People with type 1 diabetes are at an increased risk for developing a number of other autoimmune disorders, including celiac disease. In fact, while celiac occurs in the general population at a rate of about 0.5%, it is seen in T1Ds at a rate of up to 16.4% — or 30 times more frequently.
Worse still, only about 10% of these type 1 celiac patients show any symptoms. If left untreated, someone with celiac disease is at an increased risk for malnutrition, bone density problems, and even certain types of cancer.
The connection between celiac and type 1 and the association between gluten and inflammation has many people wondering if a gluten-free diet may be appropriate for all type 1 people, rather than just those suffering from celiac.
But before you embark on a gluten-free diet, it is important to understand the potential benefits (and who will benefit most), as well as the potential risks.
Why Gluten-Free Diets May Be Beneficial
In the past decade, there have been a number of studies describing potentially huge benefits from a gluten-free diet for people within the type 1 community.
The benefits of a gluten-free diet are especially indicated for those who have yet to be diagnosed.
Gluten-free diets may prevent diabetes
One mouse study found that non-obese diabetes-prone mice were less likely to develop hyperglycemia if raised on a gluten-free chow rather than a gluten-containing chow. These researchers also noted that the gluten-free mice developed different gut biome makeup than the gluten-eating mice.
When switched to a gluten-containing diet, the same mice began developing diabetes at a higher rate and saw a shift in gut bacteria makeup that more closely aligned with mice who had been raised on gluten-containing feed.
While such findings have yet to be reproduced in human clinical trials, this study certainly seems to indicate that a gluten-free diet could be an important factor in reducing the risk of developing diabetes in someone predisposed to the condition.
Gluten-free diets can preserve beta-cell function
When one group of researchers tried to replicate the findings of the above mouse study using humans with pre-clinical type 1 diabetes, they found that a gluten-free diet appears to preserve beta-cell function.
While the study failed to show any changes in autoantibody counts in those subjects adhering to a gluten-free diet, the same subjects did show increased insulin response to glucose tolerance tests during the gluten-free stage of the study. Once these subjects returned to a gluten-containing diet, this insulin response decreased back to a more typical level.
In one case study, a 5-year-old boy who was started on a gluten-free diet immediately following his type 1 diagnosis managed to avoid insulin treatment for over 20 months. His blood sugar stabilized to near-normal levels after the initial rise at diagnosis and his fasting blood sugar remained within a healthy range throughout the entire 20-month follow up.
Low gluten diets may protect the kidneys and heart
A number of studies comparing celiac type 1 patients with type 1s without celiac have found that there appear to be some protective qualities the former possess that may be beneficial for long-term heart health. Unfortunately, no one has been able to decipher if this benefit (namely, lower cholesterol and other blood markers) is caused by celiac disease itself or by the diet used to treat it.
One study linking the celiac diet to better kidney health in people with diabetes hypothesized that this benefit was due to the lower levels of advanced glycation end products found in gluten-free foods. However, there is still no hard evidence that this same diet would produce similar results in non-celiac type 1s.
Why Gluten-Free Diets May Not Be Right for Everyone
There appear to be a lot of potential benefits of a gluten-free diet for those predisposed to type 1 and for those very recently diagnosed. But when it comes to those of us who have been living with type 1 for a while and do not have celiac, the drawbacks to such a diet may outweigh the few proposed benefits.
Gluten-free diets typically require more insulin than a traditional diet
While not true across every study, most studies looking at gluten-free diets for people with type 1 have found that patients require more insulin when eating this way. This likely has a lot to do with the glycemic index of gluten-free food choices (something we’ll talk about more in a moment) and the lower fiber content.
Most of these same studies have also found no major difference in the glycemic control and hbA1Cs of gluten-free non-celiac type 1s and gluten-consuming non-celiac type 1s.
Gluten-free diets appear to have no effect on blood sugar management, overall.
Harder to find low GI gluten-free food
Because taking insulin exogenously can never truly replicate insulin produced by the body, controlling blood sugars requires a lot of work, and paying a lot of attention to what you eat. Foods that have a low glycemic index (GI) and have a lot of fiber tend to cause the smallest blood sugar spikes.
Unfortunately, many studies have shown that gluten-free alternatives, such as gluten-free bread, crackers, and pasta, have a much higher GI than their gluten-containing counterparts. While it is easy to find whole-grain gluten-containing foods, most gluten-free alternatives utilize low-fiber, highly-processed white rice and corn flours.
This fact, more than anything else, may play a huge role in why so many type 1 celiac patients struggle to stay on a truly gluten-free diet compared to non-type 1 celiac patients.
The micro and macronutrient profile of gluten-free food is not optimal
In addition to the high GI profile of many gluten-free foods, these diets also tend to lack many important nutrients compared to their gluten-containing counterparts and are typically higher in fat.
True gluten-free diets tend to be lower in B and D vitamins, calcium, iron, and zinc.
Many gluten-free alternatives also utilize extra oils to bind and build texture during processing, which can add a lot of unhealthy fats to your diet.
Unfortunately, hard data on how these detriments stack up against the proposed benefits of a gluten-free diet are not yet available.
So, Should You Go Gluten-Free?
While much of the data surrounding this topic is still in need of more research, there does appear to be a strong case for those predisposed to type 1 and those recently diagnosed to utilize a gluten-free diet. But the evidence supporting a gluten-free diet for non-celiac, veteran T1D people is much less clear.
It appears there may be some benefit to adopting a low-inflammation, gluten-free diet for long-term health, but only if you, as an individual, are still able to manage your blood sugars relatively well.
If you are considering a gluten-free diet, it is worth looking into vitamin and mineral supplements and to pay special attention to the fiber and fat makeup of the gluten-free food you are eating.