Good nutrition is important for everyone, but if you have certain chronic diseases, like diabetes, cystic fibrosis, or celiac disease, or food allergies, good nutrition can be even more important, and sometimes a greater challenge. March is National Nutrition Month, and today we’ll be taking a quick look at just some of the many conditions that make a focus on what you eat even more important
Food Allergies: Food allergies range in severity from mild skin reactions to severe, life-threatening reactions called anaphylaxis. Some people can tolerate small amounts of the foods they are allergic to, whereas for others even touching the item can cause a severe reaction. For people who are allergic to multiple foods, as well as trace amounts of the allergen in question, eating can become difficult and anxiety-provoking. While it is always important to be careful, if you have severe food allergies, carrying an epinephrine auto injector (such as an EpiPen), as well as wearing a medical ID bracelet or medical alert necklace for food allergy (denoting what your allergy is, and if you need epinephrine) is crucial in case of an emergency.
Celiac Disease: In people with the autoimmune disorder celiac disease, the body responds adversely to gluten, which is found in wheat, rye and barley.  This autoimmune response causes the body to attack the intestine when gluten is consumed—1 in 133 people have Celiac disease, although many may not know it. While some people may be asymptomatic and have celiac disease, others have abdominal and gastrointestinal problems, don’t absorb nutrients well, headaches, fertility problems, mood issues like depression; children may also not grow as quickly as other children. Both weight loss and weight gain may occur from Celiac disease.  An endoscopy and blood tests most commonly are used to diagnose celiac disease.
The treatment for celiac disease is to adhere to a strict gluten-free diet to halt intestinal damage and reverse symptoms. Avoiding even small amounts of gluten is important, and this can pose challenges when eating out or when others may be preparing food for you.
Cystic Fibrosis: In cystic fibrosis (CF), sticky, thick mucus not only makes breathing difficult as it lines the lungs, but also blocks ducts in the pancreas that secrete digestive enzymes to help break down food. People with CF must usually take enzymes by mouth when they eat to break down food properly, but malnutrition is still a problem. A high fat, high calorie diet is important for people with CF to gain and maintain weight, and as people with CF have higher levels of sodium (salt) in their sweat, more sodium intake may be a specific dietary need. Because of malabsorption of nutrients, supplements of vitamins and minerals may be prescribed, especially fat-soluble vitamins (A, E, D and K) as these may be poorly absorbed. Most people with CF will work with a dietitian to address their nutritional needs. CF related diabetes (CFRD) can also make managing nutrition and CF more complex.
Diabetes: The relationship between diabetes and nutrition, specifically carbohydrate intake, is both straightforward and complex at the same time.
Type 2 diabetes means the body does not respond to the insulin that it makes properly (called insulin resistance), meaning carbohydrates cause an increase in blood glucose which is not properly responded to by the body. Most people with type 2 diabetes are instructed to reduce carbohydrate intake and burn more energy through exercise to assist in managing blood glucose levels, however, in many cases these changes alone are not sufficient and medications taken orally or by injection (including in some cases insulin) are needed. It is important to note that while type 2 diabetes is sometimes linked to lifestyle-related factors, including obesity, it is not always the case, and most if not all people with type 2 diabetes will find a genetic link to the disease.
Because of the stigma around type 2 diabetes, I feel it is important to stress that some people will do all they can and still require medication, or insulin, to manage their type 2 diabetes: needing meds or insulin does NOT mean a person has failed to adequately manage their diabetes, it means that they are taking the right steps to be in control of their disease. Diet and exercise changes should always be a part of managing diabetes, but taking medicine is a positive step forward, NOT a negative one!
Type 1 diabetes is an autoimmune disease, and means that the cells in the pancreas that produce insulin have been attacked by the body, making it unable to produce insulin. People with type 1 diabetes (or type 2 on insulin) must take insulin daily, either by injection or using an insulin pump. An insulin pump will provide consistent rapid-acting insulin, and the pump user can program extra insulin for the carbohydrates they consume; if on injections, a long acting type to keep their blood glucose level, and faster, short-acting insulin that is dosed according to the carbohydrates consumed (which raises blood sugar). Understanding how nutrition—carbohydrates, both simple and complex, as well as how fat and protein intake—impacts the speed at which blood sugar rises is extremely important in managing type 1 diabetes.
All people with diabetes should wear medical ID jewelry, but is especially important for those taking insulin who are at higher risk of low blood glucose (hypoglycemia) or extremely high blood glucose (hyperglycemia, or in severe cases, diabetic ketoacidosis), which can lead to coma. It may also be important for people with diabetes to meet a dietitian to learn how food affects their blood sugar levels.
Anemia, and other vitamin or mineral deficiencies. Most people will have had a basic hemoglobin blood draw in their lifetimes, and this is the marker for whether or not a person is anemic. Anemia, as well as other vitamin and mineral deficiencies, can be a result of imbalanced diet, or medical conditions. While there are lots of supplements on the market, it is important that use of these supplements is recommended by your doctor and that they ensure the dosage you take is right for you, and it will not interact with other medicines you are taking. Other than perhaps a daily multivitamin (which are often not necessary either), I would recommend speaking to your doctor before beginning any sort of vitamin or mineral supplement regimens, as they can be costly and could have harmful interactions with your meds, as stated above. However, many people commonly require supplements of iron, vitamin D, and calcium, so these may be recommended to you by your doctor.
This is just a brief look at a few of the conditions that may require differing attention paid to nutritional intake. Regardless of if you have chronic disease or not, nutrition plays a bigger role into your life—your energy, thought clarity, and more—than you may realize. If you are concerned about nutrition, speaking with your doctor about meeting with a registered dietitian may be a positive step in figuring out how you can eat differently to feel your best.