Low Carb? Fasting? Keto? High fat? No fat? Just google ‘Diabetes Diet’ and your screen will be flooded with an overwhelming number to choose from. Along with these options, comes a load of misinformation which makes choosing the right diet for you unnecessarily complicated. Never fear, Fuel Your Life is here to filter through the mounds of information to help you decide which dietary strategy may be the best fit for you*
*The following article discusses the general pros and cons of a number of common diets, however, dietary intervention should be discussed with your dietitian and GP before commencing to ensure it is the right fit for you!
So, what diets are available and how might they benefit me in managing my diabetes?
Diets & Diabetes
Low Carbohydrate Diet
Carbohydrates are our bodies’ chief source of energy, especially for our brain function. Found in wholegrains, fruit, legumes, starchy vegetables and low-fat dairy, in addition to nutrient-poor foods such as cakes, biscuits, chips, chocolate and other sweets such as soft drink.
Carbohydrates are often the target of diets marketed to those with diabetes, due to their impact on blood sugars. When digested, they break down into sugars which are then transported around our body for energy. Therefore, when eaten, carbohydrates can increase our blood sugar levels, which is why the type and amount we eat needs to be considered, especially in those with diabetes.
This is where the idea of a low carbohydrate diet comes in; the fewer carbs you eat, the less your blood sugars rise? Seems simple, right? Well, it is a little bit more complex than that. Here is what the evidence says to support the use of such an intervention:
- Can be safe* in lowering your blood sugar (blood glucose) levels in the short term
- May reduce body weight
- Can assist in reduce cholesterol levels, HbA1c and blood pressure
- May lead to reduction in diabetes medications. (Diabetes Australia, 2018)
*If you are taking insulin, SGL2 inhibitor medications or hypoglycaemic medications, you will need to discuss altering your medication before trialling a low carb or keto diet, due to risk of hypoglycaemia.
Although promising, there are still some downsides of such an intervention including:
- Restricts core food groups necessary for health including fruit, starchy veg, wholegrains, legumes and low-fat dairy, all of which can play a role in disease prevention, promoting a healthy gut and overall health
- Restrictive nature may increase risk of nutrient inadequacies including dietary fibre, calcium, B-group vitamins and Vitamin C
- May lead to unwanted side effects such as dizziness, headaches, tiredness, constipation and bad breath
- Not appropriate for those on hypoglycaemic medications, children under 18 years, during pregnancy or lactation, those with Type 1 Diabetes, individuals with a history of eating disorders and those with certain health conditions such as kidney or liver failure. (Diabetes Australia, 2018)
What about the Ketogenic Diet?
The keto diet has received a lot of attention over the past few years. But what actually IS a keto diet? Based on the idea of a low carb diet, reducing carbohydrate intake will assist in reducing blood glucose levels. Carbohydrates are restricted even further than a low carb diet, to 30-50g/day and 70-80% of the total daily energy intake from fat. Such a low intake of carbohydrates can put your body into ‘ketosis’ which leads to fat being the chief energy source in the body.
Research has shown that compared with a low kilojoule diet, the ketogenic diet was more favourable in achieving weight loss, improved blood sugar control and greater reduction in diabetes medication. The keto diet has been shown to have greater benefits on these factors, compared to a low carb diet (Bolla et al., 2019).
Although there is some promising evidence to support its use, the long-term implications of low carbohydrate and keto dietary approach remains unclear and requires further investigation, with some evidence contradicting their benefits (Bolla et al., 2019). The same cons from a low-carb diet apply, with many core foods groups being restricted and adverse side effects such as headaches and constipation may occur.
There is much research which indicates carbohydrate quality may be more important than carbohydrate quantity when it comes to improving overall heart health and diabetes management. Additionally, although there is some positive evidence, other research which compared a conventional low energy diet to a low carbohydrate diet, indicated no difference in weight loss and HbA1c in the long-term, despite an initial greater improvement in HbA1c in the lower-carb group (Bolla et al., 2019).
*If you are looking to undertake a low carb diet, discuss this with your Dietitian and diabetes specialists, to ensure your nutrient targets are met, medications are considered to reduce risk of hypoglycaemia and it is safely planned and monitored to reduce risk of adverse health events.
Intermittent fasting has received increasing attention over the past few years. There are many approaches, but two of the most popular include:
- 5:2: where you eat ‘normally’ on 5 days and eat a low kilojoule amount on 2 days of the week
- Time-restricted eating: where you fast for 16 hours/day and eat within an 8-hour window.
Both ideas aim to reduce total energy intake and therefore may assist with weight loss, which can have beneficial impacts on diabetes management. There is also some evidence to show that intermittent fasting may have favourable impacts on our insulin sensitivity and blood glucose control, in addition to blood lipids, which can contribute to improved heart health. In saying this, most of the research into intermittent fasting has been conducted in animal studies and the long-term impacts are not yet well researched (Grajower and Horne, 2019).
As with the low carb diet, ensure you discuss this with your healthcare professionals before undertaking this method as there is a risk of hypoglycaemia depending on your current medication regimen.
A plant-based diet is one based around plant foods, including:
- Legumes and nuts
Foods which are restricted, include:
- Meat, fish and poultry
- Other animal-based products.
This diet is typically high in fibre and low glycaemic sources of carbohydrates (this means they are digested more slowly), two factors which can have positive impacts on blood glucose control and diabetes prevention. A plant-based diet can also assist with weight loss and reduce body fat, both of which can protect the body from insulin resistance and therefore reduce risk/better manage diabetes (McMacken and Shah, 2017).
This style of diet aims to limit processed and refined carbohydrates, in addition to other foods which may worsen diabetes control and risk such as processed meats and excessive meat consumption, due to their contribution to excessive saturated fat intakes and increased inflammation in the body (McMacken and Shah, 2017).
Will you see the same benefits if you eat highly processed vegan foods? This is unlikely. The premise behind the benefits of a plant-based diet is consuming more whole foods as described above.
Thinking about going plant-based? Speak with one of our wonderful dietitians. It is essential your plant-based diet is well-planned, with the assistance from a dietitian, as certain nutrient such as Iron, Vitamin B12 and Calcium are at-risk.
A Mediterranean diet is one which has been studied in depth. This diet style encourages regular consumption of:
- Nuts and legumes
- Olive oil
- Lean protein such as fish and chicken
It also recommends limiting the consumption of red meat, dairy products and ultra-processed foods.
Due to the nutrient-dense nature of the diet, filled with vitamins, minerals, antioxidants, ‘good’ fats and fibre, the health benefits are immense. This diet style typically consists of lower glycaemic index foods, which can have favourable impacts on blood sugar control. A large study demonstrated that those who complied with this diet style had a lower HbA1c (reflecting blood sugar control), lower body mass index, better cardiovascular health markers and reduced inflammation in the body (Vitale et al., 2018). This makes it a great dietary style to follow, for those with diabetes! It is also one of few diets which has been studied in the long-term, supporting the above benefits and idea that it can be adhered to.
So, Which Diet is Best for Diabetes?
The diet which is best for you is one which works for you! This includes a diet which takes into account your food preferences, lifestyle, medical history and medications. Does this mean one of the above diets needs to be followed to improve the management of your diabetes? No – even simple changes to our diet and lifestyle can lead to improved diabetes management. Who can help you with that? One of our incredible dietitians of course! Head to our website today and begin your journey in devising a diet plan which fits and works for YOU!