Dietary Approaches to Diabetes Management

Goal/objective: To identify your dietary approach to managing your diabetes, within your chosen dietary lifestyle.
Time frame: Ongoing. With the caveat that you can adjust/change your dietary approach at any time.

For all of us—type 1 and type 2 diabetics, “pre-diabetics,” ex-diabetics, recovering diabetics—whatever we choose to call ourselves, we can choose to follow a specific dietary approach to diabetes management. Or not.

Dietary Lifestyles

Don’t confuse dietary approaches with dietary lifestyles. Typical dietary lifestyles include:

    • Dietary vegan – no meat, eggs, or dairy
    • Lacto-ovo vegetarian – no meat, but includes eggs and/or dairy
    • Adventist pescatarian – eats “clean” fish but no meat
    • Adventist non-vegetarian – eats “clean” meat/fish
    • Flexitarian – mostly vegetarian, occasional “clean” meat/fish

Other terms for dietary lifestyles include:

    • Herbivore – An animal that gets its energy from eating plants, and only plants. A dietary vegan.
    • Carnivore – Eats only animal products, including meat/fish, eggs, and dairy products. In theory, one could be a “Vegetarian Carnivore,” eating only eggs and all types of real-food cheeses.
    • Omnivore – An animal or person that eats food of both plant and animal origin. There are many reasons why a fully omnivore dietary lifestyle would not be appropriate for Adventist Vegetarian Diabetics™.

And within dietary lifestyles above, there is a spectrum of disciplines, identified as:

    • Whole-food – Vegetables and fruits in their natural state, fresh or frozen. No dried fruits, no juices. Whole grains. Dried legumes (not canned). Raw nuts and seeds. Beef, chicken, and turkey meat unprocessed. Wild-caught fish. Whole milk, homemade almond milk, homemade cashew milk. Real  cheeses (in blocks, not shredded).
    • Processed/packaged food – May include canned fruits and vegetables, canned beans, whole grain breads and cereals, uncured beef, chicken, or turkey. Packaged unsweetened almond milk, coconut milk, cashew milk. Shredded cheese.
    • Junk food – Most fast foods, canned soups, boxed dinners, cakes, pies, doughnuts, pizza, hot dogs, hamburgers, tacos, potato chips and corn chips, funnel cakes, ice cream, all candy, all forms of sugar and artificial sweeteners.

Diabetes Dietary Protocols

Standard American Diet (SAD)

Image Source: https://www.industrious.info/16/10695-american-food-pyramid-parody.html (may no longer be available)

A modern dietary pattern that is generally characterized by high intakes of processed, pre-packaged foods, fried foods, high-fat and high-carb products (like doughnuts and French fries), refined grains, potatoes, corn (and high-fructose corn syrup), and high-sugar drinks. If you are a diabetic who eats SAD, we recommend that you commit to making a lifestyle change.

If you find yourself unable to stop consuming the foods and beverages that are damaging to your health, you might consider joining a group therapy for food addiction. If that doesn’t help, the best you can do is to make sure you test your blood sugar according to your doctor’s instructions, take your medications and insulin as prescribed, and be sure to get your A1C and lipid panel tests when ordered. And stay with us in the Adventist Vegetarian Diabetics™ Facebook group to get important information and diabetic-friendly recipes.

U.S. Department of Agriculture (USDA)

Image Source: https://www.myplate.gov/ 

The U.S. Department of Agriculture developed MyPlate in 2011, which it calls “the official symbol of the five food groups” (Fruits, Vegetables, Grains, Protein, and Dairy). Promotes low-fat and fat-free foods. The major improvement over the Standard American Diet is that it provides a way to avoid high-carb and high-fat foods eaten together.

ADA (American Diabetes Association)-compliant

Image Source: https://www.365doctor.in/health/diabetes-meal-plans-and-a-healthy-diet

This is the approach that most of us were given when first diagnosed with diabetes. Typically, we were told to walk a minimum of 30 minutes a day at least 3 days a week. We were instructed to limit carbohydrate intake to 45-60 grams per meal, with 3 servings of 15 grams each, for a total of 135-180 grams per day. With a snack of 15-20 grams, we could easily consume 150-200 grams per day. We were also told that after a time diet and exercise would not be enough, that we’d probably need to take oral medications and, eventually, insulin.

Image Source: https://diabetes.org/healthy-living/recipes-nutrition/eating-well

In 2019, the ADA recommended a “low” carb diet. They took away milk and fruit as separate items. #1, Non-starchy Vegetables, includes leafy greens, cruciferous vegetables, and other low-carb vegetables. #2, Protein Foods, includes meat/poultry, fish, eggs, cheese, and legumes. #3, Carbohydrate Foods, includes fruit, yogurt, milk, and starchy vegetables.

American Diabetes Association (ADA)’s annual Standards of Medical Care in Diabetes (2019) has said that “a low carbohydrate eating pattern was defined as 26-45% of total calories from carbohydrate and a very low carbohydrate eating pattern (ketogenic) was defined as 20-50 g of non-fiber carbohydrate per day.”

Low Carbohydrate Dietary Approaches for People With Type 2 Diabetes—A Narrative Review

This is an EXCELLENT article! It’s a peer-reviewed evidence-based documented scientific study. Access the article then bookmark it for your future reference!

“There is a strong physiological rationale supporting the role of carbohydrate restriction for the management of Type 2 diabetes, and available evidence suggests that low carbohydrate dietary approaches (LCDs) are as effective as, or superior to, other dietary approaches for its management. Importantly, LCDs appear to be more effective than other dietary approaches for facilitating a reduction in the requirement for certain medications, which leads to their effects on other health markers being underestimated. LCDs have also been demonstrated to be an effective method for achieving remission of Type 2 diabetes.”

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8319397/

Sadly, there are still many ADA-trained physicians, nurses, and dietitians who follow the old advice of 150-200 grams of carbs per day.

Low-carb/Keto

Image Source: https://www.100dayspaleo.com/

There does not seem to be a consensus of opinion about the definition of “low-carb.” But for purposes of discussion in Adventist Vegetarian Diabetics™, we have chosen these definitions:

    • “Prescription Strength” Keto (Dr. Eric Westman) (< 20 grams TOTAL carbs/day)
    • Dr. Bernstein’s Diabetes Solution (< 30 grams total carbs/day)
    • Very Low Carb (< 50 grams total carbs/day);
    • Low Carb (< 100 total grams carbs/day);
    • Moderate Carb (100-200 grams NET carbs/day);
    • High Carb (> 200 grams carbs per day, or untracked).

Low-carb High-fat Moderate-protein (LCHF)

The great thing about this diabetes dietary protocol is that it can be utilized by all dietary lifestyles, from carnivore to vegan (but probably not fruitarian). The proponents of this protocol advise limiting carbohydrate intake to < 30 grams/day for the best success. They also advise limiting protein to only what is needed for cell growth and repair to avoid gluconeogenesis, a process which converts excess protein to glucose and thus raises blood sugar. This protocol is recommended by Canadian nephrologist, Dr. Jason Fung, who prefers to identify LCHF as “Low-carb Healthy Fat.”

Ketogenic Diet

There is no one “ketogenic diet.” A “keto diet” is any dietary protocol that allows one to achieve and maintain nutritional ketosis, generally limited to 20-30 grams carbs/day, though some claim to have achieved ketosis with as much as 50 grams total carbs/day. A “keto” diet is a LCHF protocol, but not all LCHF protocols are ketogenic. More details about ketosis and a ketogenic diet are in a later chapter.

Low-carb High-protein Moderate-fat (LCHP)

This protocol is recommended by diabetes expert and type 1 diabetic, Dr. Richard K. Bernstein. He also recommends an aggressive exercise regimen for all diabetics.

High-carb Low-fat Whole-food Dietary Vegan (WFPB, “Whole-Food Plant-based”)

Image Source: https://www.pinterest.es/pin/227009637455154027/ (230213)

Although there are many types of vegan “diets,” the only dietary vegan protocol that seems to promote success in normalizing blood sugars is a whole-food protocol, meaning little or no processed packaged foods, including no industrial vegetable/seed oils. Promotes eating a variety of vegetables, fruits, raw nuts and seeds, beans and legumes, and whole grains. Avoids heavily processed foods, all animal products, and added salt, oil, and sugars. The proponents of this protocol advise limiting fat intake to < 30 grams/day for the best success. Weimar Institute approves of the “reversing diabetes” program developed by Dr. Neal Barnard.

The objectionable features of this dietary protocol are:

    • The myth that sugar doesn’t cause diabetes; fat does.
    • The myth that carbs don’t count; you can eat as much carbohydrate as you want.
    • They don’t recommend that diabetics use their glucose meter on a daily basis. That’s totally irresponsible! “You can’t manage what you don’t measure.” They know that if you “eat to your meter” you will discover that high-carb foods spike your blood sugars!
    • They promote eating rice at every meal and as much potatoes and oatmeal as you want.

Intermittent Fasting…

…is a time-restricted eating practice that can be incorporated into any diabetes dietary protocol but works best with Low-carb High-fat Moderate-protein (LCHF) or High-carb Low-fat Whole-food Dietary Vegan (WFPB).

At its most simple, intermittent fasting is simply fasting between supper and breakfast, with nothing but water, when you can fast for 12 hours. And you have an eating window of 12 hours. Then you can begin to extend/expand your fasting to 16 or 18 hours with an eating window of 8 or 6 hours. At this point, you may find that two meals (rather than three) better fit your intermittent fasting routine. Some people practice an even longer fasting period and smaller eating window. Any fasting period over 24 hours would be Extended Fasting, and we recommend that you consult with your physician. A full chapter is devoted to “Intermittent Fasting” later in this book.

Diabetics with multiple other medical conditions—such as gastroparesis, colitis, fatty liver disease (NAFLD), kidney disease, cardiovascular disease, migraines, fibromyalgia, gout, etc.—in addition to diabetes are certainly more challenged. Please work with all your health care practitioner(s) for indicated treatments and let them know of your preferred dietary lifestyle and diabetes dietary protocol.

Explanations of the infographic

At the top of the circle is the Low-carb/Keto approach. It can be low-carb high-fat or low-carb high-protein. This protocol can be vegan/vegetarian or non-vegetarian. We recommend < 20–50 grams total carbs/day, whole foods. Eliminate sugar in all its forms and trans fats, such as margarine, shortening, and industrial seed oils (canola, corn, cottonseed, grapeseed, safflower, soybean, and sunflower). We strongly recommend “eating to your meter.” We encourage intermittent fasting. “No sugar, no starches.”

At the bottom of the circle is the Standard American Diet (SAD), which is high-carb, high-fat, without limits on calories or carbohydrates. It can be vegan/vegetarian or non-vegetarian. We do NOT recommend this approach!

In the center of the circle is the U.S. Department of Agriculture (USDA) MyPlate, representing the “Five Food Groups” (Fruit, Vegetables, Grains, Protein, and Dairy). It promotes low-fat or fat-free. The only advantage it has over the SAD is that high carbs and high fat will not be eaten together.

At the right of the circle is the ADA (American Diabetes Association)‘s plate method, not requiring counting of carbs or calories. Since 2019, the ADA has been promoting what they consider low-carb (50-100 grams of net carbs/day) or very low carb (20-50 grams of net carbs/day). It supports vegan/vegetarian and non-vegetarian.

At the left of the circle is high-carb low-fat Dietary Vegan. No meat, eggs, or dairy. No limit on carbohydrates or calories. It promotes eating unprocessed foods, “no sugar, no oils.” They encourage eating as much rice, potatoes, and oatmeal as you want; but they do not recommend testing foods with a blood glucose meter. We do NOT recommend this approach.

 

References

American Diabetes Association. “Standards of Medical Care in Diabetes—2020 Abridged for Primary Care Providers”  ©2019 by the American Diabetes Association. https://clinical.diabetesjournals.org/content/38/1/10 (accessed on 7/17/2020).

American Diabetes Association. “Understanding Carbs,” (1995-2020). https://www.diabetes.org/nutrition/understanding-carbs (accessed on 7/17/2020).
Official ADA website.

Diabetes Care. “Standards of Medical Care in diabetes—2020” (January 2020).
https://care.diabetesjournals.org/content/diacare/suppl/2019/12/20/43.Supplement_1.DC1/Standards_of_Care_2020.pdf (accessed 7/17/2020).
The complete 224-page book in PDF format.

Diabetes.co.uk. “Very low carb Bernstein diet leads to exceptional type 1 diabetes control” Diabetes.co.uk (May 8, 2018). https://www.diabetes.co.uk/News/2018/May/very-low-carb-bernstein-diet-leads-to-exceptional-type-1-diabetes-control-91241367.html (accessed on 7/17/2020).

Diabetes Forum. “A New Low-Carb Guide for Beginners,” Diabetes.co.uk (December 9, 2014). http://www.diabetes.co.uk/forum/threads/a-new-low-carb-guide-for-beginners.68695/ (accessed 7/17/2020).
Discussion in “Low-carb Diet Forum”

Evert, Alison B., et. al. Corresponding author: William S. Yancy, Jr. “Nutrition Therapy for Adults with Diabetes or Prediabetes: A Consensus Report,” Diabetes Care 2019 May; 42(5): 731-754. https://doi.org/10.2337/dci19-0014. https://care.diabetesjournals.org/content/42/5/731 (accessed on 7/17/2020). Available online or as a PDF file.

“How to Eat Low Carb as a Vegan or Vegetarian,” Virta Health (February 28, 2018). https://blog.virtahealth.com/vegan-vegetarian-low-carb-keto/ (accessed on 7/17/2020).

Jessica, MS, NTP. “The SAD Diet,” Food Foundation (January 27, 2015). https://foodfoundation.guru/blog/2015/01/27/the-sad-diet (accessed on 7/17/2020).
The Standard American Dietary Guidelines have often been referred to as the SAD diet in the holistic health community. We are speaking of the sad results in health when people eat the processed foods recommended to us by a nation that profits from our poor food purchases.

Lundberg, George, MD, Editor-at-Large. “Low-Fat, High-Carb Diets Reverse Insulin Resistance”
MedPage Today, February 28, 2012. https://www.medpagetoday.com/Columns/At-Large/31400 (accessed on 7/17/2020).