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Diabetes Forecast August 2004FOR TYPE 1/TYPE 2 Wheat, Me Worry?If you have both celiac disease and diabetes, you might be wondering if there's anything tasty in the world that's left for you to eat!By Joyce Render Cohen and Gayle Render Dinerstein Just as with the diagnosis of diabetes, being told you have celiac disease can hit you like a punch. If you have celiac disease, you are intolerant of the gluten in wheat, rye, and barley. If you consume any of these, you will get progressively sicker. If you've got both diabetes and celiac disease, you might find yourself getting very frustrated and angry. Unlike the case for diabetes, there is no medication for celiac. The only good treatment is eliminating wheat and gluten from your diet. Trouble is, gluten is everywhere—in breads, beer, pasta, flour, and even on the surface of a slab of gum. You might find yourself wondering if there's anything in the world you can eat. Take heart. The answer is a resounding Yes! But before you can get to "yes" you have to develop the right attitude. Once you go through denial, anger, and frustration, you'll come out feeling strong and realize that sticking to a gluten-free diet can help you treat both diseases. The main components of this attitude are control and understanding: control over the food you eat and the understanding that by exerting this control, you will remain healthy. But you're the only one who can make this happen. Here's how you do it. Educate yourselfCall the Celiac/Sprue Association. (See Resources below.) This association has over 95 chapters, plus resource units able to help in cities without chapters. It offers a wealth of knowledge, support groups, and get-togethers to help you realize that you're not alone. Scout out the natural food stores in your city for gluten-free products. Surf the Internet for an even larger selection. Develop a good support systemPass on what you learn to your family and friends so they can see how important these eating changes are for your health. Let them know how they can best support you. StrategiesEach person's "danger foods" are different; there is a great range in sensitivity to foods. For some, any contact with gluten is unhealthy, so they must keep a totally separate set of cooking utensils, dishes, and cutting boards. For others, it may be enough to simply follow a "no double-dip" policy with your family and friends for foods such as butter, peanut butter, jams, and mayonnaise. That means once a knife, fork, or spoon has touched a piece of bread or a cracker, it should not come in contact with that food again (until it is washed, of course). Between the crop of new, good-tasting, gluten-free products available and advice on how to adapt your favorite recipes, it's possible to eat well and accommodate both celiac and diabetic food plans. According to Cynthia Kupper, RD, who has celiac, you need to ask yourself what you enjoy eating now and how you can adapt recipes so that you can continue to enjoy them. Kupper also notes that gluten-free foods such as rice may be calorie- and carbohydrate-dense and must be accounted for in your food plan. Here are some additional helpful hints to allow you to live the gluten-free good life: Eating outRestaurants: If you are planning to go out for a meal, make a reservation at least one day in advance. Be specific when you speak to the manager or chef about your dietary restrictions and make sure that the restaurant can accommodate your needs. Ask if the restaurant has a gluten-free plan. Many do. You should also make a list of foods that can sicken you. (You may find it useful to laminate it.) Give it to the waiter and chef. Again, check ahead: Some restaurants will allow you to bring gluten-free pasta for the chef to prepare. Remind the chef that it must be cooked in fresh cooking water. Or ask your waiter or chef to alter the menu. For example, instead of chicken over pasta, request chicken over spinach. Be aware that deep-fried foods, such as French fries, may be fried in the same oil used for frying foods that contain gluten. Social events at a hotel or banquet hall: Call the catering manager and discuss your situation. When you arrive, identify yourself. Bring along a listing of your pre-arranged meal, as well as the foods you absolutely cannot eat. Also provide the name of the person who arranged the changes. Dinner parties away from home: Going to a friend's home for a dinner party can be trickier. Explain the situation to your host. To ensure your safety, it's often best to simply bring your own food. Home cookingOrganize your kitchen and refrigerator. You may need to reserve a gluten-free area. Decide whether the "no double-dipping" rule for butter, peanut butter, jams, and other condiments works or if separate jars are necessary. There are many gluten-free cookbooks available. Check your local library and bookstores, as well as with the Celiac Association. Standard recipes can be changed to fit this diet as well. Cynthia Kupper gives an easy example: If your favorite meatloaf recipe includes crackers or bread crumbs, you can substitute potato chips or potato flakes. For baking, select recipes with less flour, then substitute a gluten-free flour mix. Remember that xantham or guar gum may be necessary to hold the bread together. Learn about the other flours such as rice, glutinous rice, potato, bean, and tapioca. They can all be used with good results. Family issuesThe gluten-free way of life is a family affair—make sure everyone knows the rules. Some families adopt a gluten-free diet, while others maintain separate meals. TravelingWhen traveling, never leave home without your food. Don't trust the airlines, trains, or concession stands to have what you need; call ahead to make the way easier once you arrive. Cruise ships offer gluten-free breads and cereals, but once again, the cruise lines require advance notice. If you're staying at a hotel, the concierge can be a great ally, especially in a foreign country. He or she can recommend restaurants that best suit your needs. Wherever you go, take a card listing your intolerances with you, along with the phone number and address of the Celiac Association's local chapter. You can also experience other cultures gluten free; it just takes planning. Feeling overwhelmed?It's likely that your frustration level will rise and your emotions will boil over from time to time. These feelings are normal, but they shouldn't be ignored. It's important to take action to manage your anger. Physical release is good. Exercise, tear up an old phone book, hit a pillow, or take a walk. Count to 10. Try relaxation breathing. Do something creative or let music soothe your soul. Use water as a calming agent: Take a shower, swim, or simply swish your hands in a pan of warm water. Seek professional helpWhen you develop a chronic disease, it's not unusual to feel depressed. Add a second condition, and it's easy for people to start seeing themselves solely in terms of their conditions. Talking to a friend or family member can be very helpful, but at times professional help is necessary. If you find yourself sinking into depression, seek out the help of a mental health professional. Don't delay: Depression is serious, but it can be treated. Finally, make a revision to that old line, "you are what you eat." When you have celiac disease and diabetes, you're a lot more than what you can't eat. Joyce Render Cohen has had type 1 diabetes for 23 years, and she has lived gluten free for 12 years. She writes and gives talks on health issues. Gayle Render Dinerstein is a freelance writer living in New York City.
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