STUDENT CONTRIBUTOR: Michael Sheng | School of Nutrition, Ryerson University
October 29, 2020
Managing Diabetes with Nutrition:
As stated in our "How to be a Diabada**" blog published earlier this month, there is no shortage of evidence showing that a healthful eating pattern - Mediterranean, vegetarian, vegan, keto, Portfolio and DASH eating patterns, to name a few - and regular physical activity are key components in diabetes management. Health Canada recommends at least 150 minutes of low-moderate daily aerobic activity in 10-minute bouts for adults, with 2-3 days of muscle-building activities per week. In this blog, we will cover three eating patterns and provide additional detail as to what the diets are all about and how they provide benefit to self-management of diabetes.
Just the Basics is a simple diabetes management plan developed by Diabetes Canada that divides your plate into three sections: one half vegetables, one quarter grains and starches, and one quarter meats and alternatives, with a glass of milk and fruit along with your meal.
Just the Basics also provides some tips for diabetes management which are
Eat 3 meals, 2 snacks per day - no more than six hours apart
Choose high-fibre foods; such as whole grain breads and cereals, lentils, peas, brown rice, fruits, and vegetablesDrink water when thirsty - try for 6-8 cups per day
Get active for at least 30 minutes every day, with 2 days being resistance or weights
Limit sugars and sweets; such as honey, candies, and jams
Limit high-fat foods; such as fast food, chips, and pastries
Limit alcohol consumption
Just the Basics also provides sample meal plans for small and large appetites.
For smaller appetites: For bigger appetites:
THE MEDITERRANEAN DIET
The Mediterranean Diet is based on traditional foods eaten in the 1960s in countries such as Italy and Greece. The diet is rich in fruits and vegetables, plant-based proteins, whole grain carbohydrates, seafood, and extra virgin olive oil. The diet also has moderate consumption of poultry, eggs, cheese and yogurt, rare consumption of red meat, and no consumption of added sugars, processed meat, and refined grains. Remember, 1960s Greece didn’t have the same abundance of highly processed foods that we do today, so if you can’t imagine Coca Cola being a staple in the 1960s Greek diet, it’s probably not a good fit for the Mediterranean diet.
Research suggests that the Mediterranean diet is very beneficial for type-2 diabetes, as it is shown to improve glycemic control (blood sugar management), as well as slow the development of type-2 diabetes from pre-diabetes. Unlike the keto diet, there are no major health risks associated with the Mediterranean diet, and there is a stronger foundation of research supporting the Mediterranean diet for diabetes management.
VEGETARIAN & VEGAN DIETS
The vegetarian diet is a diet that excludes meat products such as chicken, beef, and pork. The vegan diet also excludes meat products, but also excludes all animal byproducts, such as milk from cows, honey from bees, gelatin from pork, or eggs from chickens. The lack of animal products in these diets mean the vegetarian and vegan diets can also minimize your carbon footprint, so you’re improving both your own and the planet’s health at the same time!
Both vegetarian and vegan diets are shown to improve glycemic control, helping with diabetes management, since many foods in the vegan and vegetarian diet have a low glycemic index, meaning that they cause a slower rise in blood sugar. This is especially helpful for those with type-2 diabetes, as lowering it can lead to restored insulin sensitivity in the body. Vegetarian and vegan diets can also aid diabetes management through weight loss, thanks to increased vegetable intake, which are not calorically dense, but still take up space in your stomach. This means that you feel fuller with less calories, leading to manageable weight loss.
THE KETOGENIC DIET
The ketogenic diet, a.k.a. the ‘keto diet’, is a diet low in carbohydrates (<30g CHO/day), moderate in protein and higher in fat. This eating pattern got its name from the process the body undergoes when there are such low levels of carbohydrates provide to it through food; ketosis. In this state, the body switches from to burning calories to burning fat stores, producing ketones; a compound used for energy instead of carbohydrates.
A ketogenic diet decreases the body’s need for insulin production, as insulin's main purpose is to reduce the amount of sugar in the blood from carbohydrate intake through diet.. As a result, the keto diet can help to maintain blood sugars within target range while reducing the body’s exogenous (external) insulin requirements. Two great benefits for people with both type 2 and type 1 diabetes.
Following the keto diet is also shown to lead to improved weight loss and helps to reduce appetite; another potential benefit to diabetes management, especially for those challenged by type 2 diabetes. Since insulin requirements are typically lower than usual on a keto diet, it’s also possible that the body’s insulin sensitivity can be restored - especially helpful for self-management of type 2 diabetes.
Potential Risks of a Keto Diet
Choosing a keto diet has its drawbacks. As your body switches from carbohydrates for energy to fat for energy, your body will lose salts and minerals. To combat this, Health Canada recommends making water your drink of choice, staying hydrated throughout the day. Be sure to also add some sea salt to your food and get your potassium (K) and magnesium (Mg) from healthy foods; such as nuts, fish, dairy, and vegetables.
When transitioning to a keto diet, be sure to not only count how much carbohydrates are in your diet, but also the type of carbohydrates. Include more complex, whole grains and fibre rich foods such as oats, popcorn, or brown rice.
Many people who have tried or adapted to a keto diet have experienced what’s known as ‘keto-flu’ within the first few weeks. This involves brain fogs, dizziness, fatigue, insomnia, and cravings. To combat keto-flu, it’s recommended that you slowly reduce your daily carbohydrate intake, rather than jumping in at the deep end of keto and eliminating ALL sources of carbs completely. Temporarily increasing sodium intake or taking a magnesium supplement may help ease this side-effect during the transition phase.
There is limited evidence to support the switch for people with diabetes to a ketogenic eating pattern. Some research has spotlighted an increase risk in cardiovascular disease and other undesirable long-term health consequences following a keto-diet. The keto diet has also been connected with eating disorder development. People with type 1 diabetes are at risk of increased hypoglycemia - low blood sugar - due to the lack of carbohydrates to stabilize blood sugars, and potentially diabetic ketoacidosis (DKA) due to the dramatically reduced infusion of exogenous (external) insulin. Listen to your body and speak with a physician or registered dietitian to make you’re not putting yourself at risk for other health problems.
TRUST YOUR INTUITION!
When transitioning to a new diet, it’s always important to make sure that it fits your lifestyle and your body. Research has shown that intuitive eating can be used to manage blood sugar levels in both type 1 diabetes and type 2 diabetes.
Intuitive Eating is the practice of being aware of your body’s response to food and adjusting your eating habits accordingly. The Intuitive Eating Scale (IES) is a scale from 1-10 that measures how satiated (satisfied) you feel after eating a meal. Level 1 means you are starving. Level 10 means you feel stuffed and uncomfortable, to the point of feeling sick. Landing in the middle around 5, means you are neutral; not hungry, but not full.
The twist is that many times we eat mindlessly when we are bored, depressed, anxious or because we have gotten in the habit of social snacking when watching TV or chatting with friends. Studies show that by listening to your body and reflecting on how hungry you really are, eating intuitively can reduce the chances of poor glycemic (blood sugar) control by up to 89%.
THE FINAL WORD
All diets covered today have positive benefits for diabetes management, each with their pros and cons. Be sure to consult a physician or registered dietitian before embarking on a new diet that drastically changes your regular eating habits, or amount of food eaten.
Overall, it seems like the ketogenic diet might pose the greatest risk, is the most restrictive diets and unsustainable approaches. In contrast, Just-the-Basics allows more freedom when meal planning and variety in enjoying a wide selection of foods. Diabetes Canada provides infographics and tips to make it easy for anyone to follow. The Mediterranean diet is very flexible, is not very limiting in what foods you can eat and poses no major health risks! Vegetarian and vegan diets are also great for those who prefer a plant-based lifestyle or have required dietary restrictions due to other health concerns (co-morbidities), and has a smaller carbon footprint than other diets. With all these diets for diabetes management, it’s time to take your pick, and fill your plate!