Diabetes and celiac disease
Dungeness crab with cucumber and ginger slaw, grilled salmon with brocollini and wild rice pilaf, spinach and fresh strawberries tossed in Balsamic vinaigrette with polenta croutons and toasted almonds. It was a lovely meal prepared and served to us diabetes educators by chef Jason Giles using local sustainable foods. And it was totally gluten-free.

Then our speaker, registered dietitian and diabetes educator, Lynn Senecal, served us samples of her homemade rosemary bread, lemon layer cake, and pumpkin bars. All yummy and gluten-free as well.

"Gluten-free does not have to taste nasty," she reminded us. And she speaks from personal experience. Senecal has celiac disease - an intolerance to gluten, a group of proteins that give "glue" or elastic properties to wheat, rye and barley. In people with celiac, gluten is toxic to the lining of the intestines that absorbs nutrients. And the only treatment is a strict lifelong gluten-free diet.

Before being diagnosed with celiac disease, Senecal learned she had type 1 diabetes. And there is a connection, she reminded us. Both are "autoimmune" disorders, described by the National Institutes of Health as conditions that occur when our own immune system mistakenly attacks and destroys healthy body tissue.

In celiac disease, healthy tissues in the intestinal tract are destroyed. In type 1 diabetes, cells in the pancreas that make the hormone insulin are destroyed. We know the trigger that causes celiac ... gluten. We don't know the trigger that causes type 1 diabetes ... yet.

Does having one autoimmune disorder increase one's risk for having another? Perhaps. Current statistics show that 7 to 12 percent of people with type 1 diabetes also have celiac disease.

How does Senecal manage her duo-disorders? Very well, thank you. Here are some of her suggestions:

1. Choose fresh food "in their natural state" that are gluten-free: fruit, vegetables, milk, potatoes, corn, rice, fresh meat, fish, poultry and eggs.

2. Read labels carefully: As of 2006, food products in the US are required to list products that contain wheat. That helps but remember that not all "wheat-free" items are "gluten-free." "If there is no label, I don't eat it," says Senecal.

3. Avoid flours that contain gluten, including: bulgur, couscous, graham, spelt, and triticale.

4. Add fiber. Most gluten-free grains like rice and corn are lower in fiber and higher in carbohydrates and fat than gluten-containing grains - not good for people with diabetes. Senecal adds ground flax to her recipes as a safe fiber source.

5. Be very careful with processed foods. Common sources of gluten include: canned soups and sauces, soy sauce, beer, communion wafers, and chewing gum. Gluten-free sources of these foods are now available, however.

6. Carefully avoid accidental ingestion of gluten. "I don't go into bakeries," says Senecal, "because a flour molecule in the air can stay active for 24 hours." She still bakes cookies for her grandchildren at home, however...wearing a mask and using separate pans only for this purpose.

7. Get educated. People with one or both of these disorders need help and support from friends, family, and their healthcare providers.

(Barbara Quinn is a registered dietitian and certified diabetes educator at the Community Hospital of the Monterey Peninsula. She is the author of The Diabetes DTOUR Diet, Rodale, 2009. Email her at bquinn@chomp.org.)