Gluten free diets linked to increased risk of type 2 diabetes

Does a gluten-free diet increase your risk of developing Type 2 Diabetes (T2D)? It’s an interesting, perhaps concerning, point to ponder given so many people need to remove or limit gluten in their diet these days, however, current research suggests it might (1).

Researchers at Harvard University’s Department of Nutrition completed a recent study that found limiting gluten in the diet leads to reduced consumption of cereals and whole grains thereby reducing overall fibre intake and increasing the risk of developing T2D, as fibre is known to have protective effects against the disease (2). The study findings were presented to the American Heart Association’s Epidemiology and Prevention / Lifestyle and Cardiometabolic Health 2017 Scientific Sessions in March this year and as such the full article is not available for review at this stage. However, I thought it was still important to highlight the association between reduced gluten intake and T2D was found, along with discussing why it might occur.

The key points made in the abstract are:

  1. Gluten-free diets have grown in popularity but as yet, evidence regarding the long-term health effects of them are lacking
  2. Gluten intake is strongly correlated with intakes of carbohydrate sources, especially grains, starch, and cereal fibre (which is known to be protective against T2D)
  3. An inverse association between gluten intake and T2D risk was observed in the three very large groups that were studied (approximately 200,000 people combined). This basically means less occurrence of T2D was found in people who consumed gluten.

The things for us to consider here are:

  1. People who eat more gluten would, in most cases, tend to eat much more fibre given they continue to consume cereal and grain products such as bread, oats, pasta etc. and;
  2. People who eat a gluten-free diet are likely to be eating a lot less fibre and a lot more sugar, trans fat and salt if they are consuming a large amount of gluten-free products over fresh foods. In some cases these products are much less nourishing than their gluten-containing counterparts.

All of that being said, when you’re told you can no longer consume gluten because you’re coeliac, or you’ve decided to stop having it because it really doesn’t agree with you… it’s fair to assume you’d want to find something to replace it with. If I’ve come to realise anything over the years I have been navigating food intolerance for myself and now my clients, it’s that successfully going gluten-free (or anything free) often requires a change in mind-set, not a like-for-like food swap. It’s less about replacing things that are missing and more about exploring an array of new, whole, fresh foods that you may not have enjoyed before.

A change in mind-set is necessary because a walk through any ‘health food aisle’ in the supermarket will tell you those gluten-free products they’re peddling are anything but ‘healthy’. In fact gluten-free is getting so big, my local supermarket has swapped the health food aisle for a gluten-free aisle. The ingredients list on some of those products are truly appalling and I’m often left wondering where the actual food is! Take a few gluten-free pastas and cereals here as a case in point…..

   

I don’t eat gluten-containing foods… am I at risk of T2D?

It’s impossible to say a blanket yes or no to that, as several factors are involved in T2D onset including being overweight, having a nutrient poor diet (only 2% of Australians eat sufficient fruit and vegetables each day for good health!), high blood pressure, insufficient exercise, history of gestational diabetes, ethnicity or having a family history of the condition (3). As previously mentioned, a lack of fibre can also contribute (2).

Much can be done to keep you well if you are gluten-free though. Regular exercise, keeping your stress levels in check and managing your weight are all beneficial as is increasing your fibre intake through the use of whole fresh foods. Fruit and vegetables with the skin on, legumes and pulses, gluten-free ancient grains such as millet or amaranth as well as nuts and seeds are all great sources of fibre. Become one of the Australians who do meet that fruit and vegetable target each day. Two fruit, five veg! Additionally, be conscious of what you’re consuming if you do buy gluten-free products. Start reading labels more closely, become very acquainted with ingredients used in these products and decide whether you really want to consume them. A great app to help with understanding ingredients is The Chemical Maze and I highly recommend a purchase.

There are also some excellent producers out there making wholesome gluten-free products and these are the people you tend to find at farmer’s markets. Conjurup food is a great example I’ve been speaking about recently on Facebook. Owned and operated by Anna-Jane Dalton, the company produce nourishing take-home meals that are all intolerant friendly and most importantly, contain no nasties so they’re a great option too.

    

If you just can’t do without your bread, there are some wonderful Artisan bakers around Sydney (and many parts of the world) who are making some gorgeous gluten-free varieties. My local, Pioik Bakery, certainly do, and whilst the bread does contain a small amount of the more refined flours, they also contain things like buckwheat and psyllium husk. Some bakers also used chia seeds to bind loaves, which adds to the fibre content. Another option is to make your own bread! I stumbled across a fabulous gluten-free bread website only recently called Recipes for Living. The author and baker, Chris Stafferton, has been developing gluten-free sourdough recipes for over a decade with the more nourishing flours and they are divine! Check out the two variations of buckwheat sourdough I tried…

Perhaps one of the most important things for you to consider though, is whether it is the gluten that’s to blame for your symptoms. For coeliacs and those with gut issues or autoimmune disease it’s definitely necessary to keep off the gluten (4) however, it may not be for everyone else. I absolutely believe people are reacting to gluten more than ever before and figures from the Australian Health Survey support this by highlighting that 2.5% of the Australian population choose to avoid it (5). We are still unsure of the exact cause although having so many hybrid style crops, and consuming such highly refined gluten-containing products is certainly not helping. With this in mind, I always suggest trialling something like a spelt sourdough (much lower gluten content and an ancient grain) to confirm whether symptoms persist before taking a client off gluten completely. It is trial and error though and sometimes the symptoms have been bad enough that client’s just don’t want to go there and I completely respect that!

What are the top 5 take-away message for me here?

  1. A recent study found that gluten-free diets may be associated with an increased risk of developing T2D
  2. Fibre is known to have a protective effect against T2D onset and is often drastically reduced in a gluten-free diet. So, if you are going without gluten, ensure you replace the lost fibre from glutinous products with fibre in fresh fruits, vegetables, gluten-free ancient grains, nuts, seeds, legumes and pulses. They’re nutrient rich and will provide you with a host of other health benefits
  3. Limit gluten-free products from the supermarket such as breads, pastas, biscuits etc., as these tend to be full of highly refined flours as well as increased sugar, salt and trans fat in many instances, thereby increasing the risk of disease onset. Instead, think about changing your mind-set and getting familiar with new, whole, fresh foods that you may not have enjoyed before
  4. Consider whether you absolutely need to remove gluten from your diet (coeliacs, and those with gut issues or autoimmune disease aside). Try something like a small amount of spelt sourdough, which is an ancient grain and lower in gluten, to see whether your symptoms persist
  5. Do not mistake gluten-free for healthy. With so much misinformation in the health space being spouted by just about everyone these days, knowing what to eat to stay well can be incredibly confusing. I believe some people have been sold on gluten-free being the most health promoting but this is not necessarily true for everyone. All whole foods are health promoting if food allergy and intolerance are not present. Moderation is key though, it can’t all be sourdough bread and adzuki bean pasta!

For more information on managing food intolerance or allergy or to discuss ways to ensure all your nutrient needs are being met on a gluten-free diet, book in for a consultation so we can tailor a plan to your own unique needs and ensure the most successful outcome. To make an appointment, you can book online, call the clinic on (02) 8007 4275 or email me at gabby@awakenyourhealth.com.au

Resources

1. Zong G, Chan T., Lebwohl B, Hu F, Sampson L, Dougherty L, et al. Associations of Gluten Intake With Type 2 Diabetes Risk and Weight Gain in Three Large Prospective Cohort Studies of US Men and Women. In: Epidemiology and Prevention, Lifestyle and Cardiometabolic Health [Internet]. Portland; 2017. Available from: http://www.abstractsonline.com/pp8/#!/4299/presentation/3048

2. Post RE, Mainous AG, King DE, Simpson KN. Dietary Fiber for the Treatment of Type 2 Diabetes Mellitus: A Meta-Analysis. J Am Board Fam Med [Internet]. 2012;25(1):16–23. Available from: http://www.jabfm.org/content/25/1/16.abstract

3. Diabetes Australia. Type 2 Diabetes [Internet]. 2015 [cited 2017 Mar 31]. Available from: https://www.diabetesaustralia.com.au/type-2-diabetes

4. Vojdani A. A potential link between environmental triggers and autoimmunity. Autoimmune Disease [Internet]. 2014;2014:1–18. Available from: https://www.hindawi.com/journals/ad/2014/437231/

5. Australian Bureau of Statistics. Food avoidance due to allergy, intolerance or ethical/religious reasons [Internet]. Australian Health Survey: Nutrition First Results – Food and Nutrients, 2011-12. 2014 [cited 2017 Mar 31]. Available from: http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by Subject/4364.0.55.007~2011-12~Main Features~Food avoidance due to allergy, intolerance or ethical religious reasons~600

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