There is more than ONE way to eat healthy with Diabetes! Last weekend I attended a a Nutrition Conference which had me saying….wait…what? Here I was, listening to a guy with diabetes who keeps his carbohydrate intake as low as possible all the time.
No starchy vegetables, grains, fruit, dairy or sweets. This is how Adam Brown manages his diabetes. For him, it works. He would rather skip all foods with carbohydrate than deal with the increase in glucose level that makes him feel ill. I had never heard of anyone with diabetes choosing to give up carbohydrates completely. I know I couldn’t do it. But Mr. Brown has dealt with type 1 diabetes every day since he was twelve.
Diabetes is a complex puzzle that affects people in many different ways.
I really respect Adam and admire his ability to figure out what works for him.
Not one Way to Eat Healthy
Personally, I’ve always been a fan of eating moderate amounts of mostly healthy foods from all the food groups. I’m comfortable with this approach and understand its nutritional value. But I also understand that there is not a “one size fits all” way to eat.
A qualified registered dietitian nutritionist is open-minded. We work with individuals on their personal goals. We take their preferences and combine them with our knowledge to come up with a good nutrition plan. Think of it as a game plan that a coach maps out to guide his team to victory.
When the low carbohydrate Atkins diet came out after the low-fat diets of the 1980’s I figured it was just the latest fad. Fad diets make me crazy! They are restrictive, not based on what your body is telling you, and use non-science based diet “rules.” Most people can’t maintain the restrictions and gain their weight back (and often, more). This “failure” often ends up hurting people psychologically and physically.
However, now that over twenty years have passed since the “low carb” craze began, there are sufficient reputable studies on low carbohydrate (26-45% of total calories) and very low carbohydrate (20-50g/day) eating plans. There is now credible evidence that these plans have potential to:
help reduce your A1C;
assist in weight loss;
lower blood pressure; and
lower your triglyceride level.
Needless to say, this is big news.
So, I am revising my thinking.
For years, the Institute of Medicine reported there is no benefit to consuming less than 130g of carbohydrate a day. The American Diabetes Association and the Academy of Nutrition and Dietetics do recommend an individualized nutrition plan. However, since most people don’t follow that recommendation, the educational materials then suggest 45 to 60 grams of carbohydrate per meal.
Interestingly, the 2019 American Diabetes Association (ADA) Nutrition Consensus Report did not find any research to support those recommended amounts. They have been removed from ADA patient website and publications.
It is disconcerting when new research shows what we thought was true might not be so.
However, it is also exciting. That’s what science offers – education and new possibilities. After my head stopped spinning from the new evidence on very low carbohydrate plans, I am now prepared to help people try it if they choose. It provides another possible solution to client’s problem. Adapting, learning and helping, that’s how good dietitians roll.
Nutrition is a science. When new evidence comes along and has been replicated in peer-reviewed studies, the recommendations change. Margarine used to be preferred over butter. However, that changed when we discovered that the trans-fat in margarine was not conducive to good health.
However, don’t confuse real science with “fad science.” Don’t be misled by some super diet product that touts “a” study. Be alert for people who are just trying to sell you a product or push a political agenda. Good science is replicated over several studies and peer-reviewed for legitimacy. Studies are only as good as the data they analyze.
When evaluating a study it is good to remember that nutrition studies are incredibly complex because of the number of variables that have to be controlled.
What am I talking about? Well, they involve humans eating. If you replace one nutrient or a food with another it affects other aspects of the diet. Replace an orange with a prune and you may trade one benefit for another. There’s a complex interplay among nutrients. In addition, it is difficult to accurately record food intake. The results are also confounded by other healthy lifestyle behaviors. For example, two people may say they “work out regularly.” If one person primarily lifts weights and the other runs, their nutritional intake may affect them in different ways.
Finally, nutrition studies, in general, analyze small sample sizes and last 3 to 6 months at most. The bottom line– evidence is limited.
So what should you do?
Because all the best diets — Mediterranean, Flexitarian, DASH (Dietary Approached to Stop Hypertension), and US Dietary Guidelines for Americans — promote vegetables, fiber-rich carbohydrates and limit added sugar and refined grains, focusing on more vegetables and carbohydrates with fiber, and less sugar and refined grains, is a good move. Small steps add up.
The most effective eating plan is the one you will follow. The best plans are customized for each individual. It’s important for you to enjoy your food and how it makes you feel. Thankfully, almost everyone gets to choose how they eat.
I offer Medical Nutrition Therapy (MNT), the service recommended in the American Diabetes Association Standards of Medical Care. I listen. We work together to develop that individualized nutrition plan that works for you. Research (peer reviewed and repeated) shows MNT lowers A1C almost 2% over 3-6 months and is cost effective. That’s as effective as a diabetes drug, and costs less. Why not try it if you are not where you want to be?
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