Should I Start Following a Gluten-Free Diet?
I have had type 1 diabetes for 20 years. In the past, none of my doctors have suggested that I follow a gluten-free diet. My new doctor and pharmacist have both proclaimed the advantages of this kind of diet. Is there any merit to going gluten free when you have diabetes? Jim Morris, Gainesville, Texas
Madelyn L. Wheeler, MS, RD, CDE, FADA, CD, responds:
There is no scientific evidence that people with type 1 diabetes need to follow a gluten-free diet unless they've been diagnosed with celiac disease. Celiac disease is an autoimmune disorder in which the body's immune system responds to gluten—a protein found in wheat, rye, and barley—by damaging the lining of the small intestine. The treatment for celiac disease is to follow a gluten-free diet.
The advice you've been given recently may be based on a misunderstanding of the scientific literature. There has been some research into the idea that proteins found in milk, wheat, and other foods may play a role in the development of type 1 diabetes. While the exact cause of type 1 diabetes is unknown, it is thought that in people who have genes associated with type 1, environmental factors such as viruses, toxins, and diet may cause the immune reaction that destroys the insulin-producing beta cells of the pancreas, resulting in diabetes.
Researchers are trying to determine the specific factors that may be involved. They have done animal studies, epidemiological reports (which evaluate existing data on entire groups of people rather than conduct a randomized controlled trial), and a small number of studies on human tissue. So far there is some indication that the gastrointestinal tract, as well as possible dietary antigens such as milk protein or wheat protein, may play a role in the development of type 1 diabetes in people. (An antigen is something the body sees as foreign and tries to destroy by creating an immune response.) However, findings are conflicting and inconclusive. A definitive study would have to be conducted by randomly assigning groups of people to different diets, controlling for any outside variables, and evaluating the people over time to see if they develop diabetes.
While existing research is thought provoking, the studies don't conclude that people with type 1 diabetes should follow a wheat-free or gluten-free diet. Still, there's no harm in trying it. If you decide to go gluten free, you should work with a dietitian who is familiar with both diabetes and gluten-free diets to make sure that your goals for nutrition and blood glucose control continue to be met.