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My doctor says my glucose tolerance is impaired, and while I am not diabetic I have adopted a diet similar to that of a diabetic, which as far as I can tell is how I should have been eating in the first [place]. You know; the recommended amount of whole grain, starchy vegetable, protein, non starchy vegetable... avoiding simple starches, sugar, processed food.
The thing I recently had a positive ANA [antinuclear antibodies] test and while all the tests for the usual autoimmune diseases have been negative have been told to avoid gluten. My question is how do I do that and still have the requisite amount of whole grain?
It is great that you are being so mindful of the impaired glucose tolerance. Having issues with how our bodies handle glucose is the early stages of what often develops into diabetes and your efforts have clearly been shown to help you avoid that progression.
Your statement of getting "the recommended amount of whole grain, starchy vegetable, protein, non starchy vegetable... avoiding simple starches, sugar, processed food" is certainly the path, but often folks get stuck on the first part of the statement: whole grains. What the statement mostly means is getting more fiber rich foods, and folks most often associate that with whole grains, but fruits, nuts, vegetables, and legumes are all not only very high in fiber but also high in the vitamins and antioxidants that can help you better control your blood sugar.
As such, focusing on getting more of these and balancing them with some whole grains is the best strategy.
I am not sure why you would have been told to avoid gluten if you have not been diagnosed with Celiac Disease (your note implies that you have tested negative). There is no evidence that avoiding gluten containing foods will have a positive effect on your health overall or your blood sugar specifically. It might, in fact, have the opposite effect because so many of the gluten free products are made with flours that don't contain much fiber, so they could lead to a spike in blood sugar.
However, if you are more comfortable consuming a gluten free diet (and some folks are), there are still great alternatives for you. First and foremost, consuming the first four of those foods mentioned above, fruits, nuts, vegetables and legumes, can help you control blood sugar. There are a lot of great choices for you in selecting gluten free whole grains:
Any of these make great side dishes, and there are now a lot of good choices of gluten free baked goods that contain as much fiber as whole wheat bread does.
Thanks for writing,
Timothy S. Harlan, MD, FACP