Gluten Free Low Glycemic Cookbook
Gluten Free Living Secrets
Are you sick and tired of trying every weight loss program out there and failing to see results? Or are you frustrated with not feeling as energetic as you used to despite what you eat? Perhaps you always seem to have a bit of a
Celiac disease (CD) is an immune-mediated enteropathy that results from the exposure to gluten found in wheat, barley, and rye. The gluten causes an immune response that causes an inflammatory reaction in the upper small intestine leading to villous atrophy. CD occurs in about 1 of the population in the USA, and it is estimated that 97 of those people are not diagnosed (34). Approximately 6-10 of individuals with type 1 diabetes have CD (35). The autoimmune response is directed to the prolamin storage proteins in some grains wheat (gliadin), rye (secalin), and barley (horedin). The treatment for CD is to remove all foods from the diet that contain wheat, rye, and barley. This is referred to as a gluten-free diet (GFD). All sources of gluten-containing grains should be avoided and some of those ingredients are as follows bulgur, cracked wheat, durum flour, enriched flour, farina flour, gluten flour, graham flour, self-rising flours, semolina, spelt, and triticale. Many gluten-free...
People have at least one food allergy. The numbers of people with celiac disease are more precise, with the disease affecting about 1 in every 111 people approximately 3 million Americans and 1 percent of the world population. Nonceliac gluten sensitivity, with often subtle symptoms, may affect half the population, according to some estimates.
Cow's milk consumption may be diabetogenic also during childhood according to case-control and cohort findings (Verge et al. 1994 Virtanen et al. 1998, 2000). In an Australian case-control study, cereal consumption was positively related to the risk of diabetes, although the association disappeared after adjustment for other dietary factors (Verge et al. 1994). The cell-mediated immune response to gluten was detected more frequently among newly diagnosed children with type 1 diabetes than among controls (Klemetti et al. 1998).
Diarrhea and fecal incontinence are often due the effects of diabetes on the GI tract. However, features suggestive of malabsorption such as anemia, macrocytosis or steatorrhea should lead to a consideration of underlying small bowel or pancreatic pathology. Celiac disease or bacterial overgrowth of the small intestine should be actively excluded (10).
Earth Song makes several whole grain (some gluten-free) snack bars that redefine the meaning of a wholesome sweet. Among the bars are apple- walnut and cranberry-orange. In addition, Earth Song blends an excellent gluten-free muesli, known as Grandpa's Secret Omega-3 Muesli, which makes for a tasty and quick breakfast (if you take about five minutes to prepare it the night before). For more information call 877-327-8476 or go to www.earthsongwholefoods.com.
Another possible connection between diabetes mellitus and the GI tract can be infrequent autoimmune disease associated with type 1 diabetes mellitus, such as celiac disease, autoimmune chronic pancreatitis, and autoimmune gastropathy (2). Indeed, about 15-20 of patients with type 1 diabetes mellitus exhibit parietal cell antibodies (26), but on the other hand no clear-cut relationship has been found between parietal cell antibody titers and delayed gastric emptying (26). Finally, the finding of gastroparesis associated with autonomic neuropathy in a diabetic should not preclude the possibility of coexistent mechanical factors contributing to the apparent motor abnormality (27). First assessing the possibility of mechanical obstruction remains a key premise to diagnosing a gut motor disorder under any circumstances.
It is possible that nonautoimmune and autoimmune destruction of (-cells could coexist, but the current classification considers two subtypes. In type 1a there is evidence suggesting an autoimmune origin of (-cell destruction, mostly determined by the presence of circulating antibodies against islet cells insulin antibodies in the absence of exposure to exogenous insulin or antibodies to glutamic acid decarboxylase, and or islet cell-associated phosphatase. This autoimmune entity also is associated with certain HLAs. Patients with type 1a are also more likely to have other concomitant autoimmune disorders, such as autoimmune thyroiditis, Addison's disease, and celiac disease.
Stomach problem that slows glucose absorption Celiac disease, for example, is an autoimmune condition that slows glucose absorption, so the insulin may be in the bloodstream before the food. The insulin lowers the glucose already in the blood, and the glucose in the food isn't there to take its place.
Another important but easily overlooked cause of adolescent growth failure or delayed puberty in adolescents with diabetes is hypothyroidism resulting from Hashimoto's thyroiditis. Although only a small proportion of affected children, mostly girls, develop hypothyroidism, up to 10 of children and adolescents with diabetes develop a goiter and antithyroid antibodies (23). Similarly, celiac disease affects up to 5 of diabetic children and adolescents, often only presenting with growth failure or
Not only does T1DM have short- and long-term physical consequences, but as an autoimmune disease, T1DM also is associated with other autoimmune diseases such as celiac disease, an inflammation of the gastrointestinal tract thyroid disease and skin diseases. Chapter 5 explains the importance of checking for those diseases and correcting them, if present.
The occurrence of hyperthyroidism or hypothy-roidism (insufficient thyroid hormone) along with T1DM is greater than expected by chance. Many autoimmune diseases occur together in the same person. In particular, celiac disease (intolerance to gluten in wheat and other grains) is found in up to 5 percent of children with T1DM and causes anemia, abdominal discomfort, and diarrhea. Uptake of all foods is decreased in celiac disease, and that includes glucose, leading to more hypoglycemia in these patients.
It is essential that a person with IBS investigate the possibility of food sensitivities. The most likely dietary culprits are gluten-containing foods (wheat, rye, barley, and nearly every type of processed food) and dairy products. Eliminating these foods should improve symptoms within one to two weeks, if they were a cause of IBS.
Other dietary factors being investigated include the active form of vitamin D,5 which is thought to help prevent the development of autoimmune diabetes and gluten since studies have shown that islet cell antibodies may disappear after a gluten-free diet in celiac patients.6'7 However, time is needed before an answer on the efficacy of these dietary intervention trials is known.
I mentioned in Chapter 3 that people with type 1 diabetes are at risk for other autoimmune diseases, especially thyroid disease and celiac disease. In celiac disease, eating foods containing gluten (that is, those derived from wheat, oats, rye, and barley) cause an autoimmune damage to the wall of the small bowel. This damage leads to diarrhea, abdominal pain, tiredness, problems absorbing vitamins such as vitamin B12, poor weight gain, and decreased growth. It can also affect the absorption of carbohydrates, causing hypoglycemia. The treatment is a gluten-free diet. Screening for celiac disease is done when a diagnosis of type 1 diabetes is made, and then again if the child has problems such as growth failure or weight loss or gastrointestinal problems. The blood test that is done is called tissue transglutaminase IgA autoantibody. If the blood test is positive, then your child will need to see a gastroenterologist, who may do a small bowel biopsy to confirm the diagnosis. You need...
That have been linked to human type 1 DM include mumps, Coxsackie B, retroviruses, rubella, cytomegalovirus and Epstein-Barr virus. Bovine serum albumin, a major constituent of cow's milk, has been implicated as a cause of type 1 DM in children exposed at an early age, but definitive proof is lacking and this remains controversial. Nitrosamines (found in smoked and cured meats) may be diabetogenic as may chemicals known to be toxic to pancreatic p-cells, including alloxan, streptozotocin and the rat poison Vacor. Recent reports suggesting that early ingestion of cereal or gluten increases the risk of type 1 diabetes remain to be confirmed.
After an evaluation, Lieberman suspected that gluten intolerance was at the core of Roberta's problems and that dairy was likely a contributing factor. In gluten-sensitive people this protein triggers an autoimmune reaction that often leads to wide-ranging food sensitivities. Roberta was also under considerable stress related to family issues, and Lieberman made a referral to help Roberta cope with these problems. In terms of diet, Lieberman recommended that Roberta avoid all food containing gluten chiefly wheat, rye, and barley as well as dairy. She also suggested a number of supplements. Among them were betonite clay and psyllium supplements, both of which add bulk without being a laxative. This nonlaxative effect was important to avoid further diarrhea. Lieberman also suggested fish oils for their anti-inflammatory properties and a number of antioxidants, including 1,000 mg of vitamin C and 1,200 of natural vitamin E, plus a high-potency multivitamin multimineral supplement.
Principally, it occurs in persons with autonomic neuropathy. Factors responsible for its occurrence are stasis of the intestinal content and bacterial overgrowth due to decreased motility, bile acid malabsorption, defective exocrine pancreatic function due to parasympathetic nervous system damage and disturbed water and electrolyte absorption due to sympathetic dysfunction. The typical diabetic diarrhoea is a secretory diarrhoea, occurs more frequently at night, is not associated with food intake, is bulky, lasts for days or even weeks and then subsides without specific therapy, only to recur in a different time. It commonly alternates with periods of constipation. Differential diagnosis should include drug-induced diarrhoea, especially due to metformin and acarbose, lactase deficiency, parasitic infections, various malabsorption syndromes and coeliac disease, which is more common in Type 1 DM.
Recently, it was suggested that exposure to gluten-containing cereals and rice at the age of 4 to 6 months would protect from development of early beta-cell autoimmunity compared to earlier or later exposure (Norris et al. 2003). German birth cohort findings related early gluten exposure to development of early beta-cell autoimmunity (Ziegler et al. 2003).
1 The association of coeliac disease and diabetes, as well as their common genetic predisposition, has long been recognized. Several important epidemiological studies have appeared recently. If a temporal relationship between the appearances of the two diseases could be established, a firmer opinion about screening might emerge. Recent evidence is conflicting, with a French study5 suggesting that coeliac disease generally preceded the diagnosis of diabetes, while in a large Italian series6 the reverse seemed to hold true. The latter study also suggested that female gender, the presence of thyroid autoimmunity and earlier age of diabetes onset were all associated with increased risk of coeliac disease. Adults with type 1 diabetes have a lower prevalence of undiagnosed coeliac disease than do children, amounting to around 2.5 .7 2 Initiation of a GFD in children suffering from diabetes and coeliac disease both improves growth and leads to improved metabolic control of diabetes.8,9...
When faced in clinic with a child who is having recurrent episodes of hypoglycaemia, a detailed history should be obtained regarding the timing of hypoglycaemia, insulin regimen, dietary intake and the relation to periods of physical activity. This will enable an assessment to be made of possible risk factors and inform how these may be avoided. If no obvious cause is found then other pathology should be sought, such as coincidental coeliac disease or the possibility of Addison's disease, although these are relatively rare causes of recurrent hypoglycaemia (see Chapter 3).
FSH Follicle-stimulating hormone GABA Gamma-aminobutyric acid G-CSF Granulocyte-colony stimulating factor GDM Gestational diabetes mellitus GFD Gluten-free diet GFR Glomerular filtration rate GI Glycaemic index GIK Glucose insulin potassium GIST Glucose Insulin in Stroke Trial GLP-1 Glucagon-like peptide-1 HAAF Hypoglycaemia associated autonomic failure
Much more common associations with type 1A diabetes include celiac disease (25-27), thyroid autoimmunity, Addison's disease (often as part of APS-II) (28), myasthenia gravis, and pernicious anemia. For example, 1 20 children with type 1A diabetes have celiac disease. Approximately 1 10 express antitransglutaminase autoantibodies, and half of these (thus, 1 20) have celiac disease on biopsy (27,29). Most of these children are asymptomatic. In addition, relatives of patients with type 1A diabetes also have an increased frequency of nondiagnosed celiac disease (27). Thyroid autoimmunity is usually screened for with determination of thyroid-stimulating hormone (TSH) levels. Addison's disease probably occurs in approx 1 200 individuals with type 1A diabetes compared to 1 20,000 in the general population. The presence of 21-hydroxylase autoantibodies suggests the need for prospective evaluation of adrenal function (28,30).
The diagnosis of chronic diabetic diarrhea is essentially one of exclusion. A major problem with this approach remains that some of the main conditions in the differential diagnosis (pancreatic insufficiency, bacterial overgrowth, celiac sprue) can themselves be part of the diabetic diarrhea syndrome. A careful history should be taken to exclude osmotic diarrhea from excessive ingestion of nonabsorbable hexitols (e.g., sorbitol). A 48-72-hour stool collection for weight and fat measurement used to be standard approach, but it is cumbersome and nowadays tends to be bypassed in favor of other tests, as listed in Table 2. Therapeutic trials with antibiotics, gluten-free diet, pancreatic enzyme supplements Celiac disease might be associated with diabetes and accompanied by features of more severe malabsorption (considerable steatorrhea, hypoalbuminemia, anemia, abnormal Schilling and xylose test, low serum folate) than is characteristic of diabetic diarrhea. Serological tests for celiac...
Lotus Foods offers a variety of original and tasty rice and rice flour products, including Bhutanese Red Rice and purple Forbidden Rice. The different rices will enhance your appreciation of rice, and the flours can be used to bread fish and chicken as well as to make gluten-free crepes. This company's products are truly exceptional. If your health food store does not carry Lotus Foods' rice and rice flours, ask it to order these products. For more information call 510-525-3137 or go to www. lotusfoods.com to order or to find recipes.
Celiac Disease in Patients with Type 1 Diabetes The prevalence of celiac disease (CD) in the general population is estimated at about 0.3 . As CD is often symptomless (silent CD), its recognized prevalence depends on how actively antibody tests or small-bowel biopsies are carried out, as well as the extent of exposure to gluten (90). CD is considered to be rare in the absence of IgA antibodies (or IgG in case of patients with IgA deficiency) to gliadin (AGA), reticulin (ARA), endomysium (EMA), or the specific antigen tissue transglutaminase (tTGA) (91). However, the true diagnostic value of these antibodies for silent CD is unknown, as small-bowel biopsies have not been performed in large unselected patient cohorts. Celiac disease is 4-20 times more prevalent in patients with type 1 diabetes (1.3-6 ) (92-100) than in the general population. As explained here, the true prevalence could be even higher. However, no CD was found in the absence of AGA in the only reported study that...
Further consideration of demographic issues poses additional obstacles to generalizing from these results. In particular, two issues are very evident, the socio-economic status and ethnicity of participants. As Glasgow and Anderson163 have already noted, few researchers in this field publish data on recruitment rates and subsequent bias, but it seems reasonable to conclude that there is a bias towards white middle-class families. Furthermore, the vast majority of studies have been conducted in North America, further limiting the generalizability of studies. Finally, there is the issue of comorbidity, especially with concurrent additional chronic illness. Nearly every study reported here excluded individuals with concurrent chronic illness, or did not even raise the question. A significant number of individuals with diabetes also suffer from a range of other chronic illnesses (e.g. asthma, coeliac disease, cystic fibrosis). There is a good argument for excluding these individuals from...
Approximately 5 of women and 1 of men suffer from anorexia nervosa, bulimia nervosa, or binge eating disorder. An estimated 1 in 100 American women binges and purges to lose weight and 15 of young women have significantly disordered eating attitudes and behavior (56). Although eating disorders can strike anyone, the most common demographic affected is adolescent, Caucasian females, of middle to upper middle class socioeconomic status. At particular risk, however, may be people who modify their diet because of an illness such as diabetes or celiac disease (57) When considering the development, prevalence, and medical risks of dysregulated eating among adults with DM1, it is important to remember that most adults with DM1 are diagnosed as children or adolescents (58). For both women and men in the United States, adolescence constitutes the developmental period during which dieting, dysregulated eating, and eating disorders are most likely to develop (59,60). Therefore, a discussion of...