Updated: Oct 16, 2020
STUDENT CONTRIBUTOR: Julianna Bennett | School of Nutrition, Ryerson University
October 7, 2020
Finding success with a sustainable diet when living with diabetes is a challenge in itself. Imagine having to manage one or more common inflammatory conditions linked to diabetes, like celiac disease, gastroparesis or ulcerative colitis, on top of the already burdensome demands of diabetes.
If you're someone dealing with one or more of these issues, give yourself mad props cuz it's no easy feat! It's our hope that this blog will provide you some nutrition tips and tricks that help make life a little easier. At the very least, whether you are the person diagnosed, a caregiver or just an eager learner, the information provided here will help make it easier to understand what these diseases are, how they impact both physical and mental health and what the latest research reveals.
The Difference in Diabetes
Diabetes is a chronic disease related to the body's ability to make or use a hormone called insulin. Insulin is like a key that unlocks the cells and allows sugars in the bloodstream to be taken up and used for energy by both the cells and brain. The two most well known types include Type 1 and Type 2; both affecting the pancreas and its ability to secrete insulin to regulate blood sugar levels.
Type 2 diabetes happens when someone is insulin resistant and the body either doesn't make enough insulin, or the body is unable to effectively use the insulin available. Type 2 is usually diagnosed in older and/or overweight populations. Type 2 diabetes is typically managed through diet, increased physical activity and oral medications,
Type 1 diabetes is an auto-immune disease with no known cause and no available cure. This means the body does not produce insulin at all. People with type 1 diabetes have to provide the body with the insulin it needs through multiple daily injections or via an insulin pump.
Next to insulin, food is the number one strategy used to manage blood sugars for people with diabetes. Following a balanced diet that aligns with the Canada Food Guide including food choices from each of the 3 macronutrient groups - fruits & vegetables, lean proteins and whole grains & starches - is key to self-management of either type of diabetes in an effort to maintain blood sugars in target range. Food becomes especially important to prevent hyperglycemia (high blood sugar) and/or hypoglycemia (low blood sugar). Extreme swings in blood sugar in either direction can be life-threatening or lead to long-term health complications.
Not All Carbs Are Created Equal
The main culprit in the diet that can cause the most chaos are carbohydrates. Carbohydrates are found in foods like fruits, vegetables, starchy grains, pastas and bread. They are broken down by the body into glucose. Just like diabetes, there are different types of carbohydrates; simple and complex.
Simple carbohydrates are broken down quickly by the body to be used as energy and have an immediate impact causing a spike in blood sugars. Simple carbs are found naturally in foods like fruits, milk, and milk products. They are also found in processed and refined sugars such as candy, table sugar, syrups, and soft drinks.
Complex carbohydrates are made up of sugar molecules that are strung together in long, complex chains that the body has to work harder to break down. Complex carbohydrates do not cause as immediate or severe spikes in blood sugars and are found in foods such as peas, beans, whole grains, and vegetables.
Counting carbs and choosing foods that are lower on the glycemic index are common techniques used in all types of diabetes to help manage blood sugars and/or match insulin requirements to help keep blood sugars in target range.
These techniques can get tricky, though, in the case of comorbidities - when a person has two or more chronic conditions - as certain foods known to help with one disease could be detrimental for managing another.
Diabetes and the Gut
So, how do celiac disease, gastroparesis and/or ulcerative colitis connect back to diabetes? They are all inflammatory diseases that can develop when the body is under stress. What makes things more complex is that each of these diseases pose different health challenges and require different management approaches that sometimes conflict.
At least 6% of people with type 1 diabetes also have celiac disease; an autoimmune disease that causes mild to severe discomfort including nausea, vomiting, bloating and cramping. There is a genetic link between celiac and type 1 diabetes. Developing one of the diseases increases the risk of developing the other. Those with celiac have an intolerance to gluten; a protein found in wheat, barley and rye. Gluten triggers an immune response in the small intestine putting them at risk for nutrient deficiencies. Adhering to a strictly gluten-free diet helps to prevent further damage to the intestine, where the nutrients are absorbed, and prevent flare ups. A gluten allergy or intolerance is especially problematic when a person also has diabetes, as a damaged intestine can affect sugar absorption into the blood and many gluten-free food choices are low in carbohydrates, potentially resulting in a low blood sugar.
Diabetic gastroparesis - a nerve disorder impacting the way the food moves from the stomach through the small intestine and the absorption of essential nutrients - affects about 40% of patients with type 1 diabetes and up to 30% of patients with type 2 diabetes; especially those with long-standing disease. Gastroparesis has similar symptoms to those of celiac disease and ulcerative colitis, often described as delayed stomach emptying, and means that food in the stomach does not leave and pass into the intestines as quickly as it would in most individuals. Diabetes is the most common cause of gastroparesis, as diabetes often damages the vagus nerve, which is responsible for stomach muscle movement. Delayed movement can impact the timing of insulin, leading to frequent bouts of low blood sugars. The insulin hits the system before the food it's been given to compensate for does. On the flipside, when food doesn't get absorbed until hours after eating, it can lead to high blood sugars. The insulin taken has already worked itself through the body, leaving nothing to balance the increased sugar levels in the bloodstream as a result of the foods finally digested.
Type 1 diabetes is one of the top 3 common comorbidities a patient with ulcerative colitis (UC) will develop. UC affects the digestive tract causing both inflammation and sores in the colon and rectum, otherwise known as ulcers. It can lead to deficiencies because the body isn't able to absorb nutrients from food as easily or effectively. Prescription drugs (steroids) used for pain management often cause a rise in blood sugars and ultimately increase your risk of more serious complications; such as heart disease, nerve damage, and vision loss.. Conversely, eating a diet high in fibre, often recommended for people with diabetes, can trigger colitis flare ups. Eating smaller meals made up of anti-inflammatory foods, limiting foods with soluble fibre, avoiding greasy or fried foods, and exploring alternate medications like immunosuppressants or biologics are proven strategies to manage both diabetes and colitis.
Some popular dietary approaches recommended by health practitioners to help manage these diseases include the Mediterranean diet, FODMAP, an anti-inflammatory diet, and the low residue diet. When managing diabetes in addition to any of the previously mentioned inflammatory diseases, common foods to limit or avoid include:
Refined foods high in sugar (cookies, candies, cakes etc)
Deep fried foods
Highly processed foods
White rice, white bread
Fruit salads (large quantity of fruit in one sitting)
High fat dairy products (cream, cheese, butter)
Other food choices of concern that may increase the pain that comes with gastroparesis and ulcerative colitis include: beans, legumes, corn, seeds, nuts and cruciferous vegetables (e.g., broccoli, cauliflower, cabbage).
It is important to work with a Registered Dietitian to ensure you maintain a healthy, balanced diet that helps manage chronic disease while providing optimal nutrition.
Sample Meal Plan
The following is a glimpse into what an eating pattern that does not follow any one specific diet, but is still a good example of what someone with any combination of these diseases could eat.
Breakfast - Kale Smoothie
½ cup unsweetened non-dairy milk
1 cup kale
1 tbsp of peanut butter (or any other nut butter)
1 tbsp chia seeds
1 frozen banana
Place milk in a blender then add nut butter, chia seeds, kale and the frozen banana (chopped). Blend until smooth. If the mixture is tooth thick add cold water until desired consistency is reached. Serve immediately.
2 boiled eggs with celery sticks
Lunch - Fish Tacos
3 Corn tortillas
½ tbsp of Olive oil
Top with tomatoes, cilantro and Greek yogurt
Salt and pepper for seasonings
Season one 4oz Tilapia filet with salt and pepper. Heat olive oil in a skillet over medium-high heat; Sear Tilapia for 4 minutes per side until internal temperature of 145°F. Warm 3 corn tortillas in a dry pan until heated through and pliable. Top tacos with fish, avocado slices and Greek yogurt along with tomatoes and cilantro for garnish.
1 cup 0% fat vanilla Greek yogurt with ¼ cup of raspberries
Dinner - Baked Sweet Potato Fries with Oven-fried Chicken and Asparagus
1 Sweet potato
1 Chicken breast
¼ cup of Gluten free bread-crumbs
5 Asparagus spears
1 tbsp of Olive oil
Salt and pepper for seasonings
For the chicken breast: slice the chicken breast in half coating both pieces with the olive oil. Mix breadcrumbs with salt and pepper then cover all sides with of the chicken breast with the bread crumb mixture. Line a baking tray with parchment paper (or non-stick aluminium foil for crispier chicken) and place in the oven for 20 minutes flipping them halfway through the cooking time. Let rest for at least ten minutes.
For the fries and asparagus: While the chicken breast rests, preheat oven to 425 degrees F. Slice sweet potato into strips and place in a bowl. Add any desired seasonings (would recommend, salt + pepper + smoked paprika) and ½ a tbsp of olive oil. Mix the fries until they are completely coated. Line a baking tray with parchment paper (or non-stick aluminium foil for crispier fries) and place in the oven for 25 minutes flipping them after 15 minutes. Trim the ends of the asparagus spears then place on a baking tray with parchment paper or non-stick aluminium foil. Season with salt and pepper then bake alongside fries for 12-15 minutes.
This 1-day meal plan is focused on excluding foods with gluten and using complex carbohydrate replacements such as corn tortillas and sweet potato as a starch for both lunch and dinner. Foods high in fat are avoided throughout, with an emphasis on baking and pan frying the protein choices (tilapia and chicken breast).
Breakfast featured a smoothie made with food choices from each macronutrient group portioned accordingly to minimize flare ups or spikes in blood sugars. Both snacks pair protein with fibre to reduce the load on the digestive system, provide energy to the body, minimize impact on blood sugars and increase satisfaction between meals.