Amy Keller, MS, RD, LD, is a dietitian and celiac support group leader from Bellefontaine, Ohio.
Q: I was diagnosed with celiac five years ago, then went for my annual physical last week and found out I also have type 2 diabetes. My mom, aunt and grandfather all have it, but it was still a surprise. How am I going to manage a gluten-free diet along with my diabetes?
A: Getting a diagnosis of type 2 diabetes can be overwhelming, and you are correct that family history plays a role in its development. Ask your doctor to refer you to a registered dietitian nutritionist (RDN) who treats both diabetes and celiac. He or she can help you plan the most balanced, varied and enjoyable diet that meets the needs of both conditions.
Selecting foods appropriate for both diabetes and celiac may seem daunting at first, but the diets really can work well together. Selecting balanced meals including lean meats and protein, whole grains, dairy, fruits, vegetables and healthy fats can go a long way in controlling your blood sugar. Pay attention to the Nutrition Facts panel, with particular focus on the amount of total carbohydrate. You and your dietitian, diabetes educator or physician will work together to decide how much carbohydrate you should have at each meal and snack. People with diabetes often focus on the grams of sugar in a food, and while that’s just fine to note, the carbohydrate total is most important. Once you know how many grams of carbohydrate you should have at each meal, check the Nutrition Facts panel to see if the food you’re selecting fits into that carbohydrate budget.
Also, don’t forget about exercise. Getting moderate exercise for 30 to 60 minutes every day is a great way to control blood sugar. I tell my patients it’s the cheapest diabetes medicine available!
Q: I was diagnosed with celiac six months ago. I was a little underweight at that time, so I was happy to initially gain some weight on the gluten-free diet. But now it seems I can’t quit gaining, and it’s really upsetting me. I used to be able to eat whatever I wanted and not gain a pound. How do I make it stop?
A: Your experience of gaining weight on the gluten-free diet is a common one, unfortunately. Just like you were initially, many are thankful to gain some weight; but that can quickly turn to frustration when the extra pounds don’t stop piling on. Several factors play a role in weight gain on the gluten-free diet. Many gluten-free foods are higher in calories and fat than their gluten-containing counterparts. When your celiac was undiagnosed, you were likely experiencing malabsorption, which made it possible to eat bigger portions without gaining weight. Now that your body is absorbing food better, you‘re seeing that unwanted weight gain.
What works for one person in terms of losing weight may not work for another. If you are comfortable tracking what you eat and drink, using either a phone app or food diary can increase your awareness of the calories you consume. Research shows that keeping track of what you eat is very effective for weight loss. But if the thought of writing everything down makes you a little crazy, adopting a more mindful eating approach might work better for you. Pay attention to how your body feels and try to eat when you are gently hungry instead of waiting until you are starving, when you’re much more likely to overeat. As you eat, check in with yourself every few bites to assess how full you are. It can take 20 minutes for your brain and stomach to recognize fullness, so simply slowing down can help you eat less.
Q: I was diagnosed with celiac 20 years ago and have done very well with the gluten-free diet. Recently, I decided that I’d like to also become a vegetarian. I’ve read up on it, and it seems like a healthy way to eat, especially in light of my family history of heart disease. What options do I have to get enough protein and iron without meat?
A: People choose to follow a vegetarian diet for many reasons, including health. There are many different types of vegetarians. Some continue to eat dairy and eggs (lacto-ovo vegetarian), while others eat no animal products at all (vegan). Depending on which type of vegetarian you plan to become, your nutrition needs will vary.
To get enough iron in a vegetarian gluten-free diet, try gluten-free whole grains like quinoa and buckwheat, dark leafy greens, beans and lentils, soybeans and soy nuts, and cornmeal or corn flour. Some gluten-free cereals, breads and pastas are now enriched with iron. Try to choose the enriched varieties whenever possible. You should pair foods that are high in iron with foods high in vitamin C, such as oranges and tomatoes, to help enhance the absorption of iron.
Getting enough protein is easier if you consume eggs and dairy, but even as a vegan, it’s possible with a little planning. Good sources of protein in a vegan diet include gluten-free whole grains, beans, lentils, and nuts and nut butters.
One word of caution—if you choose convenient vegetarian items like veggie burgers, veggie sausage, veggie bacon and meatless hot dogs, be sure to read the labels carefully because many are not gluten free.