One of the most contentious topics in health care today revolves around diet. Should it be low fat or low carb? This question is especially pressing for people with diabetes. That’s because the food they eat has an immediate impact on blood sugar. Recommendations on the diabetes diet have changed over the years. The resulting confusion has led to some heated debates.
Do Carrots Belong in a Diabetes Diet?
Q. I have picked up some tips from your column, but as a licensed dietitian I was disturbed to see you repeating common misinformation about carrots. You said that people with diabetes should be cautious about carrots, as they are a starchy vegetable. This is incorrect; carrots are listed on the diabetic exchange list as a low starch vegetable.
Indeed, their effect on blood sugar as determined by the glycemic index (a measure of blood sugar rise after consuming a food) is in the low range. You also failed to mention that peas are considered a starchy vegetable, though they are not as likely to raise blood sugar as potatoes.
Glycemic Index Offers a Range of Values:
A. Thanks for an interesting observation. When we checked the glycemic index database at the University of Sydney, we found a wide range of values for carrots, cooked or raw. Clearly, carrots are more healthful than high-starch vegetables such as potatoes.
The American Diabetes Association lists carrots as non-starchy vegetables, along with pea pods and sugar snap peas. Of course, people with diabetes or pre-diabetes should consult a dietitian for guidance on meal planning. Keep in mind, though, that individuals may vary in their response to certain foods (mSystems, Sep. 29, 2020). As a result, personal experimentation monitoring blood glucose after eating makes more sense than a predetermined diabetes diet.
Diabetes Treatment Before Insulin:
Before insulin, people with diabetes were treated with diet alone. A century ago, doctors told their patients to avoid starchy foods. The leading experts of the day recommended a diet that got 70 percent of its calories from fat and only 8 percent from carbohydrates.
When insulin was introduced, people with diabetes found it was easier to follow a conventional diet. Moreover, by the middle of the 20th century, nutrition researchers were pointing a finger at fat as the culprit behind heart disease. Recommendations for the diabetes diet changed accordingly.
Because diabetes increases the risk of death from heart attacks, the conclusion was that people with this metabolic disorder should eat as little fat as possible. That was the recommendation into the 21st century, although the consequence of restricting fat meant more calories from carbohydrates.
Changing the Diabetes Diet:
Then a group of researchers has published a critical review of the scientific evidence and called for a completely different approach to the best diet for diabetes control (Nutrition, Jan. 2015).
The authors state,
“Replacement of carbohydrate with fat or, in some cases, with protein, is beneficial in both types of diabetes leading to better glycemic control [blood sugar levels], weight loss, cardiovascular risk markers and reduction in medication.”
Data collected since the early 1970s show that the epidemic of obesity has corresponded to an increase in the amount of carbs Americans are consuming. More carbs are the result of trying to lower the amount of fat in the diet. Experts are still arguing over why obesity rates have risen so rapidly.
Are There Benefits from Low-Carb Diets?
Low-carb diets bring blood sugar down without the side effects that occur with the most frequently utilized drug treatments. What’s more, weight loss is not necessary to see beneficial changes in glucose control.
What are the benefits of a low-carb diabetes diet? For many years, the ADA recommended between 45 and 60 grams of carbohydrate per meal, with fat limited to less than 20 grams.
What Is the Diabetes Plate Method?
Now the organization has changed its approach, switching to the Diabetes Plate Method. The ADA suggests that one quarter of the plate contain starchy vegetables or rice. Half the plate should contain non-starchy vegetables, and the remaining quarter is for lean protein, such as chicken or fish.
The recommendations include substituting sweet potatoes instead of white potatoes, whole grain oatmeal instead of cold cereal and whole grain bread and pasta instead of white bread and regular pasta. Other carbohydrate foods include beans, legumes, fruits and dairy products such as yogurt. These suggestions for a diabetes diet probably work for many people. But it is important to acknowledge that individuals differ in their responses to various foods.
Dr. Richard Bernstein Discusses the Diabetes Diet:
Here’s what Richard Bernstein, MD, a long-term advocate of low-carb eating for diabetes control, has to say:
“…over forty years ago…I discovered that more and more of the things that the American Diabetes Association had been telling me were perfectly fine to eat made blood sugar control impossible.”
Instead, Dr. Bernstein suggests non-starchy vegetables like asparagus, beet greens, bell peppers, broccoli, cabbage and spinach as well as meat, fish, fowl, seafood and eggs. He has found that even whole grains raise his blood sugar unacceptably. While he was practicing, he encouraged his patients with diabetes to check their blood glucose after meals and track how various foods affect it.
Learn More:
For more details on this promising approach, you may want to check out the book, Dr. Bernstein’s Diabetes Solution or our Guide to Managing Diabetes. You may also want to listen to our interview with Dr. Kasia Lipska. It is Show 1173: How Is Diabetes Diagnosed and Treated? More recently, we spoke with Dr. Mitchell Lazar on Show 1275: The Vicious Cycle of COVID and Diabetes.
