Theories about diet for type 2 diabetes

In My Humble Opinion
1

I’m confused by two different types of diets I’ve seen suggested for improving glucose control in type 2 diabetes. They seem pretty opposite. Not sure if there’s one correct answer or you just have to try a diet that you can reasonably maintain and works reasonably well for your blood sugar levels.

One of the ideas is low carb or keto, mostly through use of animal products. You could try to do it with a vegetarian or vegan diet, but the restrictions will be pretty severe. The idea is to eat things that don’t spike your glucose level. You should avoid eating anything that will cause glucose to go up precipitously. Eating a potato or piece of bread is out of the question. Too much of a spike. As long as you eat low carb, you can keep your A1c in non-diabetic range, even if you are a type 2 diabetic. Protein and fat are fine as they don’t raise blood sugar to any notable degree.

The other camp advocates eating a plant-based or pretty much vegan diet. There will be carbs - potatoes, fruit, even some bread and noodles. But you will eat very low fat. Eating fruit or potatoes will raise your blood sugar, but eventually the fat that has accumulated around your pancreas and liver will “burn off” and blood sugar will return to normal-ish levels.

I figured this is the best place to ask if anyone knows if either one of these theories is “better,” or just use whatever works for you personally?

2

Each of those seems to work for some people. The same can be said for other diabetic diets. I worked as a diabetes counselor for quite a while, and where I come down on it is that a person should try the one they think they are most likely to have success with strictly for 3 months with glucose testing twice a day, fasting in the moning and about an hour and a half after dinner, plus an A1c on either end of that 3 month to get a better picture of overall blood sugar. Food should be logged for awareness and accountability. There are online programs for this, or a person can simply keep a notepad wherever they eat their meals. One ought to bear in mind also that other factors, such as exercise or stress or sleep patterns, can also affect blood sugar, so it’s good to keep a log that is more extensive than simply what a person is eating.

All of that said, I’m neither a medical doctor nor a nutritionist. I am a person with type 2 diabetes, as well as a former diabetes counselor, and my personal experience is that I have to change diet plans every few months because my body is super good at having diabetes, and figures out how to compensate for whatever I’m doing by raising my blood sugar. The only way for me to maintain any kind of decent blood sugar with diet and exercise is to alter my diet every few months.

3

I’m having a difficult time figuring out what to eat or what version of diabetic diet would work for me. I don’t really like eating animal products, but I grew up on them and they are what seems “normal” to me. I don’t love vegan milk, tofu, fake meats, etc. I would have to eat mostly salads if I went that route.

4

You might find a modified Mediterranean Diet acceptable. A regular Mediterranean Diet emphasizes fresh vegetables, a certain amount of fruit, nuts, olive oil, fish, and some meat, mostly chicken. It also includes a lot of whole grains. A diabetic version of this diet might, for example, decrease the number of grains and increase the number of leafy green vegetables. No tofu required unless you want it.

ETA: there are a lot of Mediterranean Diet cookbooks, and South Beach, which is a form of Mediterranean-ish diet. This can make food preparation somewhat easier since you don’t need to figure it all out on your own and there are multiple sources of information.

5

I used to work in supported living, and have had several clients with this diagnosis. Basically, one strategy is short-term, and one is long-term. But “which appeals to you more” is also highly relevant.

The “Keto” aims to immediately reduce blood sugar and keep it low.

The low fat diet is a weight loss + maintenance diet, which, if it works, can remediate Type 2 diabetes.

Which way you go will depend on a lot of things, and one of them is which diet you think you can stick to. But your immediate needs count too. If your sugars are so high that you are altered, the short-term strategy might be necessary, but if you doctor thinks you are a good candidate for no longer “being diabetic” if you lose weight (not really-- if you gain it back, you will start having high sugars again, but as far as needing daily treatment, you may function as non-diabetic), then the long-term strategy may be best for you.

I’m over-simplifying, and I’m not a Type 2 myself-- just have worked with people who are.

6

I’ve got a friend, who, not for diabetes, but strictly weight control, eats a version, but it’s meatless. She eats a lot of fat-free Greek yogurt, lentils, chickpeas, and some beans fixed with a Mediterranean spice palette, plus goat and sheep cheese sparingly. Cow’s milk cheese only when she’s out someplace.

I know that last rule isn’t very scientific, but it’s also her rule for eating dessert foods that are not sugar-free Popsicles, fresh fruit, and coffees with Splenda and fat-free creamer. Just a rule that lets her have something, but limits it, and she doesn’t over-indulge.

I’m not really sure whether goat and sheep cheese are lower calorie than cow’s cheese, but recipes seem to call for them more as seasonings and garnishes than as a main ingredient.

It works-- she took off well over 100 lbs, and no longer has the hip and knee problems that she had in her early 30s. And she’s stuck to it for like, 7 years, including through a pregnancy.

7

Not my field but did a quick google scholar search and the evidence for mostly plant based is extremely solid. The evidence for the long term safety, sustainability, and efficacy of the low carb approach still lacking. Lack of evidence is not evidence of lack … but if it was me I’d go with where the evidence already exists.

Money quote to me:

FWIW.

Plus it seems unlikely that someone who does not like eating animal products is going to find low carb as a good fit for a long term plan.

8

I’m “in range” on Ozempic and in the midst of losing weight, but I would like to see my fasting sugar a bit lower. Oddly, after I went up to the 1 mg, my fasting morning sugar has been a bit higher than it was on the 0.5 mg. What is up with that?! Maybe I am just panicking and it will settle back down.

I am still just torn on whether the low-carb/keto people or the low-fat/all vegetable people are “right.” Also still torn about animal products. I’d be happier to be vegan or at least vegetarian. But that’s so limiting, and I do enjoy a bit of chicken or even a burger occasionally. I’m not much of a cook, either, and cookbooks all seem to go over my head.

ETA: Well, DSeid’s post seems to give a good nod toward plant based.

Also ETA: It’s gross to me to eat straight-up meat without any vegetables or noodles or bread mixed in. The texture is awful and brings out unhappy thoughts in my mind. Not rational, I know, since if I eat a burger I’m eating the same thing, just “hidden” in bread.

9

I call myself “vegeprefarian.”

When I went from .25 to .5 Ozempic, my A1c went up by .3. Now trying .75 for a few weeks to see if that knocks it down a bit.

10

When I was diagnosed with type 2, I was put on metformin and given no dietary regime, except avoid sugar. I don’t test glucose, but I do have the A1C checked regularly and it was always in the 5.5-6.0 range–until last summer when it was 4.6, which is a bit low. Two months ago it was 5.4 which is better, but the doctor I saw yesterday has halved the metformin and, depending on what happens, might try stopping it completely.

Meantime, while I avoid sugar, I eat most everything, including bread and potatoes. Testing glucose was never suggested. Obviously, YMMV.

11

I am type two and was on insulin, lots of it. I say was because I just lost 30 lbs on a carnivore diet and my blood sugar is more stable and in the normal range for the first time in years. At this point I still measure my blood sugar 3 to 4 times a day, I have only needed small amounts of insulin maybe 4 times in the last 6 weeks.

I also have been doing intense water aerobics since February, but did not lose weight until I decided to try carnivore. Its working for me. The second week was brutal, so I am not sure if many folks make it past the “keto flu” stage.

I stated watching videos by a guy named Sten Ekbert where he explains a holistic approach to reversing insulin resistance and fatty liver. The guy made sense to me, in a way my doctor never took the time to explain. Or maybe I’d just been stubborn, stupid, in denial, or all of the above.

It also helps that I like all kinds of meat and I also learned why you should eat heathier types. Wild caught fish, grass feed beef, free range eggs and such. It gives your liver a break, which good for helping improve insulin sensitivity which in turn improves your blood sugar control.

12

Former diabetes educator here.

Either diet could work to help control Type 2.

The carb issue hinges on what type of carbs you are eating. There are fast-acting carbs - simple sugars - that will spike your BG rapidly (followed by a too-rapid drop), which is where you get into trouble. Carbs to avoid would include non-diet soda, juice (fruit is ok but not to excess), and anything else that is “sugary”.

Complex carbs, such as whole grains, nuts, and vegetables, should not cause spikes and are allowed/encouraged, although some individuals react differently to specific types of carbs (one common complaint I hear is that pasta tends to make BGs rise quickly). The key is, of course, moderation, which goes hand-in-hand with properly counting how many carbs you are eating. Oh yeah, exercise too. :slight_smile:

It is important to mention that a keto diet is absolutely not appropriate for a Type 1.

ETA: The Mediterranean diet, as @susan described, is probably the best overall approach.

mmm

13

When I was first diagnosed, I tried substituting cheese for carbs whenever I got the munchies. They were tracking my cholesterol along with the A1c, though, and they told me to cut that out.

There actually is such a thing as too much cheese.

14

Well! I, for one, am shocked– SHOCKED! I tell you!

15

There’s apparently no such thing as too much cabbage soup. At least, according to the lab reports. According to roommates . . .

16

I’m about 4 months in and still on .5mg. My A1C went from 7.0 to 5.7 and I have lost about 10 lbs.

I splurged on dinner today and had a burger and fries. The big difference from the olden days is that I ate half the burger and a handful of fries vs the entire burger and a huge serving of fries and it followed oatmeal for breakfast and a salad for lunch. Ozempic has completely changed the way I eat for the better.

17

IMO @Mean_Mr.Mustard nailed it. As you’d expect from a pro in the field.

IMO …
In addition to the difference between type 1 & type 2 and between insulin dependent and not, there’s another difference among patients that I think is essential to understand.

Some DM patients are significantly obese. Like 50-300 lbs worth. Those folks need to focus on fat loss first and the glucose will improve as they get rid of the fat. Or the glucose won’t if they can’t / won’t dump the fat.

Just slightly pudgy or even slender DM sufferers need to work the low simple-carb eating. Losing weight is nice, but carb control is it.

I was in the plump-but-not-obese crowd when I was diagnosed. I switched my diet to zero simple carbs, low complex carbs, and moderate calorie restriction with aggressive exercise. And Metformin. The weight / fat melted away, as did the A1C. Well over a decade later that still works great for me.

The idea that fat “accumulated around the pancreas or liver” is significant is bunk. Fat anywhere is a significant contributor to insulin resistance and to out-of-control appetite.

18

I believe it is better to be successful, use a method that works for you, keeping in mind this isn’t a “diet”, it’s a long term permanent lifestyle change. Trying to adhere to something radically different than what you are accustomed or cannot sustain just creates frustration, I expect.

While I am not a diabetic, it has a history in one side of the family, and in any case is something to be avoided if possible. You know what they say - there is “more than one way to skin a cat”, some combination of carbohydrate control, calorie restriction, exercise, etc will improve blood glucose levels.

What really clicked for me, was a white paper outlining the typical 3 meals a day + snacks, the high carbohydrate diet and how this rapidly causes weight gain, metabolic syndrome, chronic high insulin, insulin resistance, obesity, and eventually, type II diabetes.

What the research is showing, time-restricted eating, or intermittent fasting, has many benefits similar to exercise. It is a type of metabolic workout. Restricting calories forces fat burning, and typically blood work improves greatly, including HDL and LDL or blood lipid parameters, blood pressure, and insulin sensitivity. Anecdotally, it improves energy levels, sleep quality, and I don’t worry too much about what I’m going to be eating for breakfast or lunch, since I don’t. One meal a day might not be for everyone, but it worked for me. I shed about 55 pounds. I don’t worry about what I eat so much as when, and how much.

But a reducing diet, one cannot help but be very mindful what one is putting in your body. That’s not to say I don’t eat “junk food” once in a while, but there’s no getting around the fact that we need to eat high quality protein, fats, and whole foods in realistic portion sizes, and avoid excessive carbs, refined sugars, processed seed oils, and highly chemical laden ersatz. You will naturally gravitate away from foods that make you sick. They won’t even taste good any longer.

19

A lot of people who promote time-restricted eating recommend pairing that with a low-carb or outright keto diet, so they kind of go together in my mind. But of course, fasting can be used with a plant-based diet as well. The only thing with fasting, to me, is that by the time I am “allowed” to eat, I’m SO hungry, truly hungry rather than just bored, I’m at my most vulnerable to eating junk rather than lean meat and vegetables!

Even on the Ozempic, which is helping me go longer in between meals, I can get suddenly ravenously, genuinely hungry. Lately I’ve been eating small meals more often. It’s easier for me to fast on the weekend for some reason.

20

Sorry but unfortunately it does not.

Which doesn’t mean that it isn’t an effective option for some people, it is, but when it is it is because it results in fewer total calories in. Same thing for low carb works when it does. And neither is having benefits similar to exercise.

You are completely correct about each individual finding the approach that works best for them. And that there’s

So @Skypist, while the evidence based answer is that there is more evidence supporting the safety, efficacy, and sustainability of a plant predominant diet plan approach than there is for low carb, the question as which is better is really that simple: given your preferences and make up, which will result in your having a better chance of eating high quality protein, fats, and whole foods in realistic portion sizes, and avoid excessive carbs, refined sugars, processed seed oils, and highly chemical laden ersatz?