Should People With Diabetes Go Gluten-Free?

If you’ve been diagnosed with celiac disease or have a gluten intolerance, you may be familiar with the gluten-free diet. For people with celiac disease, gluten – a protein found in wheat, barley, and rye – damages the lining of the small intestine, preventing nutrients from being properly absorbed. 

“If you have diabetes alongside celiac disease or gluten sensitivity, adopting a gluten-free diet can help alleviate digestive issues and improve nutrient absorption,” said Michelle Routhenstein, a registered dietitian and certified diabetes care and education specialist.  

People with celiac disease or a gluten intolerance should stay away from the following grains: 

• Wheat
• Barley
• Rye
• Oats (note that oats do not contain gluten, but most oats are grown in fields contaminated by nearby wheat fields. It’s therefore best to consume oats that are certified gluten-free.)

Eating gluten-free usually means avoiding foods like bread, crackers, cereals, pasta, beer, cakes, cookies, and pastries. Or, you can bake with or purchase gluten-free alternatives made with special wheat-free flour, though it’s important to keep in mind these options may not necessarily meet all nutritional needs (more on that below).  

Does a gluten-free diet have benefits for diabetes? 

Put simply, the only people who should eat gluten-free are those with diagnosed celiac disease. 

Because gluten-free products are often advertised as health foods, some people with diabetes who do not have celiac may wonder if a gluten-free diet has any benefits for diabetes management. In particular, gluten-free diets could seem appealing as a way to reduce carb intake. 

However, unless you have celiac disease or a gluten intolerance, there’s no need to follow a gluten-free diet, said registered dietitian and certified diabetes care and education specialist LaurieAnn Scher. 

“I’m loath to put another restriction on people with diabetes,” Scher said. “If someone doesn’t have to be gluten-free, it’s really not necessary. It’s just another thing to worry about.” 

"As someone who grew up with food allergies, defining yourself by what you can't eat is limiting and one dimensional,” Scher said. “We are so much more as people, what we can and can't eat is only one part of that." 

It’s important to recognize the potential risks of eating gluten-free with diabetes. First, some gluten-free products are highly processed and contain high amounts of added sugars, which could spike blood sugar. It can be challenging to consume enough fiber, vitamins, and minerals when following a gluten-free diet. 

Considerations for going gluten-free

If you have recently been diagnosed with celiac disease or a gluten intolerance and are new to a gluten-free diet, Scher suggests starting simple. Think about foods you enjoy that are naturally gluten-free, such as fruits, vegetables, dairy products, and lean meats. 

While it might feel daunting at first, Scher emphasized that there are many possible workarounds. If there are certain glutinous foods you really can’t live without, you can usually find a gluten-free alternative that looks and tastes similar. 

“It’s so much easier these days to be gluten-free,” Scher said. “There’s gluten-free pancake mix, pretzels, breads, and more.” 

Many grocery stores sell gluten-free products and some cafes and restaurants are fully gluten-free, too. 

Because gluten-free products are made of different ingredients than their glutinous counterparts, you may experience a different rise in blood glucose after eating gluten-free foods. When first going gluten-free, Scher suggests paying extra attention to your fingerstick or continuous glucose monitor (CGM) readings after meals. 

Making sure you get enough nutrients

While it’s certainly possible to eat a balanced gluten-free diet, if you rely on packaged gluten-free products, it may be difficult to meet your fiber, vitamin, and mineral intake goals, said Routhenstein. 

She suggests looking for net carbohydrates on food labels to gauge fiber content. It’s also a good idea to add fiber-rich foods like fruits and vegetables to meals to better regulate blood sugar levels.

In addition to fiber, it’s especially important to pay attention to B vitamins and iron. When wheat is processed, the germ (or bran) is stripped, which removes these crucial nutrients. By law, wheat flours have to have vitamin B and iron added back in. However, some gluten-free flours may not follow the same guidelines and may therefore lack these essential nutrients, Scher cautioned. 

One of the most common examples is folic acid, a B vitamin. Folic acid deficiency at the time of conception can lead to serious birth defects, so most countries fortify their grains with this vitamin. If you’re thinking of becoming pregnant or are concerned about folic acid deficiency, Scher suggested taking a prenatal vitamin, which usually contains folic acid. 

It’s always a good idea with any packaged food to check the nutrition label and supplement as needed. If you’re struggling to meet your nutritional needs with celiac disease, consider meeting with a dietitian or nutritionist to develop a personalized plan. 

Some gluten-free foods are highly processed

When you trade foods that contain gluten for gluten-free ones, it’s important to consider how they’ve been processed. For instance, Scher noted that most gluten-free breads have gums and additives to make them behave like bread. This may cause your blood glucose to respond differently compared to bread containing gluten. 

An example is tapioca starch, obtained from cassava roots, which may be used as a flour for gluten-free baked goods. Tapioca starch is high in carbs and lacks fiber, protein, vitamins, and minerals. This means any tapioca-based products may lead to blood sugar spikes. 

Some gluten-free foods also have more added sugars and saturated fat than gluten products to make them taste better. Again, it’s a good idea to review food labels to see if there are added sugars or other ingredients that may affect blood sugar levels.

Watch out for hidden gluten 

In addition to grain-based foods like bread and pasta, some condiments and other products contain hidden sources of gluten. For instance, regular soy sauce is not gluten-free because it contains wheat. Several alternatives exist, such as tamari and soy sauce made with coconut aminos. 

When eating at restaurants, you may need to use a little extra caution. Fortunately in the U.S., wheat is one of seven allergens that require labeling. That said, a little bit of planning can go a long way when dining out. 

Scher suggests calling ahead or using apps like FindMeGlutenFree to locate restaurants with dedicated gluten-free options. Some people who are very sensitive to gluten will also want to inquire about separate pizza ovens or gluten-free toasters for restaurants serving both gluten and gluten-free items. 

Best gluten-free foods for people with diabetes 

Many foods are naturally gluten-free, such as fruits, vegetables, legumes, beans, seeds, nuts, meat, eggs, and most low-fat dairy products. These foods are a better option than heavily processed gluten-free products, which lack fiber, vitamins, minerals, and overall nutrient density, Routhenstein said. 

Naturally gluten-free grains, flours, and starches include: 

• Rice
• Quinoa
• Corn
• Gluten-free flours made from rice, corn, soy, beans, tapioca, potato, or nuts
• Buckwheat
• Flax
• Millet

Many of these products are available in grocery stores or can be ordered online. If you can’t find them, check out the bulk section at your local co-op or natural foods store. Today, there are also many naturally gluten-free pasta options, such as noodles made from chickpeas, lentils, and vegetables like spaghetti squash and zucchini. 

The bottom line

If you’ve been diagnosed with celiac disease, going gluten-free will prevent discomfort and ensure your body gets the nutrients it needs. 

While going gluten-free can seem very limiting, the reality is that many stores and restaurants now offer a range of gluten-free products. Plus, many common foods that are part of a balanced diet are naturally gluten-free, such as fruits, vegetables, and legumes. 

Since gluten-free foods can be highly processed and lack key nutrients, it’s a good idea to check nutrition labels carefully and supplement with vitamins as needed. 

Ultimately, it’s important to ensure you have a well-rounded nutrition plan with enough fiber, vitamins, and minerals. Doing so will help you better manage your diabetes and prevent long-term complications, like heart disease. 

Learn more about diabetes and nutrition: 

• Five Best Diets for Diabetes
• Owning My Carbs and Being Honest with Myself
• 8 Best Grains for People With Diabetes