The diabetes prescription is the conversation I wish I could have with all of my patients. I, like most doctors, love to teach. However, we just don’t have the time in clinic to teach in depth. So, this website is a growing body of information that I want my patients to know. Most of this information you can find other places on the internet, but it is broken up into little nuggets of knowledge here and there, interspersed with useless or conflicting information.
So what is the first thing I want you to know? I want you to know what diabetes actually is (link opens in new window). After reading the above link , it should be clear that diabetes is a problem of metabolism, and that the primary treatment for it is nutrition.
From there, it follows that you must take great interest in the food and substances you put in your body, and must place yourself in a position where you have total control over what you eat and drink. I am adamant that cooking is the single most important skill someone with diabetes can have. Being prepare your own food puts you in control of your health.
I know time is an issue for many people, but do not sell yourself short. Lack of time is not an excuse to treat yourself. You DO have the time once you make your health a priority. Your body is out of balance, and you need to heal it- Nothing is more important than your health. Your job is not more important than your health- How will you work if you develop serious complications? Your spouse and kids are not more important that your health- How will you love them and support them if something happens to you because you did not take care of your body? If you do not find invest the time into your health, you are mortgaging your future to have an easier present.
WHAT SHOULD SOMEONE WITH INSULIN RESISTANCE OR DIABETES BE EATING?
This is a controversial subject. There is no consensus on the “best” diet for diabetes, as you can tell by reading the 2019 American Diabetes Association guidelines section on nutrition. Everyone agrees that calorie deficits are needed to trigger weight loss, and nearly everyone agrees that diet with a large component of vegetables is important, but outside of these concepts there are differing professional opinions. Let me explain why many endocrinologists, including myself, are convinced that carbohydrate restriction is important.
It is a fact that carbohydrates stimulate a much higher blood glucose rise than an equivalent number of calories from protein or fat. It is also a fact that carbohydrates require more insulin than protein or fat in order to be used by your cells as metabolic fuel. Based off these facts, many physicians speculate that shifting food consumption to more fat and protein will result in smaller glucose spikes and lowe1r insulin requirement from the pancreas. This helps treat the dysregulated appetite and makes it easier to restrict food consumption and lose weight. This then directly results in fewer medications to treat diabetes. And in some people, with enough time for the pancreas to heal and enough weight loss to eliminate insulin resistance, resulting in remission of diabetes.
So when I say you need to restrict carbohydrates, I do it because there is a high biological plausibility that lower carbohydrate diets are advantageous for people with diabetes. If you want to go deeper into the scientific argument for low carbohydrate diets in treating diabetes, start here.
But what about vegetarian and vegan diets? Aren’t they high in carbohydrates? Are you saying that these are not good for people with diabetes?
No, I am not saying that. These diets, if done properly, also severely restrict caloric intake and actually also restrict carbohydrates as well. These diets will result in lower insulin requirement, reduced glucose fluctuations, weight loss, lower insulin resistance, and have the potential to trigger remission of diabetes as well. I am wholeheartedly in support of this approach to diabetes. I personally have many vegetarian recipes in my diet, and there are over a dozen vegetarian options in the diabetes prescription mealplan. Most of my patients still want to eat meat and/or fish, and this is perfectly fine. If you prefer the vegetarian/vegan approach to diet, I think a another good website besides mine is Forks Over Knives.
What about other popular low carbohydrate diets?
There is a wide range of definitions of “low carbohydrate”, and many of these diets restrict carbohydrates severely. Popular examples include the “keto” diet, Atkins Diet, and the Bernstein Diabetes Solution. Others popular diets restrict carbohydrates far more modestly, such as the Mediterranean Diet or the South Beach Diet, and these diets may focus on the types of carbohydrates consumed. I have patients that have been on every one of these diets and have had success.
However, I personally can’t live with any of these diets. The extreme low carbohydrate diets are too boring to be maintained long term, and the Mediterranean/South Beach diets are too puritanical from the standpoint of the types of carbohydrates that are recommended. There is not a single person on the planet that actually likes whole grain rice or whole grain pasta. (If you think you like these two culinary abominations more than real pasta or white rice, then you are lying to yourself. Just kidding… ; ) )
How far should I restrict my carbohydrates?
The approach I recommend for most of my patients is to restrict carbohydrates to about 30% of caloric intake, which still allows people the flexibility to eat real food, but restricts carbohydrates enough to provide the blood glucose control benefit. (Also, you will find it very hard to eat junk food if you are eating only 30% carb)
For simplicity, my daily carbohydrate cutoff recommendation for most people with diabetes is 100 grams per day. This is 30% of an ~1300 cal/day diet. Most people will lose weight at that calorie intake, which is the goal for most people with type 2 diabetes, and for many people with type 1 diabetes. For some larger men, I may relax this restriction, and for some patients we need to tighten the restriction to less that 100 grams.
I have tried to diet before and failed. I feel like it’s hopeless. How do I make it work this time?
As I’m sure you already know, going “on a diet” for a few months will help while you’re on it, but once you stop all of your progress will eventually fade. There are innumerable diets you can use to quickly lose weight, but the uncomfortable truth is that if you can’t do the diet forever, it isn’t going to give you the results you want. Contrary to popular thought, most people do not fail diets due to a lack of willpower. In my experience, people fail in changing their diets for one of 4 reasons:
- The diet did not give them the results they were looking for. This is usually due to expectations that were too high or not actually following closely enough to the diet in the first place.
- The diet is too boring to stick too long term, such as extreme calorie restriction or diets that eliminate entire food groups.
- The person has not learned to cook and is not prepared to invest the time in meal preparation, so they rely on others (companies, people) to make the food for them.
- Failure of planning and organization. Being unable to keep up with amount of meal planning needed, which causes them to fall back into old habits.
The key to successful change are proper expectations and proper implementation. Looking up meals for an entire week and making shopping lists can be very intimidating in the beginning, and is a barrier many people never overcome. The 30 day mealplan here on the diabetes prescription will ease you into this, setting you up for success.
The diabetes prescription diet is based on 6 principles.
- Food should be enjoyable. Food is not the enemy, it is nourishment to be enjoyed.
- Cooking is a part of life, but must be practical. While you need to make time in your life for preparing meals, we need to plan on preparing meals that are not too complicated or take too much time. You need to find about an hour in your day for food preparation, it is not too much to ask.
- The diet must be economical. Routine meals should not require expensive and rare ingredients.
- Diets should be plant predominant. Eating meat, fish, dairy, and grains can be perfectly healthy, but you will not likely achieve your health goals without routinely eating vegetables. I don’t believe people when they say they don’t like vegetables. They just haven’t had them prepared properly.
- The diet must be self-reliant. YOU (not your spouse, not your parents, not your kids, not some company) need to be able to prepare your food. You are in control of what you eat when you make it yourself. It does not matter if your kids are picky eaters, or your spouse does not support your nutrition goals. YOU still are in control.
- Diets for people with diabetes should be carbohydrate restricted. To achieve success, you need to invest time in learning to identify carbohydrates and structure your diet so that you don’t rely on them to be full and satisfied.
What skills do I need in order to treat diabetes?
If you have been diagnosed with diabetes and you have never met with a certified diabetes educator (CDE) you need to go ahead and schedule an appointment with one. CDEs have extensive training in how to teach people how to treat their diabetes. The diabetes prescription focuses on nutrition, but there are 6 other skills to learn in the long term. Read more about diabetes education here (CDC) and here (AADE).
To start treating diabetes, you need 4 basic skills:
1. How to read food labels (link goes to a video on the ADA website)
2. How to measure the amount of a serving
3. Know the difference between carbohydrates, fats, and proteins.
4. How perform basic cooking skills
To fully treat diabetes, you eventually need to master 2 more complex skills:
5. How to counting and restrict carbohydrate intake
6. How to make a meal plan