My Notes From the Diabetes Summit
An Interview with Franziska Spritzler RD, CDE
Why the Low Carb Diet is Preferred for most People with Diabetes
The benefits of a low carb diet for diabetes is number one at being able to control your blood sugar levels before and after meals. I think a problem is a lot of people will test their blood sugar in the morning and if their on diabetes medication they will be around one hundred and think their good and eat a bowl of oatmeal, take their medications and then not test their blood sugar levels afterwards. If they have something different for breakfast they can maintain more even blood sugar levels. They wouldn’t be hungry a couple hours later, that’s a big one keeping hunger levels at bay by eating a lower carb diet. They may make you feel fuller for a little bit but your going to feel hungry a couple hours later unless you have a lot of fat with it. If you have a lot of fat with it it’s not healthy and your likely to gain weight. That leads me to another benefit of low carb diets it’s much easier to maintain weight on a low carb diet, insulin levels stay low as well as the blood sugar levels, it’s a more enjoyable way of eating. I think people talk themselves into it that they like oatmeal it really doesn’t taste very good unless you add some sweetener to it usually in the form of honey and fruit and think their doing good it’s not, that’s going to increase your sugar levels.
People with type 1 will need insulin regardless even if they ate nothing all day, they would still need to take basil insulin to control their blood sugar but they can take a much lower dosage if they eat less carbohydrates. Let’s say they have ten grams of carbohydrates they may need a unit or two of insulin but that insulin is going to be much more predictable than a meal with fifty to eighty grams of mixed carbohydrates. It’s really hard to estimate exactly how much insulin you need to cover that, how well the insulin will be absorbed. It just makes the blood sugar control so much simpler when you eat less carbohydrates and can take less insulin, it behaves in a much more predictable fashion. People with type 1 tend to have a more difficult time maintaining blood sugar levels and preventing low blood sugar. Eating low carb you need less insulin and your at less risk for low blood sugars and this is huge. Staying away from carbs lowers your insulin requirement and overall improvement with blood sugar control. High levels of exogenous insulin or any kind of insulin can damage your blood vessels you don’t want to have to inject more insulin that you need. Having lower levels is just going to keep you healthier all around. It’s more convenient and it helps prevent the hypo’s, less risk of insulin resistance and decreased cancer risk.
Dr. Bernstein’s 6-12-12 diet that low 30 grams per day I personally don’t think that people with any type of diabetes needs to go that low. Some people it works wonderfully and they don’t mind going that low, other people can eat fifty grams a day and still have good control. Whatever you can do to maintain good blood sugar control it’s going to be based on person to person, it’s not always dependent on how heavy you are or how long you’ve had it. It really is an individual thing you just need to experiment and see how you are with different levels of carbohydrates. I want to present an article that’s an alternative to ‘my plate’ diet because every meal contains a starchy component and I don’t believe every meal needs a starchy component. I believe pretty much almost every meal should contain vegetables and a good protein source but I don’t agree with a glass of milk on the side and I don’t agree with the starches. They have half the plate as higher carb foods, a quarter of the plate is fruit and a quarter of the plate is starch, they don’t specify between starchy and non starchy. The protein could be beans so you have beans for your protein, green peas for your vegetable a fruit and a starch you could wind up with a very high carbohydrate plate. A lot of people don’t know the difference between a low carb and a high carb plate, they think their following the plate method and think this is healthy for people with diabetes and many times it’s just too high in carbohydrates.
I have a handout it’s a low carb alternative to the my plate, half the plate is vegetables, 1/4-1/3 is protein, 1/3 fat and a sliver for fruit and starchy vegetable and that’s an option. Some days you may have some and other days you may not, it’s a good balance of plants and animal products. I am mixed on a vegan diet for diabetics, I did know someone with diabetes that lost a lot of weight on a vegan diet and got his blood sugar under control with it. I think if your very overweight and your problem with insulin resistance are due to being obese that usually works best for people getting blood sugar under control, I don’t think it works for everybody.
I have an article What Happened to my Lipids on a very low carb diet. A certain number of people their cholesterol goes up on a low carb diet, is this harmful in the context of a low carb diet. Are you able to keep your sugar levels low on a low carb diet no one really knows we don’t have enough research. I say find a level your comfortable with and for someone who needs to loose a lot of weight and has problems with blood sugar and insulin levels and loose a lot of weight on a low carb diet but their cholesterol goes up and all their other markers are good if this is ok it very well might be it’s just really hard to say for now. For me personally I follow a very low carb diet about 30-50 net grams, I do subtract the fiber without the fiber included I probably get 70-80 grams. I think that helps keep cholesterol down having a high fiber content and just watching my saturated fat some people don’t. You should be monitored by a doctor low carbohydrate diets and the whole metabolic syndrome thing. Monitored with lipid testing and particle size looking at specific genetic markers like lipoprotein Apo B and some other markers look at your HDL and HD2 levels even if your cholesterol is high, lets say 250 not super high but elevated. But your HDL levels are good that may be cardio protective. Individualize is the key everyone’s numbers are going to be different I don’t think everyone should be shooting for the same target for that cholesterol, you can be higher if all your other numbers are ok.
Subtracting, separating the fiber for net grams we definitely need to subtract half if not all of it. The reason I subtract all of it is the most recent reports I have seen is that soluble fiber that is converted to short chain fatty acids propionate is the only one that can undergo gluconeogenesis and is happening in the intestine. It does not cause it to rise in the blood, it’s not hepatic if anything to me it’s going to lower it. You do get calories certainly but you get calories out of anything. In terms of the effect on your blood sugar there will be people it doesn’t effect the blood sugar so however you want to do it is fine. I don’t think it’s the fiber directly that’s causing that there may be something else that’s going on.
My meals look like starting with breakfast I rotate between two, either two eggs with spinach or kale cooked in a little coconut oil or butter or I’ll have sardines with tomatoes and cucumbers with a little olive oil and vinegar. I’ll have berries on the side blackberries or raspberries with a little bit of yoghurt and some chopped nuts and then I’ll have coffee or tea. For lunch I have almost the same thing everyday I take a couple cups of arugula and a cup of plain greek yoghurt and half an avocado two teaspoons of olive oil, salt and sometimes I’ll have some nuts and berries on the side. It’s great, it’s delicious, mix it all together it takes me a while to eat it and even makes a good dressing. For diner it’s variable some type of meat, fish or chicken and vegetables with some kind of fat, occasionally dairy. I usually don’t have berries after diner but I do have chia seeds that’s another thing I do make a chia seed pudding with some cocoa powder, cinnamon and sea salt.
Some people do well with dairy and some don’t it can be insulinogenic but not in everyone, the glucagon in dairy can raise your blood sugar. Some people find they gain weight with dairy and some people are sensitive to it. For a lot greek yoghurt is ok and cheese but not milk. The biggest thing with grains is they tend to raise blood sugar if you really love grains and you don’t have an autoimmune issue you can have a little grains instead of fruit or something else higher carb at that meal. They can be inflammatory for people with type 1 diabetes and an autoimmune component they should stay away from them altogether. Start with the basics get your carbs under control get yourself on a good macronutrient balance of protein, fat, carbohydrates and then look at the quality is it real food or is it processed food.
I think it’s vital to have in your diet fats, the greatest percentage of your calories are going to come from fat, on a low carb diet it’s the only way to do it. I think 15-20% of your calories in carbs you can’t have seventy percent as protein your going to settle on 20-25% protein the rest is going to be from fat. You need fat but you want to chose high quality fat and that would be non-processed oil no seed oils, corn, sunflower, safflower any of those otherwise depending on your cholesterol and how strict you want to be. Having butter and coconut oil those are saturated fats they are whole foods based, also olive oil. Avocado is a fruit technically but is so high in fat, healthy fat it’s got a lot of other things going for it it’s got potassium and phytonutrients. Also olive oil has those phytonutrients as well and the avocado is loaded with fiber. Avocado is my favorite fat you can have a lot of that, the saturated fats are better for cooking their much more stable and more resistant to oxidative stress.
Franziska Spritzler web page lowcarbdietitian
Disclaimer: The information contained on this site is for educational purposes only and should not be used as a substitute for diagnosis or treatment rendered by a licensed physician. It is essential that you discuss with your doctor any symptoms or medical problems that you may be experiencing.
M. Scherker medical researcher