Diabetes & Coeliac Disease Melinda Morrison, Dietitian, Diabetes Australia NSW What is diabetes? Diabetes is a condition where the body is unable to control blood glucose levels. Diabetes develops when an organ called the pancreas is either unable to make the hormone insulin or the insulin is unable to work effectively. This results in higher than normal levels of glucose in the blood stream, which if left untreated can result in long term health problems. There are two main types of diabetes: Type 1 Diabetes – occurs when the pancreas stops producing insulin because the cells which make insulin have been destroyed by the immune system. Type 1 diabetes usually occurs in people under 30, but can occur at any age. Management of Type 1 diabetes includes lifelong daily insulin injections and a healthy lifestyle. There is currently no known cure for Type 1 diabetes. Type 2 diabetes – occurs when the pancreas is still producing some insulin but the insulin is not working effectively. This type of diabetes tends to occur in those who are older, have a family history of Type 2 diabetes or are overweight (however this is not always the case). Management of Type 2 of diabetes includes healthy eating, regular physical activity, in many cases diabetes medication and sometimes insulin injections. What is coeliac disease? Coeliac disease is a condition where the lining of the small intestine is damaged due to a sensitivity to a protein in food, called gluten. The management of coeliac disease involves the lifelong removal of all gluten from the diet. Coeliac disease and diabetes may occur together. This is more common with Type 1 diabetes, where the risk of developing coeliac disease is higher. Gluten free Diet A gluten free diet is currently the only known treatment for coeliac disease. Foods containing gluten include wheat, rye, oats, barley and triticale. Processed foods with ingredients such as wheaten cornflour, wheat starch, malt, malt extract, maltodextrin and the thickeners 1400 to 1450 may also contain gluten. Gluten containing foods must be permanently avoided along with products made from these foods. This includes many regular breads, cereals, biscuits, cakes, scones, pizzas, pies and processed foods. Gluten free foods include: corn, rice, sago, tapioca, buckwheat, potato, soy, arrowroot, fresh fruit, vegetables, meat (with the exception of most processed meats), poultry, fish and most dairy foods. Eating well with Diabetes & Coeliac Disease A healthy diet for diabetes and coeliac disease is one that is gluten free, low in saturated fat, includes regular meals and snacks and follows the dietary guidelines for all Australians. Carbohydrate foods Carbohydrate foods are the best energy source for your body. When they are digested they break down to form glucose in the bloodstream. Eating regular meals and spreading carbohydrate foods evenly throughout the day, may help maintain energy levels without causing large rises in your blood glucose levels. If you take insulin or certain diabetes tablets, you may need to eat between-meal carbohydrate based snacks. Discuss this with your dietitian or diabetes educator. All the foods listed below are gluten free (GF) carbohydrates. Those in Italics have a slower effect on blood glucose levels. These slower-acting foods are said to have a lower glycaemic index or GI and are a good choice for people with diabetes. Try to include one low GI food at each meal. ¨ Gluten free bread - made from rice, corn, potato, soy, GF pizza bases, GF corn tortillas, GF pancakes & GF muffins ¨ Gluten free breakfast cereals – rice flakes, GF cornflakes, GF muesli, rice bran, puffed rice & corn, rice porridge ¨ Rice - Basmati, Doongara TM, white rice, arborio rice, brown rice, jasmine rice ¨ Legumes – kidney beans, chick peas, lentils, three bean mix, butter beans, GF baked beans (check the ingredient list for gluten containing thickeners) ¨ Fruit - all types such as apples, oranges, peaches, bananas, melons. ¨ Gluten free crispbread – corn thins, rice cakes, corn cakes, GF crackers ¨ Dairy products - milk, GF soy drink, GF custard, GF yoghurt & GF ice cream (check ingredient list for sources of gluten) ¨ Starchy vegetables - potatoes, sweet potato, yams, sweet corn ¨ Gluten free pasta – corn pasta, rice pasta, rice vermicelli, rice noodles What about sugar? A healthy eating plan for diabetes and coeliac disease can include small amounts of sugar. However, it is still important to consider the nutritional value of the foods included in the diet. Added sugars in nutritious foods such as GF breakfast cereals or low fat dairy products are preferable over food or drinks such as confectionary and soft drinks, which contain little else other than kilojoules. Fats Fats have the highest kilojoule (calorie) content of all foods. Eating too much fat can lead to weight gain, poor diabetes control and can increase blood fats (cholesterol and triglycerides). On the other hand small amounts of healthier fats add flavour to your food, may improve your health, and reduce your risk of heart disease. Therefore, the type of fat you eat is important, as well as the amount. Saturated fat It is important to limit saturated fat. Saturated fat is found mainly in animal foods like milk, meat, butter, and cheese. Vegetable fats that are saturated include palm oil (found in solid cooking fats, snack foods or convenience foods) and coconut products such as copha and coconut milk or cream. To reduce saturated fat: Choose low fat dairy foods Choose lean meat and trim any fat off before cooking Remove the skin from chicken Avoid the use of butter, lard, dripping, cream, sour cream, copha, coconut milk, coconut cream and hard cooking margarines Healthy Fats Some fat is important for good health. Use a variety of polyunsaturated and monounsaturated types to achieve a good balance. Polyunsaturated fats include - polyunsaturated margarines and oils (check the label for the word polyunsaturated), fish, nuts and seeds Monounsaturated fats include - canola, olive or Sunola TM margarines and oils, avocadoes, nuts and seeds Fats are naturally free of gluten, however always check other ingredients in food products to ensure that your diet remains gluten free. Protein Foods Choose protein foods that are also lower in fat. This will help to reduce your intake of saturated fat. Protein foods include lean meat, skin-less poultry, seafood, eggs (not fried), soy products such as tofu and legumes. Most protein foods are gluten free, however many crumbed and processed meats are not. Check the ingredient list on these products. For further information contact Diabetes Australia or Coeliac Society of Australia. More information on gluten free diets is available in: Living with Diabetes and Coeliac Disease -The Coeliac Society of Australia, Diabetes Australia, Dietitians Association of Australia. Ingredient List Book - The Coeliac Society of Australia Inc.