Myth 4: Patients with diabetes should not eat bread

Unfortunately, several best-seller books written by physicians have tried to convince the public that eating wheat is the cause of many diseases, including diabetes.

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It is amazing that physicians will not prescribe medications that have not been proven to be efficacious, yet they will write and promote a “diet” book based on their assumptions and without any clinical trials proving it to be of benefit. Yet this is what these authors have done.

However, after reviewing available scientific evidence, nutrition guidelines from professional organizations and nutrition scientists, such as the American Heart Association, the American Diabetes Association (ADA), and the Dietary Guidelines for Americans, all recommend regular consumption of whole grains, including wheat.

The ADA also notes that an important goal of nutrition therapy for diabetes is “to maintain the pleasure of eating by providing positive messages about food choices while limiting food choices only when indicated by scientific evidence.” 1

People with diabetes commonly choose bread products as part of their overall healthy eating pattern. What is important for them is that they are aware of portion sizes and the number of servings that will fit into their eating plan.

People with diabetes, as well as the general public, can overeat on healthy foods just as they can overeat on unhealthy foods. Therefore, it is important that persons with diabetes have an eating plan that has been developed collaboratively with a Registered Dietitian Nutritionist and that meets their energy needs and will allow them to meet their metabolic and body weight goals.

Some persons with diabetes who also have diagnosed celiac disease must follow a strict gluten-free diet for life, which includes avoiding wheat. The ADA recommends that children with type 1 diabetes be screened for celiac disease soon after the diagnosis of diabetes as both are autoimmune diseases.23

Testing should be repeated in children with growth failure, failure to gain weight, weight loss, or gastroenterological symptoms or with frequent unexplained hypoglycemia or deterioration of glycemic control. However, a gluten-free diet should not be recommended unless a diagnosis is firmly established after a complete diagnostic evaluation, including positive serology and intestinal biopsy.23

Eating a gluten-free diet before biopsy can lead to false test results; therefore these tests must occur while the patient is consuming gluten to ensure an accurate diagnosis. The gluten-free diet is complex, and ongoing nutrition therapy, education, and support are necessary for best clinical outcomes.