Healthy Diabetes Diets

Gretchen Becker Health Guide
  • Well, we got through the holiday season. Mostly. A new year is upon us, and this is the time when many people evaluate their diets, looking for something better.

    When you have diabetes, you'll get advice from all sorts of dietary experts, some of them telling you to eat lots of carbohydrate and very little fat and others telling you the exact opposite, to eat very little carbohydrate and not worry about the fat. Others will propose something in between.

    Even within diet groups the opinions differ. Some proponents of low-carb diets say you can eat any kind of fat you want as long as you severely curtail your intake of carbs (for example, the original Atkins diet, which was heavy on rib roasts and sour cream). Others tell you to limit the saturated fat and concentrate on monounsaturated fat instead (for example, the Four Corners diet, which I coauthored). And others want you to focus on getting enough protein so you won't break down your muscle tissue (for example, the Protein Power diet of the Eadeses).

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    There are so many studies of diets that you can pretty much find a study to back up any theory you have. And the definition of "low carb" or "low fat" may differ from study to study. So one study might conclude that "low carb" diets (with 140 g of carbs a day) did one thing whereas another study might conclude that "low carb" diets (with 50 g of carbs a day) did something quite different.


    If you were following a recommended 60% carbohydrate diet with 2000 calories a day, that would work out to 300 grams of carbs a day. Compared with this, a diet with 150 g of carbs would be considered "low carb." Another group might test a really low carb diet of 50 g a day vs a "high carb" diet of 150 g a day. That would mean that in one test the same level of carbohydrate would be labeled "high carb" in one study and "low carb" in another.


    Most people don't notice these discrepancies when they read diet studies in the popular press (which often omits such details) or even when they read the entire papers. So it's easy to cite the study that supports the conclusion you believe in.

    The same problem affects the use of the word "healthy." You could eat what I would consider a pretty healthy low-fat diet, and you could also eat what I consider a pretty unhealthy low-fat diet. The same applies to low-carb diets. (I'm using the two extremes here to make a point.) For example, here are two menus in what I'd consider both unhealthy and healthy versions of the low-fat and low-carb diets (alas, a tad difficult to read because of the way the table is uploaded).






    Although I haven't put these menus into a nutritional program, so they might differ in caloric content, I think they'd all be considered appropriate by people on a low-fat or a low-carb diet. If you compared the unhealthier diets at the left, you'd most likely see big differences in various metabolic parameters, including postprandial blood glucose (BG) levels and postprandial lipid levels.

  • But there's less difference in the diets on the right. They both contain vegetables and fruits. They both include salad. There's more fat in the low-carb menus and more carbs in the low-fat menus. But depending on your type of diabetes and how many beta cells you have left, whether or not you're using insulin or oral drugs, how much insulin resistance you have, your activity level, and your personal tastes, some people could control well with either the healthier low-fat diet or the healthier low-carb diet.

    Perhaps some people could control well on the less healthy low-fat diet if they injected insulin to cover the high carb loads, but they'd most likely be bouncing around between highs and lows all day, and this is not very healthy.

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    One could control BG levels with the less healthy low-carb diet, but postprandial lipid levels would be quite high, and I myself would feel nauseated with all that fat.

    What this means is that you should first try to apply any diet philosophy in a healthy way. Almost everyone agrees that nonstarchy vegetables are healthy. Everyone agrees that we need some protein in our diet, and as long as it's lean, both dietary camps (except vegans) approve of fish and chicken.


    Most people agree that we need more omega-3 and less omega-6 unsaturated fatty acids. In general, whole unprocessed foods, the kinds you find in the outer aisles of the supermarket, are healthier than the processed junk you find on the inside aisles. The healthier versions of both diet approaches have a lot in common: protein, salad, vegetables, fruit, minimally processed foods, and not a lot of vegetable oils.

    Second, rather than following what the media report is the latest "best" diet, you should see what is the best diet for you. Try different approaches. Use your meter to test your postprandial as well as your fasting and premeal BG levels, and make sure that the eating plan you choose keeps those numbers at a level you can live with.

    Also, make sure you get your lipid levels tested regularly. Unfortunately, the fasting lipid levels -- like fasting BG levels -- won't tell you what is happening with your lipid levels between meals. You can buy lipid meters that work like the BG meters. You insert a strip, put some blood on the strip, and get a reading. But unfortunately, the strips are more expensive than the BG strips, and it's unlikely your insurance will cover them.

    Finally, make sure that whatever diet plan you follow is one that you can enjoy in the long term. If you don't like fat but you crave bread and apples and pears, it won't work to go on a low-carb diet no matter how much it helps your BG levels. Conversely, if you can't live without butter and beef, there's no point in trying a vegetarian low-fat diet even if it works for you in the short term.

    We're in this for the long haul. There are a lot of delicious foods that you can make no matter what dietary approach you choose. Sometimes it takes a little more time to prepare them. But in the long run, as someone diagnosed with type 2 diabetes said, "This has been the best thing that ever happened to me" because it forced her to improve her eating habits and lose a lot of weight.

  • As someone else once said, "The best way to live a long life is to get a chronic disease that makes you take care of yourself." And once we get beyond craving junky snack foods, it makes us eat tastier food as well. Enjoy!

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Published On: December 30, 2008