A LOT of people ask me:
What is the best “diet” for diabetes?
Literally, it is one of the first things asked when I start to work on diabetes management with someone. “What should I eat? Should I do low carb or Paleo or Mediterranean, etc.? How much should or do I need to eat? What will make me feel good and have the control I want”?
Especially in the past 5-10 years there have been more questions about the Low Carb style of eating (despite the low carb idea having been around for a long time already) and a lot of questions about glycemic index.
Honestly, there is a lot that goes into answering all these questions. One very important thing to consider for any change to habit is that the decision ultimately has to come from a personal level.
Within this are these important considerations:
- Where are you in diabetes management? Where are things falling short of your goals?
- Why do you want to make a change to your current plan?
- Can you stick with this way of eating long term? Not 1 year, but many years, essentially lifelong.
- Are you willing to put the effort in to make this advantageous for your health long term?
When I look at all the diets out there today it makes my head spin, honestly. As a professional as well as someone living with diabetes, I read a lot. What I find makes me feel like there is no end to the clicking and research digging when it comes to talking about what to eat. Every study or new bit of info seems to have the right thing that will work the best. Eat only grapefruit for 10 days, have cabbage soup, eat only grass-raised beef with lettuce…on and on the recommendations and restrictions go. No wonder we are all confused about what will work for overall health, not to mention management of a chronic condition like diabetes.
What do I think and follow?
Yet another question a lot of people ask me. I’m not perfect by any means, and what I choose works well for ME majority of the time. I have found that paying attention to the carbs that work best for me helps considerably. I kept records and evaluated my CGM information to evaluate and adjust. I learned what gets me where I want to be and it works for my preferences, lifestyle and long term health goals.
Does low carb help?
I’m not truly low carb in terms of the true definition, but low glycemic is more what I follow. I aim for about 50% of my carb intake at a meal to come from veggies (non-starchy variety). Carbs that are not veggies, are things like quinoa, berries, wild rice and bean based pasta. I also remember that there are other food groups that need to be eaten which offer balance and help with BG management and optimized long term health too. I include healthy protein and fat sources such as beans, tofu, eggs, fish and nuts/nut butters, coconut oil, olive oil, and avocado as part of every meal.
Looking back, I feel I also learned a lot from my old-school initial education when I was first diagnosed. For those who have had diabetes a long time, you will likely remember the Exchange Diet which encouraged intake from every food group – veggies, fruit, milk, meat/protein, fat and starches. It skimmed the surface of teaching that all the food groups offer some nutrients that are healthy, food in certain groups have similar effect on BG, and it taught portion of EVERY food group. As I’ve learned over the years with education and personal evaluation, it did miss out on teaching the variation in impact, especially on different types of carbohydrate as well as the impact from protein and fat.
We have become so carb centric in considering food intake that we have lost the importance of balance as well as the impact of other food groups.
Most people today don’t even know what a portion of protein or fat looks like – they are merely part of a meal but not really considered when it comes to “how much” should be eaten. (Think of a deck of cards for cooked protein portion, or 2-3 eggs, 2-3oz of cheese and for fat, a portion is about the size of a soup spoon for oil/mayo/salad dressing).
To really learn what works best for BG management, we should start to pay attention to the glycemic impact of what is eaten, and how it can keep things more in target when portion and type of food is managed well.
What is the Glycemic Index?
Glycemic index (GI) can be a great place to start when trying to figure out what works best for BG management. GI refers to the rate (or speed) with which foods turn to glucose. High-GI foods raise the blood sugar quickly; low-GI foods produce a more gradual, prolonged rise. Start with your 20-25 most commonly eaten foods – look at the GI and then follow post meal/snack BGs. What seems to work the best? Is it the meal that is all carb, is it the meal that contains protein and veggies or perhaps the meal with low GI carbs, protein and fat? Since the 20-25 “most common foods” in each person’s diet make up more than 80% of total food intake, evaluating these and making changes based on GI should produce a nice change in post-meal glucose control. It also helps to consider portions – once you know how quickly a food or meal effects BG, pay attention to the sizes. Glycemic Load considers both the quantity (portion) as well as the quality (GI) of the food. The lower Glycemic Load, the lower the total impact on blood glucose.
Is a Low Carb Diet Good for Diabetes?
Low carb diets tend to keep BG more stable than diets containing larger amounts of carbohydrate. An important thing to remember if/when starting a low carb diet is that dietary protein can still impact blood sugar levels. Since the body’s vital organs require glucose at all times, a portion of the dietary protein will be converted to glucose if insufficient carbohydrate is consumed. Interestingly, true low-carb/ketogenic diets contain low amounts of protein as well – most of the calories (80% in some cases) come from fat. Consuming low-carb and low-protein is what keeps you in a state of ketosis, which is the aim for a low-carb/high-fat (LCHF) diet.
Another important piece to remember when following the LCHF plan is to monitor ketones. Nutritional ketosis is different from DKA (diabetic ketoacidosis), which occurs when the body is dehydrated and severely deficient in insulin. With nutritional ketosis, there isn’t adequate carbohydrate intake to meet the body’s energy needs, so the body switches to burning fat as its primary fuel source, and ketones are produced as a result. These ketone levels are generally much lower than when someone is in DKA. As long as some insulin is present in the body, ketones can be used as an efficient source of energy.
It is important for people with type-1 diabetes to monitor ketones when choosing a low carb or LCHF lifestyle to ensure they are maintaining the right ketone level. If ketone levels become too high, particularly in a state of elevated blood sugar and reduced insulin, DKA can occur.
Low Carb Diets: The bottom line
All in all, the people who succeed are the ones who plan properly, individualize, and commit for the long term. Almost any dietary approach can work well given the right direction from a knowledgeable diabetes educator. Find someone to work with who can ensure you have all the facts and set you on the right path for success.