Following a healthy gluten free diet with coeliac disease

Coeliac disease is different to gluten intolerance – people with gluten intolerance may experience uncomfortable digestive symptoms like those with coeliac disease, however it does not cause damage to the intestine. Left untreated, coeliac disease can lead to nutrient deficiencies, problems with the bones, joints and other organs, as well as having an impact on fertility. For those with diabetes, untreated coeliac disease can also make blood glucose levels more difficult to manage.

People with type 1 diabetes have an increased risk of coeliac disease – it affects up to 10 per cent of people with type 1 diabetes. Having type 2 diabetes does not increase your risk of developing coeliac disease. However, about 1 in every 70 Australians have coeliac disease, so people with type 2 diabetes can still be affected. People with type 1 diabetes should be routinely screened for coeliac disease with a blood test. If you have type 2 diabetes and are regularly experiencing symptoms like diarrhoea, constipation, bloating, or similar gut symptoms, speak to your doctor about whether a coeliac screen would be worthwhile.

The only treatment for coeliac disease is a lifelong gluten free (GF) diet. Removing gluten completely from the diet allows the lining of the small intestine to heal and properly absorb nutrients. Gluten is found in the grain’s wheat, rye, barley and triticale. Some people with coeliac disease are also sensitive to oats. All gluten needs to be removed from the diet as even small amounts of gluten will trigger inflammation in someone with coeliac disease.

When following a GF diet, it can be more difficult to get enough fibre and find suitable low glycaemic index foods. This can have an impact on blood glucose levels, and bowel health. Here are some tips to help manage a healthy gluten free diet for people with diabetes.

1. Choose low GI high fibre cereals and grains

• Choose wholegrain gluten free cereals and grains, like quinoa and buckwheat
• Look for breads and cereals with added fibre – ideally aim for >5g fibre per 100g.
• Add ingredients like rice bran, psyllium husks, or LSA (ground linseed, soy, almond) to boost the fibre of lower fibre cereals and flours. Also try replacing some GF flour with nut meal/flours when baking
• Choose brown rice instead of white rice as it has double the fibre
• Try legume based pasta's - like chickpea or lentil pasta as these have a much higher fibre content than regular GF pasta

2. Eat plenty of vegetables and fruit

• Aim for at least 5 serves of vegetables each day
• Leave the peel on your carrots and potatoes – it’s got lots of fibre!
• Eat plenty of legumes like chickpeas, beans or lentils – these are all naturally GF as well as being high in fibre, very low GI, and a good source of protein
• Aim for 2 serves of fruit per day

3. Include healthy fats regularly

• Healthy unsaturated fats are good for your heart and help to lower the GI of your meals
• Choose olive oil and other unsaturated oils like sunflower and canola oil
• Avocado is a great source of monounsaturated fat
• Nuts and seeds have a range of healthy fats and are also a good source of fibre and protein – making them a great snack

4. Eat a range of healthy protein foods

• Most protein foods are naturally GF unless they have grains added to them (e.g. meat coated in breadcrumbs)
• Include 2-3 serves of dairy foods each day:
  - choose low fat yoghurt and look for those that are low in added sugar
  - reduced fat cheese
  - if you don’t drink cow’s milk, choose calcium fortified soy milk. Soy milk has more protein than most nut milks
• Choose a variety of lean meats, poultry, fish and eggs
• Eat plenty of vegetarian proteins like legumes, tofu, and nuts and seeds
• Avoid processed meats as these are high in saturated fat and sodium.

If you have recently been diagnosed with coeliac disease, see a dietitian for further advice on changing to a GF diet that is nutritionally balanced and works for your diabetes. You can make an appointment with one of our experienced diabetes dietitians in the Diabetes Victoria clinic, by calling 1300 153 123. Appointments are available face-to-face in Melbourne, or via telehealth.

To read more, including further information about managing coeliac disease and diabetes and carb counting GF foods, visit Coeliac Australia.