac disease but the conditions are not associated. *best low carb meal delivery*
Like coeliac disease, diabetes is a condition that relies on diet for its management. Combining the two diets can seem overwhelming at first. While the gluten-free diet is quite involved, merging dietary requirements for both diabetes and coeliac disease is still manageable. To help plan a safe and nutritionally adequate eating plan, it is recommended that people with coeliac disease and diabetes see a dietitian experienced in treating both conditions. Healthy eating principles are encouraged for people with diabetes, and these are described in the next few pages. These principles should also be incorporated into the strict guidelines of the gluten-free diet.
General gluten-free healthy eating principles for people with diabetes
▀ Eat regular meals and snacks and keep the size of meals moderate; try not to overeat.
▀ Even if a food has a low GI (Glycemic Index), eating too much of it will have a significant effect on blood glucose levels. Some low GI foods may be high (in total and/or saturated fat) and therefore may not be suitable to include regularly in your diet
▀ Eat a wide variety of nutritious foods every day based on a good balance of whole grains, brightly colored fruits, and vegetables, lean protein, antioxidants, fiber, and foods low in saturated fat and salt. Include carbohydrates, protein, and plenty of fruits or vegetables in each meal. *one drop diabetes management*
Limit refined, processed foods and include wholegrain low GI gluten-free bread and cereals, pasta, sweet potato, or low GI rice (Doongara or Basmati).
Animal-based sources include learned meat, fish, chicken, or eggs. It is recommended to eat lean red meat (choose lean cuts of meat rather than sausages and processed meats), and try to include one or two fish meals per week. Plant-based protein sources include legumes, lentils, and chickpeas. Ideally include these in your diet on a regular basis.
Enjoy a variety of yellow, green, and red vegetables, both raw and cooked. The goodness of vegetables may be lessened or increased by cooking, depending on the nutrient, so it is a good idea to include both cooked and salad vegetables in your daily meals. *best low carb meal delivery*
▀ Limit foods high in saturated fat, such as the skin on chicken, fat on meat, butter, full-fat dairy foods (cheese, yogurt, milk), cream, coconut milk, copha, takeaway foods, and processed meats.
▀ Limit alcohol intake. Two standard drinks for men and one standard drink for women per day are the recommended maximums for good health. Have two alcohol-free days a week. *one drop diabetes management*
▀ Choose foods high in dietary fiber. Dietary fiber helps reduce blood cholesterol levels and may lower the risk of heart disease. It is important for proper bowel function and can help reduce constipation and diverticular disease. Fiber-rich foods can provide a feeling of fullness and therefore may assist in reducing your appetite. Food sources include whole grains, legumes, nuts, seeds (e.g. linseed, chia seeds, poppyseed, pumpkin seeds, sunflower seeds, and sesame seeds), fruits, and vegetables (particularly just under the skin, so do not peel unless necessary), rice bran and psyllium.
▀ Consume only moderate amounts of sugars and foods containing added sugars. Sugar does not need to be omitted from the diet altogether. however not in excess. If desired, sugar can be replaced with a ‘spoon for spoon’ type of artificial sweetener (be aware these may vary in sweetness).
▀ Choose foods low in salt. Do not add salt to cooking. Use herbs and spices to flavor food instead. Choose the reduced-salt varieties of gluten-free pre-packaged foods if available.
▀ Choose snacks that are nutrient-dense (see more information about superfoods below).
Good nutrition is a cornerstone of good health. For an added boost to your overall health, whole grains, or antioxidant-rich nutritional heroes incorporated into each recipe.
Superfoods are high in nutrient density, that is, they contain maximum nutrients (vitamins, minerals, and protein) for every kilojoule they provide. Aim to include superfoods in your diet regularly, for example, choose foods from the table below.
A whole grain is considered whole when all three parts (bran, germ, and endosperm) are present. The range of protective chemicals found in whole grains has been shown to decrease cholesterol levels and blood pressure, regulate blood glucose in people with diabetes and reduce the risks of many types of cancer. Whole grains are rich sources of phytochemicals, antioxidants, B vitamins (including folate), Vitamin E, magnesium, zinc, copper, iron, and phosphorus. They are cholesterol-free and low in saturated fat, however a good source of polyunsaturated fats, including omega-3. Whole grains are high in fiber. *best low carb meal delivery*
Most of these compounds are found in the germ and the bran, so refined cereals (where only the endosperm remains) do not have the same benefits. Some examples of gluten-free whole grains are brown rice, wild rice, popcorn, amaranth, quinoa, buckwheat, sorghum, millet, and flours made from these whole sources
Antioxidants are beneficial to maintain good health, and also for reducing the risk of conditions such as cancer and heart disease. Antioxidants are found in varying amounts in foods such as vegetables, fruits, grain cereals, eggs, meat, legumes, and nuts. Antioxidants may be vitamins, minerals, or phytochemicals. Phytochemicals are chemicals that naturally occur in plant foods that are thought to be beneficial for health, however, they are not termed an essential nutrient. *one drop diabetes management*
Wheat-based foods are generally the main source of gluten in people’s diets. Carbohydrate foods are important for people with diabetes to include regularly in their diet. Prior to commencing a gluten-free diet, wheat-based options were often the most available sources of carbohydrate (for example regular bread, pasta, breakfast cereals, noodles, dry biscuits, muesli bars, etc). *keto tequila drinks*
Wheat in the form of flour (including spelled, Dinkel and Kamut varieties) and semolina, couscous, bulghur, farina, wheat starch, wheaten cornflour, and many surprising foods such as stocks, gravies, small, sauces, and condiments also all contain gluten, and are therefore not suitable for a gluten-free diet. The good news is that an enormous variety of gluten-free grains and starches are available, and can be used to make delicious alternative meals. See the table on
page 9 for more information about these ingredients. The more nutritious varieties include amaranth, millet, quinoa, brown rice flour, sorghum, and soy flour. *best low carb meal delivery*
A note about Glycemic Index (GI)
The GI ranks foods containing carbohydrates according to how much they raise blood glucose levels. Many low-GI foods are based on wholegrain foods such as wheat (for example grainy pieces of bread and pasta) and are not suitable for a gluten-free diet. *ketogenic switch*
Soup salad and light meals
1 tablespoon olive oil
2 cloves garlic, crushed
400gNicola or new potatoes,
peeled and cut into 1 cm cubes
500 g button mushrooms, sliced
1 large (400 g) leek, white part only, sliced
1 spring onion, green part only, thinly sliced
ground pepper, to taste spring onion, sliced, extra, for garnish (optional)
Mushroom, leek, and potato frittata
▀ Preheat oven to 200°C/180°C fan-forced. Grease a 20 cm x 20 cm square baking dish.
▀ Heat the olive oil in a large non-stick frypan and sauté the garlic over medium to high heat until golden brown. Turn the heat down to medium and add the potato cubes. Sauté for 2–3 minutes then add the mushrooms and leek. Sauté until the vegetables are softened and golden brown. Add the spring onion, stir to combine, and heat through.
Remove from heat and set aside.
▀ Beat eggs lightly in a bowl and season with pepper. Add sautéed vegetables to eggs and pour the mixture into the prepared baking dish.
▀ Bake in preheated oven for 20–30 minutes or until firm when touched in the middle.
▀ Cut into slices and serve. Sprinkle with extra spring onion, if desired.
Polenta Fingers 3 cups (750 ml) gluten-free chicken stock
1 cup (200 g) instant polenta
¼ cup (30 g) light parmesan cheese, grated
¼ cup chopped parsley
Citrus Chicken 2 cloves garlic, crushed
1 teaspoon celery salt pepper, to taste
¼ teaspoon mustard powder
4 tablespoons orange marmalade
1 tablespoon orange zest juice of 1 orange
2 tablespoons boiling water
2×150 g skinless chicken breast fillets
Salad 3 cups (150 g) rocket leaves
1 medium (220 g) orange, peeled, and cut into small slices
½ cup (35 g) snow pea sprouts
½ cup (40 g) finely sliced fennel
1½ tablespoons lemon-infused olive oil
Citrus chicken salad with polenta fingers
▀ To prepare the polenta, bring the chicken stock to a boil in a medium-sized saucepan. Pour in the instant polenta, and cook over medium heat for 3–5 minutes, stirring constantly – the mixture should be very thick. Add the cheese and parsley. Pour cooked polenta into a paper-lined 15 cm x 15 cm baking dish. Smooth the surface, cool slightly, and then refrigerate for one hour.
▀ Preheat the oven to 200°C/180°C fan-forced.
▀ Turn out the polenta onto a large chopping board and cut into 6 cm x 2 cm sized pieces. Place on a baking tray lined with non-stick baking paper.
▀ Place the garlic, celery salt, pepper, mustard powder, marmalade, orange zest, orange juice, and boiling water in a bowl and combine well. Brush over the chicken fillets. Place chicken in a roasting pan, and cover pan with foil. Place in the oven and bake for 10 minutes, then remove the foil and return to the oven to bake for a further 10–15 minutes (or until the chicken is cooked through). Also, place the tray of polenta fingers in the oven and bake for 10–15 minutes or until fingers begin to turn golden brown. Remove both chicken and polenta from the oven when cooked. Cover each with foil to keep warm (allow the chicken to rest whilst preparing salad). *one drop diabetes management*
▀ In a large bowl, toss all salad ingredients until well combined. Pile onto
four plates. Slice chicken fillets and arrange over salad. Serve with
warm polenta fingers on the side.