Low Carb other Popular Diets T1D

Low Carb & other Popular Diets

Could they fix our problems with type 1 diabetes?

Michelle MacPhee, D-Mom

Low carb? Low GI? Keto? Paleo? Plant-based? If some of these terms create confusion, you’re not alone! This article clears up the confusion and cuts through the hype, providing a short description of each diet, a clear outline of the included/excluded foods, plus the pros and cons of each dietary program, so you have the power to make an informed choice that fits for your family – for a meal, for a day, or for a lifetime.

Eating low carb is a popular choice – and a source of controversy! - within the type 1 diabetes (T1D) community. Some people feel that it is the best and easiest way to tame the diabetes dragon; others feel that “kids should be kids” and that healthy eating includes more than a splash of carbohydrates.

To further complicate the issue, a low carb diet is often associated with blood sugar management for those with type 2 diabetes who do not take insulin, and are, therefore, more reliant on dietary interventions to keep high blood sugar at bay. I remember when our son was diagnosed with T1D at just over a year old, I turned to the internet for information about diabetes and received a deluge of information on how low fat, low carb diets were the way to go. I was confused, and not yet informed enough to separate the information that was relevant for type 2 diabetes from that relevant to type 1. Low fat for my toddler? Cut out whole milk?! Reduce his carb intake? No more bread or crackers?! Of course, that wasn’t the case, my baby needed whole fat milk and healthy grain products for his growing body and brain.

Whether you decide to change your family's eating patterns or not, information about low carbohydrate options is still valuable for T1D families. If we are informed, then we can make choices that fit best for our unique family – for a meal, for a day, or as a lifestyle. There are times when a low carb meal is the best solution to wrap up a day on the blood sugar rollercoaster. There are days when things start to snowball and I’ve had enough of battling the dragon; I just need to restore some balance and simplify things by reducing the carb intake for all the meals that day (or even a few days in a row). And for some families, the goal is to reduce the swings as much and as often as possible, and so a consistent low carb lifestyle fits best.

Information on low carb alternatives can also be helpful as we make different choices across the lifespan: you may find this information useful for your own dietary goals, separate from your child’s diabetes care. You may want to increase your energy, for example, improve your heart health, lose weight (anyone else have that extra covid 19?) or reduce symptoms associated with food sensitivities. If so, some of the dietary programs here may help you achieve your own health goals. After all, the best thing we can do for our kids is to take good care of their parents!

Does Our Family Eat Low Carb or High Carb? Somewhere In Between?

If you ask a hundred people what a low carb diet is, you may just get a hundred different answers. Even the experts don’t always agree on what qualifies as “low carb”. However, there are some general guidelines¹ that we can use as a point of understanding for this article:

A High Carb diet includes more than 225g of net carbs per day.

Examples include: Vegetarian, Vegan, Flexitarian, Asian

A Moderate Carb diet includes 130 - 225g of net carbs per day.

Examples include: Mediterranean, DASH

A Low Carb diet includes less than 130g of net carbs per day.

Examples include: Paleo, The Zone

A Very Low Carb diet includes less than 70g of net carbs per day.

Examples include: Atkins / Eco-Atkins, South Beach, Bernstein

A Ketogenic (“keto”) diet includes less than 50g of net carbs per day.

“Net carbs”

refers to the amount of carbohydrates available to your body for energy; it’s calculated by subtracting fibre from the total carbs.

Note that these guidelines are for adults. If you are reading this article with your T1D child or teen in mind, then adjust the ranges downward according to how much they eat compared to an average adult. For example, my 13-year old son now eats more than I do, so I wouldn’t change the figures at all, leading me to recognize that he currently eats a Moderate Carb diet. When he was 7 or 8 years old, he ate about half of what I did, so I would have cut these figures in half, estimating that Moderate carb intake for him would have been ~70-110g/day.

LOW CARB

Using the guidelines above, we could say that an adult on a low carb diet consumes fewer than 130g of carbs per day. But within that guideline, different low carb diets vary in the amount of daily net carbs recommended, the foods that are featured and those that are restricted/eliminated, as well as the strictness or flexibility of the guidelines. There are both pros and cons to consistently eating a low amount of carbs:

The Law of Small Numbers: Dr. Richard Bernstein developed his low carb diet based on his friend’s mantra for diabetes management “Big inputs make big mistakes; small inputs make small mistakes.” (Kanji Ishikawa, oldest surviving type 1 diabetic in Japan)¹. The idea is that if you eat a large amount of carbs, you need to give a large amount of insulin, which give rise to large errors in insulin dosing; overdosing leads to hypoglycemia, while underdosing leads to hyperglycemia. But if you eat a small amount of carbohydrates, then there’s less room for error, which results in less variability (fewer and less extreme lows and highs), and, therefore, more Time in Range.¹
More Time in Range means a reduced risk of diabetes-related complications.
Less insulin means lower risk of severe lows.
Less insulin helps with weight management (which may not be a relevant factor for many of our kids with type 1 diabetes, but may be important for adults with T1D).
Diabetes Canada released a Position Statement on Low Carb Diets for Adults with Diabetes in which they note that “Research on lower-(carb) diets have shown improvements in people with type 1 diabetes, including lower A1C levels, reduced insulin requirements, less glucose variability, and weight loss.” The document goes on to say that “Healthy* low or very-low-CHO diets can be considered as one healthy eating pattern for individuals living with type 1 and type 2 diabetes for weight loss, improved glycemic control, and/or to reduce the need for antihyperglycemic therapies.” (emphasis added)

When you switch to low carb eating, there is an increased risk of low BG if you do not adjust your insulin doses, because your insulin sensitivity changes.¹
If you consistently eat less than 55g of carbs/day, you may need more Rescue Glucagon to treat a severe low (your body’s response to Glucagon may decrease on a low carb diet).¹
You may be missing out on some otherwise healthy food choices (whole grains, some fruits, dairy) that are especially important for growing kids. You may be missing some vitamins and minerals found in whole grains and cereals (and so may need supplementation).¹
If you replace the carbs with fat, unhealthy long-term eating patterns result, which can lead to insulin resistance, weight gain, and future cardiovascular disease.
Diabetes demands that we focus on food: counting, measuring, and thinking can turn to obsessing, especially if we are counting carbs in order to limit intake. Kids with T1D are already at increased risk of eating disorders because of this hyper-focus on food; a low carb diet may further increase that risk.¹
When kids (with or without diabetes) feel restricted or controlled, many of them react by rebelling, which may lead to power struggles and unhealthy food choices.
The more restrictive a diet, the harder it is to adhere to it long term, especially for kids and teens who see their peers eating the “fun” stuff.

Examples of Low Carb Diets

Here is a brief description of some common Low Carb diets. You’ll find some overlap between the different approaches, but each has its “niche.”

1. Paleo

The Paleo diet (“paleo” meaning “old, ancient”) focuses on hunter-gatherer-type food that was available before prehistoric humans started growing grain crops. The modern Paleo diet is less “Caveman” and more about picking up proteins and produce, while putting down the low-quality carbs (and dairy, in some variations) that proponents of the diet believe lead to “diseases of civilization” (systemic inflammation, digestive problems, obesity, heart disease, type 2 diabetes). Paleo is a Low Carb, High Protein diet that does not distinguish between lean versus high fat meat, instead taking a “snout to tail”² approach to avoid waste and add variety by using as much of the animal as possible. For example, if you roast a turkey, you would eat the light and the dark meat, the organs, and the skin; you would also boil the carcass for bone broth. Some of my favourite chicken recipes (using skin-on chicken thighs) fit in the Paleo category.

SAY YES to

Meat (beef, pork, bison), organic or grass-fed Fish (salmon, white fish, shrimp, crab, sardines…) Poultry (chicken, turkey, duck…) Eggs Fruits – all are allowed but choose high GI fruits less often – berries are especially Paleo-friendly Vegetables - all are allowed, but focus on non-starchy vegetables, squash, sweet potato, and… Fermented Vegetables (sauerkraut, kimchi…) Seeds & nuts (except peanuts, which are actually legumes, not nuts) Nut butters (almond, cashew, macadamia nut…) Other Healthy Fats (extra-virgin olive oil (EVOO), avocado, coconut oil…)

CUT BACK on

Grains (wheat, rye, barley, oats, cornmeal, buckwheat, rice) and pseudograins (quinoa) Legumes (including peanuts, chick peas, kidney beans, black beans…) Alcohol (which is made from fermented grains) Fruit Juice Sugar White Potatoes Processed Foods And (on a strict Paleo diet): Dairy (milk, cheese, yoghurt, sour cream)

Benefits of Paleo:

Combo of protein and fibre keeps you feeling full, reducing the urge to snack and otherwise over-eat
Low in sodium, as well as the “ates” and “ites” (chemicals like sulfites and nitrates), which are not good for us.
Avoiding processed foods helps avoid the blood sugar rollercoaster.
Makes a good elimination diet if you suspect your body is sensitive to gluten or dairy. You can then add back these back in one at a time to see how your body manages the re-introduction.
Can be followed flexibly so that it’s sustainable.

Tips from the Trenches

I love my rice and chick peas too much to give them up completely, and I find I need the fibre from grains to keep me regular, so we’re not full-time prehistoric eaters in our family. But we really enjoy some paleo dishes (chia pudding is my go-to breakfast) and our family plans for 1 or 2 paleo suppers per week, to restrain our love of all starches, to support healthy weight for us parents, and to help with our son’s blood glucose swings.

~Michelle

Challenges of Paleo:

A strict Paleo diet is restrictive and difficult to maintain long-term for many people
Eliminates healthy food choices: we get lots of fibre from whole grains and legumes; without them, we’re missing out on the fibre that sweeps out the intestine and keeps bowel movements regular. In addition, dairy products are rich in calcium, necessary for bone health. You can get fibre and calcium on a paleo diet, but it takes more effort and planning.
$$$ Meat and poultry are often the focus of the meal, which can be pricey. Especially if you’re consuming them for breakfast, lunch and supper.
The focus on animal protein may mean protein consumption is too high (especially for people with kidney disease).

2. The Wahls Protocol

The Wahls Protocol is a Paleo-adaptation developed by Terry Wahls, MD, that helped her reverse her own Multiple Sclerosis (MS) symptoms, get out of a wheelchair and into a long-distance bike race. The Wahls diet features moderate protein from high quality meat and fish (grass-fed), including organ meat; berries and an abundance of vegetables, including lots of leafy greens, broccoli and fermented veggies.

Benefits of Wahls:

Abundance of healthy vegetables
Increased energy
Improves insulin sensitivity by “reducing the carbohydrate load” of sugar and white flour
Eliminates gluten, a dietary trigger for autoimmune disease for some people (Celiac disease comes to mind first, but also…)
Dr. Wahls has used Paleo to treat autoimmune disorders such as rheumatoid arthritis and lupus. Research on the Wahls diet showed the largest drop in MS-related fatigue ever reported.

Challenges of Wahls:

As with any restrictive diet, it may be difficult to follow long-term, eespecially for those who haven’t experienced the severe symptoms the diet is designed to heal.

3. The Whole 30

Whole 30 is a short-term elimination diet (30 days) designed to help your body heal from the effects of inflammatory foods. Supporters say that it eliminates cravings, heals digestive issues, rebalances hormones, boosts immune functioning and increases mental health (reduces depression).

SAY YES to

Real, whole foods Lots of vegetables Fresh Fruit (very little dried fruit) Lean protein: Fish Poultry Grass-fed beef and pork Nuts and butters (cashew, macadamia, walnuts, almonds) Healthy fats: avocado, olive oil, coconut oil, ghee

COMPLETELY ELIMINATE all traces of:

Grains (wheat, rye, barley, oats, cornmeal, buckwheat, rice) and pseudograins (quinoa) Dairy (milk, cheese, yoghurt, sour cream) Sugar Legumes (including peanuts, chick peas, kidney beans, black beans…) Alcohol Processed Foods

Benefits of Whole 30:

Short term approach – in terms of motivation, we can often follow through on a program for a finite period of time (30 days) when we would otherwise cave if we had to do it indefinitely.
Makes a good elimination diet if you suspect your body is sensitive to gluten, dairy, sugar, legumes, or other foods. You can then add back these back in one at a time to see how your body manages the re-introduction.

Challenges of Whole 30 :

Like any restrictive diet, it may be difficult to follow day-to-day. Especially since it takes an “absolutely no cheating” stance (if you do cheat, you’re back to square 1).
Eliminates grains, so it may be a challenge to get enough dietary fibre, vitamins and minerals.
Some people say that they’re constantly hungry (others say they never feel hungry, so it’s a toss up).
For kids, even 30 days is too long to cut out healthy food choices (grains, dairy, legumes).

4. The Zone Diet®

The Zone Diet® is a commercial diet program, developed by Dr. Barry Sears, that focuses on reducing diet-induced inflammation; you’re “in the Zone” if specific clinical markers, including HbA1C and the level of insulin resistance in the liver, stay within an ideal range. To guide food choices, the company recommends following the Zone® Food Pyramid in which grains and starches are chosen least often, healthy oils and low-fat proteins are chosen more often, and fruits and vegetables are chosen most often. The Zone® is a Low Carb, Low Fat, Moderate Protein diet (that also highlights Low Glycemic Index carbs).

SAY YES to

Carbs from colourful veggies and a little fruit Lean protein (egg whites, fish, poultry, lean beef, low fat dairy) A little mono-unsaturated fat from olive oil, avocado, almonds…

CUT BACK on

Grains and starches (but don’t eliminate them) Avoid starchy fruits/vegetables (potatoes, corn) Avoid fruits/vegetables high in sugar (bananas, raisins) Avoid Processed foods

Benefits of The Zone:

Purported to reduce diet-induced inflammation
Focus on whole foods helps avoid the blood sugar rollercoaster (which improves energy and mental focus)
Promotes a healthy body weight

Challenges of the Zone:

Although grains are not eliminated entirely, intake is restricted, so it may be a challenge to get enough dietary fibre
Many healthy food choices are restricted (whole-grain bread, cereal, and pasta; beans and legumes; some fruits)
May be too high in protein for some people (those with kidney disease, for example)

5. The South Beach Diet

The South Beach diet is not a strict “low carb” diet, though it is lower-carb than a typical meal plan. South Beach draws a line between what it considers “good” carbs/fats and “unhealthy” carbs/fats. It does not eliminate the whole category of carbohydrates but focuses on the quality of the carbs: low glycemic index (GI) carbs are allowed; high glycemic index carbs are avoided.

SAY YES to

Non-starchy vegetables Fish Eggs Protein (chicken, turkey) Whole grains / Low GI carbs (whole grain bread, pasta, cereals; brown rice) Nuts Mono-unsaturated fats (olive oil, avocado) Omega-3 fatty acids (fish, walnuts) Saturated Fat such as: Full-fat dairy (cottage cheese) Coconut Milk, Coconut Oil

CUT BACK on

High GI carbs (white bread, white potatoes, watermelon) Trans fats Omega 6 vegetable oils

Benefits of South Beach:

Inclusion of low glycemic index (GI) carbs helps keep metabolism and blood glucose steady, and helps you feel full longer
Snacking is ok
No calorie counting

Challenges of South Beach:

Like any restrictive diet, it may be difficult to follow day-to-day, and over the long-term.

6. Atkins / Eco Atkins

Those who follow the Atkins / Eco Atkins diet limit the total amount of carbs consumed across the day, as well as the amount eaten at any snack or meal. Atkins Diet was the original version; it was criticized for being rule-bound and skewing a person’s overall diet away from healthy, balanced eating. Eco Atkins is the re-modeled, healthier version, which provides general guidelines within which you can choose the food habits that fit your needs. One key change is that unhealthy fats that can create cardiovascular problems (fatty meats, butter) were replaced with healthier, plant-based fats (nut butters, seeds, avocado, healthy oils). Atkins is a Very Low Carb, High Fat, High Protein diet; Eco-Atkins is a Very Low Carb, High Plant Fat, Moderate Protein diet.

SAY YES to

Atkins:

Protein & Fat (Chicken, Meat, Eggs) Leafy greens Low carb vegetables As low as 10% of calories from carbohydrates (when beginning the diet, only 20g/day of net carbs are allowed – that’s REALLY low!)

Eco-Atkins:

Vegetables Fruit Whole Grain Bread and Cereals Oats 31% of daily calories from plant proteins (veggie burgers, tofu turkey, lentils, soybeans, tofu, tempeh, seitan) 43% from plant fats (nut butters, seeds, avocado, canola oil, flax seed oil, walnut oil) 26% from carbs (from the sources above)

CUT BACK on

Atkins / Eco-Atkins:

Grains and starches (but don’t eliminate them) Avoid: Sugar Simple Starches (white bread, white rice, white potatoes, baked goods/pastries)

Eco-Atkins:

Avoid unhealthy fats (fatty meats, butter)

Benefits of Eco-Atkins:

Plenty of protein and healthy fat keeps you feeling full (reducing the urge to snack and otherwise over-eat)
More flexibility than original Atkins diet

Challenges of Eco-Atkins :

Although grains are not eliminated entirely, intake is restricted, and the amount of carbohydrates falls below mainstream and government recommendations for healthy eating
Little guidance is provided, which makes it feel like just an “eat healthy plants” directive.

7. Bernstein Diet

The Bernstein Diet (developed by Dr. Richard* K. Bernstein and outlined in his book “Dr. Bernstein’s Diabetes Solution) is a Very Low Carb, High Protein (LCHP) diet developed with a goal of achieving “normal blood sugars for diabetics,” both type 1 and type 2. [*Not to be confused with the other Dr. (Stanley) Bernstein, the founder of Dr. Bernstein Diet and Health Clinics.] The Bernstein Low Carbohydrate Solution is similar to the original Atkins diet, and has similar pros and cons, in addition to those listed above that apply to low-carb diets in general.

8. Keto Diet

The goal of a Ketogenic (Keto) diet is to bring the body into “ketosis” (state in which the body burns dietary fat AND stored fat for energy, rather than its preferred fuel source, carbohydrates/sugar). To do this based on food intake, carbs are extremely restricted (20- 50g net carbs/day) and fat intake is greatly increased (to 70% of your daily diet). The ketogenic diet was originally developed to treat epilepsy, and is still used for that purpose, as well as for rapid weight loss. A Keto diet is Low Carb, High Fat (LCHF).

SAY YES to

Fatty cuts of meat (bacon; chicken thighs with skin-on) Fatty fish (salmon) Eggs Whole fat milk, cheese and dairy Low carb vegetables (broccoli, cauliflower, cucumbers, lettuce, spinach, kale, kohlrabi, daikon) Nut butter Avocado Mayonnaise Oils (olive, avocado, flaxseed, palm) Ghee (clarified butter)

Eliminate

Grains & Starches (bread, pasta, rice, tortillas…) Sugar (dark chocolate is ok) Starchy vegetables (no carrots, potatoes, turnips) Choose fatty meats over lean ones

Benefits of Keto:

Effective in treating epilepsy
Possible benefits for treating Parkinson’s and Alzheimer’s diseases2
Rapid weight loss for adults who would like to do so

Challenges of Keto :

Any time whole food groups are eliminated, that’s a cause for a pause. In this case, grains are eliminated entirely, removing many healthy food choices, plus their valuable vitamins and minerals; also, it’s a near-impossible challenge to get enough dietary fibre from high-fat food sources, which often leads to constipation.
Keto is one of the most restrictive diets (not easy to follow and difficult to maintain), as well as lowest in overall health. The high fat content may lead to insulin resistance and other health issues, even as a moderate-term habit; a separate fat bolus of insulin may be required for high fat meals
In the beginning some people have general feeling of unwellness, or “Keto flu” (body aches, headache, lethargy, lack of energy). A Keto diet may also increase the risk of painful kidney stones.
Adults: Any weight loss is difficult to maintain once you start eating carbs again.
Children/Teens with T1D: The goal for all kids is to each plenty and a wide variety of healthy foods to support growth, mental fitness and general health. A keto diet doesn’t fit with mainstream healthy eating practices, nor type 1 diabetes management strategies, especially for young people.
Those of us who live with the T1D dragon get nervous when we hear the term “ketones.” For us it goes hand-in-hand with high blood sugar and an under-supply of insulin in the body. We’re right to be concerned, as there’s a fine line between ketosis and diabetic ketoacidosis1, and the risk of someone with type 1 diabetes slipping into DKA on a keto diet (because of low insulin levels to cover carbs, and the absence of endogenous insulin) should not be underestimated.

More on Ketones, DKA & type 1 diabetes:

Ketones & Diabetic Ketoacidosis

MODERATE CARB DIETS

9. Mediterranean Diet

The Mediterranean Diet is so-named because it is rich in foods common in countries that border the Mediterranean Sea, such as Greece, Italy, and Spain. It is a diet low in red meat, sugar and saturated fat, while featuring fish, produce, whole grains, nuts, legumes, olives, traditional dairy products, and herbs and spices. Because of its balanced approach and variety of flavours, it’s consistently rated #1 Diet for Healthy Eating, #1 Easiest Diet to Follow, #1 Diet for Diabetes, and #1 Diet Overall in the U.S. News & World Report annual rankings of popular diets.

SAY YES to

Fish & Seafood (2x/week) Poultry, Eggs, Cheese, Yoghurt in moderation Whole grains Fruits & Veggies Nuts Beans Legumes Olives/olive oil Herbs & spices

CUT BACK on

Red Meat only on special occasions Sweets only on special occasions

Benefits of a Mediterranean Diet:

Very healthy overall diet (nutritionally sound)
Fibre and healthy fats are filling, so you don’t feel hungry
Diverse foods and flavours mean there’s something for almost anyone
Easy to follow for the long-term

Challenges of a Mediterranean Diet:

Hmmm… it doesn’t seem like there are any. Unless you hate olives.

10. The DASH diet

The DASH diet focuses on low-fat, high-fibre foods, while also limiting salt intake. The priority is in the name - Dietary Approaches to Stop Hypertension - which is a great match for you if you want to lower your blood pressure and improve your heart health. This isn’t the case for many T1D kids, so it might not be your go-to dietary regime; but in any case, it’s considered a healthy overall diet for most people, so it’s still worth a look. And if you’re curious about credibility, the DASH diet was created by the US National Heart, Lung, and Blood Institute (NHLBI). DASH is not a Low Carb diet, but it is Low Fat.

SAY YES to

Lean protein (6 oz or less per day of fish and poultry) Whole grains (6-8 servings/day) Fibre-rich vegetables and fruit (6-8 servings/day) Low-Fat Dairy Products Legumes Nuts & Seeds Foods rich in potassium, calcium and magnesium

CUT BACK on

Salt (maximum 2300 mg/day; 1500 is the ideal) Processed Foods Saturated Fats (fatty meats, full-fat dairy, tropical oils) Trans Fats Sugar-sweetened foods and drinks Tropical Oils (Coconut Oil, Palm Oil)

Benefits of DASH:

Very healthy overall diet (nutritionally sound)
Supports healthy blood pressure and heart health (low in sodium and fat)
Supports a healthy body weight (Low in fat)
Low in the “ates” and “ites” (chemicals like sulfites and nitrates are not good for us)
Next to the Mediterranean Diet, DASH gets the most kudos (often placing or tied for #2 in Easiest, Diabetes, and Overall diets in the U.S. News & World Report annual rankings.)

Challenges of DASH:

Requires some effort and mental energy to count servings and track progress toward specific nutrition targets
May be a challenge to stick to the DASH diet if you have a sweet tooth

HIGHER CARB DIETS

11. & 12. Vegetarian & Vegan

A Vegetarian diet cuts out meat, poultry and fish, while a Vegan diet takes that one step further, eliminating all animal products, including eggs, dairy, lard, and honey. Both fall under the category of Plant-Based Since many plant-based protein sources also contain carbohydrates (think of chick peas, black beans, lentils), to get enough protein your carb intake increases, which is why plant-based diets tend to be higher in carbs than a typical diet.

SAY YES to

Fruits & Vegetables Leafy Greens Whole Grains: Oats, brown rice, whole grain bread; Quinoa Legumes, Beans (Black, Kidney), Lentils, Chick Peas Healthy fats: avocados, olive oil, nuts & seeds Plant-protein: tofu, tempeh, seitan, soy milk Almond milk, cashew milk, coconut milk, oat milk A Vegetarian diet also includes: Dairy Eggs

CUT BACK on

Meat, Poultry and Fish A Vegan diet also eliminates: Eggs (and mayonnaise, which contains eggs) Dairy (including whey) Honey Lard Gelatin

Benefits of Vegetarian & Vegan:

Carbohydrates give a boost of energy, which is particularly important for sports and physical activity.
A plant-based diet is nutritionally sound, low in fat and high in fibre.
Low level of saturated fat (often found in animal products) helps with heart health
For some people, the ethics of vegetarian/vegan diets is key: kindness to all animals

Challenges of Vegetarian & Vegan:

If you can't imagine life without meat, then this may be a hard sell for you.
Getting enough protein can be challenge, so extra attention must be given to incorporating plant proteins such as tofu, legumes, and nuts, especially on a Vegan diet.
Extra planning (or even supplementation) is needed to make sure you get the nutrients you need, especially vitamin B12 (which is naturally-occurring only in animal products, such as meat, eggs, shellfish and dairy), vitamin D (found in fish, eggs, and dairy), and omega-3 fatty acids (found in fish/seafood, but also in nuts, seeds and plant oils, which do fit within a vegetarian or vegan diet).

13. Flexitarian

Flexitarian is short for a Flexible Vegetarian Diet (developed by Registered Dietician Dawn Jackson Blatner), which means you eat vegetarian foods most of the time, with an occasional burger or steak when you really want it. Basically, becoming a flexitarian means choosing to eat more plants, and less meat.

SAY YES to

Beans & Lentils Tofu Nuts & Seeds Eggs Fruits & Vegetables Dairy Sugar (in moderation) Spices (and sometimes meat, poultry and fish)

CUT BACK on

Meat, Poultry and Fish Alcohol

Benefits of Flexitarian:

Flexible!
Acceptable range of protein, carbs, and fat makes RD's happy
Easy to follow for the long-term
Next to the Mediterranean Diet, Flexitarian gets the most kudos (often placing or tied for #2 in Easiest, Plant-based, Diabetes, and Overall diets in the U.S. News & World Report annual rankings.)

Challenges of Flexitarian:

If you love a good steak and, like my husband, don’t feel at your best when you forego meat, poultry and fish for more than a day, then this may not be an enjoyable lifestyle for you.

What About the Quality of the Carbs???

Most approaches to diabetes management and meal planning focus on the amount (not the type) of carbs. When we carb-count, we ask: How many carbs are in that bread? And a cup of jasmine rice is treated the same as a cup of brown basmati rice – we bolus for 45g of carbohydrate and call it a day.

But what about the quality of the carbs?

14. Glycemic Index (GI) Diet

A dietary program based on the Glycemic Index scale accounts for this difference between jasmine rice (which is high on the glycemic index) and brown basmati rice (which is low GI), by ranking foods as Low, Moderate or High GI according to how quickly they digest (and therefore, how quickly they affect blood sugar). Foods that are high on the glycemic index raise blood glucose a fair bit, and do so quickly; low GI foods lead to smaller, smoother post-meal BG “spikes”.

SAY YES to

Low GI Carbs (55 and under on the GI scale): Whole grain, whole wheat bread Oats, Barley, Bran Sweet Potato Low GI Fruit such as Apples, Peaches, Pears Most vegetables Chick Peas, Kidney Beans Brown or Wild Rice Yoghurt (without added sugar) Milk Vegetable Juices

CUT BACK on

High GI carbs: White Potatoes White Rice White bread Cookies Candy Corn chips Watermelon and other high GI fruit

Benefits of a Low GI diet :

Includes a wide-range of healthy foods
Slower digestion of low carbs foods means more steady post-meal blood glucose results (smaller spikes and less glucose variability)
Less need for pre-bolusing before meals and snacks (which is always a challenge for my T1D son!)

Challenges of a Low GI diet :

You need to do your homework to find out which foods are low on the glycemic Index, which often means keeping charts and tables and apps at hand.
The diet gives no guidance on how much protein or fat to eat (only carbs)
Because of the slow digestion of low GI foods, there is a greater risk of low blood sugar if the insulin starts working to lower BG before the glucose from the digested carbs enters the bloodstream. To make things worse, if the food is still digesting after the insulin has lost its punch, then the result is persistent highs later. Adjusting the timing of insulin and using an extended bolus can mediate both of these problems.

More on the Glycemic Index:

An introduction to the Glycemic Index

More on Adjusting the Timing of Insulin:

Taming Post-Meal Spikes Caused by Glycemic Index

More on Extended Bolus:

Extended Bolus

Tips from the Trenches

As a family, we have lots of experience dealing with high GI (quickly digesting) foods; we know how long to pre-bolus, and about how long the high GI foods will still be “burning”. But we have less experience with meals that are, as a whole, low on the glycemic index. So eating a purely low GI meal is often a hassle for us. Instead, we have found it simpler to build a moderate glycemic index meal by adding higher GI healthy foods (like watermelon) to an otherwise low GI meal (such as Moroccan Rice and Beans).

~Michelle

The Bottom Line

You can see many themes across the different dietary approaches above… a tendency to reduce grain intake (which may be a reaction to the current over-consumption of bread products and low-quality grains in our North American culture), to reduce sugar (again, I think we tend to overdo it more often than not), and in the heathiest dietary approaches, to eat nutrient-rich foods, lots of fruits and vegetables, with a focus on natural, whole foods (in our family, we call these “foods the way God made ‘em!”) from a variety of food groups. We also do well overall to keep saturated fat and salt in check, consume healthy fats and oils, reduce our consumption of processed foods, hydrate well, eat mindfully, and treat non-naturally-occurring sugar as an occasional treat.

This last point is a sticky one for us T1D families, as fast-acting sugar is medicine for the treatment of lows! But perhaps that’s all the more reason to watch our overall sugar intake and save it for when it’s really needed.

Perhaps we all do best if we follow these more general healthy guidelines, using the more extreme diets only for a short time period and for a specific goal. If we do so, we really can’t go wrong in building health for ourselves and our families.

Wishing you all health, happiness and in-range blood sugars!

-Michelle

References:

Lorraine Anderson, RD, CDE presentation at No Limits for T1D (online), Sept 12, 2020 MANY THANKS TO LORRAINE FOR CONTINUING TO INFORM AND INSPIRE OUR FAMILY!!!
Prevention® Big Book of Diets. 2020, Hearst Magazines, Inc.
The Law of Small Numbers from Dr. Richard Bernstein’s “Diabetes Solution” http://www.diabetes-book.com/laws-small-numbers/

This material has been developed from sources that we believe are accurate, however, as the field of medicine (in particular as it applies to diabetes) is rapidly evolving, the information should not be relied upon, as it is designed for informational purposes only. It should not be used in place of medical advice, instruction and/or treatment. If you have specific questions, please consult your doctor or appropriate health care professional.