Where Are We Now?
Diabetes: According to the Centers for Disease Control and Prevention (CDC), there are 30.3 million people with diabetes (9.4 percent of the U.S. population) including 23.1 million people who are diagnosed and 7.2 million people (23.8 percent) undiagnosed. The numbers for prediabetes indicate that 84.1 million adults (33.9 percent of the adult U.S. population) have prediabetes, including 23.1 million adults aged 65 years or older (the age group with highest rate). The estimated percentage of individuals with type 1 diabetes remains at 5 percent among those with diabetes.
Celiac Disease: Celiac disease affects not just children. Currently, 60 percent of diagnosed cases are adults, of whom 15 to 20 percent are over the age of 60. Celiac disease is diagnosed in 1:250 people in the U.S. Approximately 70 percent of those diagnosed are women. Celiac disease is a non-allergic food hypersensitivity, which is caused by a genetic intolerance to gluten, a protein found in cereals such as wheat, rye and barley. It is estimated that celiac disease affects approximately 1 percent of the population and this number is likely to grow in the future.
What Are the Connections Between Celiac Disease and Diabetes?
We first have to distinguish between type 1 and type 2 diabetes mellitus. Type 1 diabetes is early onset and is an autoimmune disease that develops typically in children and adolescents. Type 2 diabetes occurs mostly in adults, is not an autoimmune disease, and is associated with obesity, high cholesterol and related disorders collectively known as “metabolic syndrome.”
Type 1 diabetes is highly linked to celiac disease on a genetic level, and 5 to 10 percent of people with type 1 diabetes also have celiac disease. Because celiac disease is usually diagnosed later in life, it is most common to have diabetes first. It’s quite uncommon for someone to be diagnosed with celiac disease first and then to develop type 1 diabetes, unless the person is diagnosed with celiac disease very young.
In contrast, very little is known about type 2 diabetes and celiac disease. A recently published research study shows that those with celiac disease are much less likely to get type 2 diabetes compared to people without celiac disease. This was an unexpected finding in this study looking at the prevalence of type 2 diabetes in celiac disease. While it was found that people with celiac disease have substantial protection from type 2 diabetes, it’s not clear why. In the general population, type 2 diabetes is much more common than type 1 diabetes, while in celiac disease, it’s the reverse.
For a Consumer With Celiac Disease, What Does This Mean?
Many individuals diagnosed with type 1 diabetes only discover they have celiac disease through routine screening because of the known relationship between the two conditions. Most report having no symptoms of celiac disease, and that the diagnosis is sometimes seen as an after-thought to the diabetes. Whether or not individuals have symptoms, if a celiac disease diagnosis is confirmed, it is absolutely essential to follow a strict gluten-free diet to avoid the health risks associated with untreated celiac disease. Perhaps most important is that the earlier a gluten-free diet is initiated, the lower the chances are of a person developing additional autoimmune disorders.
How Can You Support Consumers With Celiac Disease and/or Diabetes?
A study has found that more Americans are turning their backs on eating gluten despite the fact that the prevalence of celiac disease has remained flat since 2009. Celiac disease is an autoimmune disorder affecting the small intestine, caused by a reaction to gluten, proteins found in wheat and other grains.
Today, some 3.1 million people across the United States follow a gluten-free diet. Seventy-two percent of them are classified as “PWAGs” (people without celiac disease avoiding gluten). The number of PWAGs has risen steadily over the past five years amid increasing public suspicions of health problems brought on by gluten sensitivity.
What We See With Respect to Gluten-free Diets
• A third of those who eat gluten-free products do so because they believe they are better for their overall health, including 44 percent of those aged 45 and over
• Three quarters (75 percent) of those who eat gluten-free foods have not been diagnosed with gluten intolerance/sensitivity or celiac disease
• Seventeen percent of all gluten-free consumers eat gluten-free versions of foods more than they eat naturally gluten-free foods (e.g. fruit, meat), including 21 percent of those aged 25 to 34.
What We See With Respect to Diabetic Diets
Making changes to one’s diet is an important way to manage and prevent type 2 diabetes. Those with diabetes do not need special, medicinal food, but rather should turn to foods with more vitamins, nutrients, complex carbohydrates as well as low/reduced-fat and sugar offerings. Because it is so important for those with diabetes to manage their blood sugar levels, limiting sugar intake is one of the top changes people make to their diets to manage or prevent diabetes. Similarly, “sugar-free” and “low sugar” are the top two product claims sought on packaged food among those who are currently dieting and who have diabetes. Carbohydrates can also affect blood sugar levels, so limiting carbohydrate intake is another top method adopted by those who are managing or preventing diabetes.
Amid concerns about artificial ingredients, many people with diabetes have a desire for more products with natural sweeteners (e.g. Stevia, Truvia) as a sugar replacement. In addition, agave syrup can be a healthful alternative to sugar, as it has a lower glycemic index, which means that it is absorbed more slowly by the body and can limit blood sugar spikes. A number of brands have introduced products made with sweetener alternatives, and this is a key opportunity for food and beverage manufacturers.
Opportunity for Food Brands to Target Those With Diabetes and Celiac Disease
Limiting sugar, carbohydrates and calories are the top ways to manage diet among those with diabetes. However, there are opportunities to promote other types of foods to those with diabetes. As with many of the mainstream population, those with diabetes and celiac disease seek foods that are:
• Low sugar, calories and carbohydrates
• High in fiber
• All natural
• Organic
• Gluten free
Some of the challenges of this blended diet can include:
• Many gluten-free flour substitutes are much higher in carbohydrate content than their gluten-containing counterparts. Gluten-free products may be highly refined and contain added sugars or starches to mimic the mouth-feel and texture of gluten.
• Additional insulin and/or smaller portion sizes may be necessary to counteract these effects when enjoying such products.
• Some gluten-free alternatives are made with very low-carbohydrate substitutes, and thus standard carbohydrate counts are not appropriate. Administering standard estimations of insulin may result in dangerously low blood glucose levels.
• Gluten-free carbs need to be kept on-hand for managing blood glucose in instances where gluten-free foods may be difficult to find.
• For the average person with celiac disease, a salad may be a reasonable option at a restaurant that doesn’t have a gluten-free menu. However, for someone with both diabetes and celiac disease, a salad comprised only of vegetables, meat, and dressing is likely too low in carbohydrates to meet standard meal recommendations for carbohydrates. For many there is a need to use a beverage (like a smoothie or a latte) as a source of carbohydrates.
• Non-perishables like granola bars, protein bars, crackers, meal supplement drinks, and dried soybeans are great to keep in a car, pocket or purse.
Following general dietary advice for maintaining good health on a diabetic or gluten-free diet is recommended. To maximize the nutritional quality of the carbohydrates being consumed is vital. Whole grains and unrefined, unprocessed complex carbohydrates will deliver maximum health benefits while helping to maintain adequate blood sugar levels for these clients. NIE
Bio-box:
A brand champion and trend expert, Tricia Ryan has more than 15 years of progressive experience in marketing and communications with a focus on food and consumer packaged goods in the food and beverage industry. She is a principal at the Gluten-Free Agency providing strategic and communication expertise on the gluten-free market. She also leads the Gluten-Free Certification Program in its marketing efforts across North America. She has an MBA in marketing and business, and has completed her internship as a registered dietitian.
