Dena, type 1 from New York, writes: I’ve just been diagnosed with celiac disease on top of type 1 diabetes, and discovered that gluten-free food is very bland! It’s all about the condiments. But mayonnaise is fatty, soy sauce has wheat in it, ketchup has lots of sugar… and on and on. Can you recommend some different tasty low-carb condiments I might use to make my new diet more interesting?

Wil@Ask D’Mine answers: Oh, man, that really sucks. As if type 1 weren’t enough! I’ve been saying for years, that in a just universe, people with diabetes would be immune from all else — including the common cold and mosquito bites. But it’s not a just universe, and it’s been my experience that misery loves company, so it may provide you some comfort to know that your case is not uncommon. It’s estimated about 6 to 8 percent of T1Ds also have the burden of celiac disease, which is about SEVEN times greater than the prevalence of celiac in the general population.

That’s a big enough number that many doctors will screen for celiac as a matter of course once T1D has been diagnosed. Well, that, and the fact that some of the symptoms of celiac and T1D — such as weight loss and fatigue — overlap enough that sometimes the celiac tree can’t be seen for the diabetes forest.

Wait a sec. Some readers may be wondering what the heck is this celiac thing all about in the first place? Celiac is in fact a not-so-distant cousin of type 1 diabetes, as another autoimmune disease. In the case of celiac, the immune system’s T-cells (those rogue cells that wiped out the insulin-producing cells in your pancreas) also over-respond to a substance called gliadin, which is one of the building blocks of gluten. Over time, the immune response creates inflammation, and that, in turn, damages the lining of the small intestine. Once damaged, the lining can’t do its day job, which is absorbing nutrients.

Nowadays, diagnosing celiac involves two blood tests — one for antibodies and one for the genetic markers of celiac — followed by either snaking a small camera down your throat (endoscopy) or having you actually swallow a tiny vitamin-sized wireless camera that takes pictures of your insides after you swallow it (capsule endoscopy). We’re not going to talk about how you retrieve the camera at the end of its fantastic voyage.

As you might have guessed by now, nothing about celiac rates very high on the fun meter, with the possible exception of April Peveteaux’s marvelous book, “Gluten Is My Bitch.”

And as you know, and our non-affected readers might have guessed, avoiding foods with gluten is pretty much the only treatment for celiac. That means wheat, barely, and rye — and anything made with them or containing them — are off the table. Which means pretty much the whole traditional Western diet is out the window. Along with most other human diets from across the globe.

As you’ve noted, this can make for a very boring diet, and many of the traditional go-to solutions for spicing up food are diabetes or heart health unfriendly. What’s a girl to do?

First, turn to the spice rack!

Let’s start by talking Pepper, and her cousin, Mustard.

Seriously, these two traditional, but commonly overlooked spices, can make a world of difference when it comes to un-blanding your new diet. Did you know there are six different kinds of pepper? Of course, there’s my go-to: black pepper. Good stuff made better by the investment in even the cheapest of pepper grinders. My grandfather was keen on white pepper. There’s also green. All three of these actually come from the same plant, just harvested at different times. The other three come from different pepper-like plants. You can buy unicolor or blends of different colored corns for your grinder, and sometimes pepper can be mixed with other spices like Trader Joe’s excellent Lemon Pepper Seasoning Blend, which totally rocks green beans.

Likewise, don’t think that all mustard is that yellow stuff from the ballpark. The mustard universe ranges from the sharp-flavored Grey Poupon of ‘80s fame, to brown, to hot whole-seed coarse-ground Old World mustard. There’s also champagne mustard, blue cheese mustard, and sweet beet and horseradish mustard, to name a few. You could probably spend the rest of your life trying out all the mustards that are out there. Of course, it might be a life wasted, but who am I to judge?

Don’t overlook hot sauces. I’m not just talking run-of-the-mill Tabasco here. Check out the crazy range of options from Yampa Valley Sauce Company, for example. Or, if you can’t stand the heat of hot sauce (and they vary substantially), you can always add some fresh jalapeño, green chili, or bell pepper to your food. All low carb, high flavor, and gluten-free!

I’m told that other favorite flavor boosters for people with gluten intolerance are various types of pesto, olive tapenade and chorizo mayonnaise, aioli, chutney (which admittedly is high-carb), and old favorite A1 Steak Sauce.

Meanwhile, don’t overlook good ol’ salt of the Earth salt, assuming you’re not also dealing with any high blood pressure issues. Even a small bit of salt has an amazing ability to bring out the underlying flavors in a wide variety of food. For what it’s worth, like pepper and mustard, there are also numerous different varieties of salt.

In my house, we have white, Himalayan pink, and Hawaiian black. I’m not sure why. They all taste the same to me. When I see excited consumers stocking up on pricey imported pink salt from the Himalayas, in my mind’s eye, I picture people in the Himalayans ponying up a pretty penny for imported “exotic” white salt.

Lastly, as to your comment on ketchup, there are sugar-free versions of this all-purpose American go-to condiment, and the taste is remarkably similar. What’s the carb impact difference? As the market leader, classic Heinz Tomato Ketchup has 5 carbs per tablespoon. Their no-sugar-added version has only 1 carb. So, that’s, what? Eighty percent less? Pass the ketchup, please!

Importantly, there are also gluten-free soy sauces available as well, and the flavor is hard to distinguish from the real thing, made with wheat.

Our fearless leader Amy Tenderich here at DiabetesMine, who also lives with the dual diagnosis of type 1 diabetes and celiac, says she’s partial to going heavy on a variety of different hummus flavors to punch up her food. She’s also constantly on the lookout for new dips to pair with veggies and gluten-free crackers. The store-bought dips often have a lot of chemicals, but there are plenty of great dips you can make at home.

Just like you’ve connected with the Diabetes Community here, you may want to seek out some gluten-free friends who can help further. The National Celiac Association is a great place to start.


Wil Dubois lives with type 1 diabetes and is the author of five books on the illness, including “Taming The Tiger” and “Beyond Fingersticks.” He spent many years helping treat patients at a rural medical center in New Mexico. An aviation enthusiast, Wil lives in Las Vegas, NM, with his wife and son, and one too many cats.