What is the best diabetic diet?

Diabetic Diet foods

The Mediterranean diet is the best diabetic diet! Yes, it was proven in studies to improve glycemic control. The Mediterranean diet was compared with other diets such as low fat, nonrestricted calorie, low carbohydrate, high carbohydrate, usual diet. In one of those studies patients who were on the Mediterranean diet were much less likely to use medications compared to patients on other diets. 44% of patients on the Mediterranean diet for diabetes took medications versus 77% of patients on other diets. At the end of the study, there was no difference in terms of weight change by 3 to 4 years. Want to know more about the best diabetic diet more? Keep reading..

Today we will talk about the best diets for diabetes or the best diabetic diet! Yes, this is the most important aspect of diabetes management, type 1 or type 2. Most people will ask me what should I eat, what diet is the best for diabetes, etc. It is so surprising to hear that people really have no or very little idea about carbohydrates or in general diets. It is a huge topic and it is definitely not simple. I always advise to my diabetic patients to eat in moderation. Is that enough?  Arent there a “the best diabetic diet”? It is true that portion size control is one of the most important elements. If you wish to learn about our online on-Demand diabetes doctors and our telehealth diabetes care center, contact us after you finish reading the article and remember to share with other people who may benefit from the information.

And yes there is a proven diet best for diabetes. Tune in. We will dive into some detail in this article.

What is the best diabetic diet?

Mediterranean diet appears to be the best diet for diabetes

The Mediterranean diet was proven in studies to improve glycemic control. The Mediterranean diet was compared with other diets such as low fat, nonrestricted calorie, low carbohydrate, high carbohydrate, usual diet. In one of those studies patients who were on the Mediterranean diet were much less likely to use medications compared to patients on other diets. 44% of patients on the Mediterranean diet took medications versus 77% of patients on other diets. At the end of the study, there was no difference in terms of weight change by 3 to 4 years.

Patients who were on a Mediterranean diet also showed improvement in their cholesterol levels. Another reason we think the Mediterranean diet is the best diet for diabetes is that the Mediterranean diet reduces the risk of heart attacks and strokes. As you may know, two-thirds of diabetics die from heart attacks and strokes.

Being on a diet is easier said than done of course. It takes a motivated patient and sometimes the help of certain medications and diabetes coaches to help achieve the final goal.

Medical nutrition therapy

Medical nutrition therapy consisted of

  • Weight loss and physical activity
  • Determining a caloric intake goal
  • A consistent amount of carbohydrates per meal and snack
  • The nutritional content of the diet
  • Setting appropriate timing for meals and snacks

We will go over These goals in the following sections

What about a low carbohydrate diet. Some people think low carbohydrate diet is the best diet for diabetes.  Is that is true?

Only in the short-term. Studies showed that low carbohydrate diets can improve weight, cholesterol, and diabetes only in the short-term. In the long-term, these low-carb diets were not maintainable by most people.

Is a low-fat diet the best diet for diabetes? How much fat should be in the best diabetic diet?

Studies indicate that 85% of patients with diabetes eat more than recommended fat in their diet. Increase amount of fat causes insulin resistance and reduced effect of insulin. High fat also increases blood sugars, increase his weight and cholesterol levels.

The type of fat consumed is also extremely important in order to prevent heart attacks and strokes. Trans fat (hydrogenated fats) causes blockage of arteries. Mono- and polyunsaturated fats (particularly omega-3 fatty acids) protect the arteries from clots. Current evidence shows that replacing saturated fat with polyunsaturated fat reduces blood sugars and insulin resistance. Also, replacing carbohydrates, saturated fat, or monounsaturated fat with polyunsaturated fat improves insulin secretion capacity.

So it is not just a low-carb or low-fat diet.  It is about good fat and a good carb diet.  Also, in terms of the best diabetic diet, it is very important to keep the total calories consumed daily on the low side no matter what the content of the diet is. 

Does ideal or the best diabetic diet to contain no carbs?

Bread Jam - food/diet for diabetics

Some people advocate for a no-carb diet which may not always be the best diabetic diet.  Because the body goes into starvation mode and enters ketosis. Keto diet for diabetes can be helpful for some people. Yet, it is hard to maintain. I would never recommend any of my patients in my diabetes care center to start a keto diet without consulting a diabetes doctor.

Some patients are on medications that can lead to ketosis as well. This can lead to diabetic ketoacidosis especially in the absence of insulin in the body. So, I advise my patients to go on a low healthy carbohydrate( not a no carbohydrate) and a high healthy protein( not just any protein) diet.

What are healthy carbohydrates?

Foods containing a similar amount of carbohydrate may show totally different glucose spiking effects. We call that glycemic index.  In general, foods with higher fiber content have a lower glycemic index. These differences led to the development of the concepts of glycemic index and glycemic load.

Carbohydrates are not created equally.  Carbohydrates are divided into two types.  Simple carbohydrates versus complex carbohydrates.  Simple carbohydrates are the ones with a low glycemic index.  Complex carbohydrates are the ones with a high glycemic index.  The glycemic index determines how fast the carbohydrate can spike your blood sugars.

As a rule of thumb, I recommend eating carbohydrates that have a glycemic index less than 45 in order to keep blood sugar spikes down. The standard glycemic range is from 0 to 100. Many applications are available to provide the glycemic index per food item which can be extremely useful.

How many carbs to eat depends on the patient, doctor, and dietitian. They all should be decided that together. There is no cookie-cutter approach to diabetes care.  Therefore, a diabetes coach is an essential component of long term success.

Unfortunately, insurance companies prefer not to pay for coaching services.  They will though pay for expensive medications costing thousands of dollars. This eventually increases health care costs and premiums. At SugarMDs diabetes specialists try to keep you on the minimal amount of medications. Yet, when you need medication we strive to get you the best medication available in the market. We choose a medication that provides you with diabetes control, weight loss, and cardiovascular risk reduction.

 

Distribution and Amount of Calories in the best diabetic diet

Another important factor to consider for the best diet while treating diabetes is the total calories consumed daily.  Everybody has a different metabolism, as a result, caloric intake should be estimated, ideally tested.

In a rough estimate you can determine your caloric intakes as below;

How many calories are needed in the best diabetic diet?

Although there is no one formula that fits all the following guideline may help determine your caloric goals

  • Men and active women: 15 kcal/lb minus 500 kcal
  • Most women, sedentary men, and adults over 55 years: 13 kcal/lb minus 500 kcal
  • Sedentary women and obese adults: 10 kcal/lb minus 500 kcal
  • Pregnant or Breast-feeding women: 15 to 17 kcal/lb minus 500 kc

What is the calorie distribution in the best diabetic diet?

Patients should carry a log which can easily be done via phone applications today. This helps keep track of total daily calories.  The distribution of calories is also very important.  Reasonable distribution of calories would be 40% of calories taken with breakfast, 30% with lunch and another 30% with dinner. Although difficult yet not impossible some patients can skip dinner. Skipping dinner create an intermittent fasting period. Skipping dinner if possible can be more successful at staying within their glucose control.

You should always tell your physician about your portion sizes and the number of calories you consume per meal.

Consistency is another key factor especially for those taking mealtime insulin.  If the calories and carbohydrates taken do not match the insulin injected, glucose control will be almost impossible.

For example, if the patient eats 60g of carbohydrates with breakfast and takes 10 units of mealtime insulin today versus the same patient eats 30g of carbohydrates tomorrow for breakfast and still takes 10 units of mealtime insulin.  It is a no-brainer that if blood sugars stayed stable the first day with 60g of carbohydrates, the same patient will develop low blood sugars for eating only 30g of carbohydrates.

Let us move on to the fat content of the diet.

How much fat should be in the best diabetic diet?

Those patients who rely on low carbohydrate and high-fat diets should understand that fat consumption can drastically increase insulin resistance.  Also, 1g of fat contains 9 calories versus 1g of carbohydrate contains only 4 calories.  As a result, most patients end up gaining weight. Because, they are on a low carbohydrate diet, high-fat diet. So low-carb and high-fat diet is not always the best diabetic diet.

As an example, a patient who eats a slice of bread versus another patient who eats a slice of bread with butter will see totally different blood sugar numbers. In reality, the carbohydrate amount is the same in both foods. Remember, your body will need to make 30% more insulin for the same carbohydrate that is mixed with fat.  That is because the fat causes insulin resistance in the patient’s body.

But, I only had a salad…

Salad on plate - diabetes diet

Occasionally, my patients will complain that they have only had a salad with chicken today and his or her blood sugar still went up. When asked they will accept that they had chicken wings instead of chicken breast. Chicken wing clearly contains a significant amount of animal fat creating insulin resistance. As a result, even the small amount of carbs in the salad will cause blood sugar elevation due to the fat content of the chicken wings.

Dressing on the salads can also contain a significant amount of sugar and fat. Most patients ignore this fact and get frustrated for not being able to lose weight or control their blood sugars.

It is not uncommon for patients to be unhappy for not being able to lose weight or controlling their diabetes. They think that they are eating a lot of vegetables and fruits.  A lot of “fluid” fruits such as watermelon, honeydew, grapes are high in carbohydrates with a low glycemic index.  On the other hand apples, blackberries, blueberries, strawberries, raspberries, and pears have a low glycemic index. So the best diabetic diet includes carbs that are healthy and low in glycemic index.

What does the best diet for diabetes look like?

In summary, an ideal diet or the best diet for diabetes is composed of 50% of healthy low glycemic index carbohydrates, 30% of healthy proteins, and 20% of healthy fat. The best diet for diabetes is also a diet low in calorie intake. The only scientifically proven diet that reduces the risk of heart attack and stroke along with blood sugars and cholesterol is the Mediterranean diet.  Portion and calorie control, awareness of glycemic index as well as consistency are the major components of best diabetic diets that lead to success for diabetes control as well as weight management.

At www.SugarMDs.com you will always have a diabetes coach on your side and diabetes specialist to consult for all your diabetes-related questions and concerns which will lead to a reduction in medication costs and a healthier, happier life.

Thank you for allowing us to help in your diabetes education. Please feel free to contact us directly for any questions or concerns.

Author: Ahmet Ergin, MD, FACE, CDCES, ECNU
About the author: Dr. Ergin operates a large diabetes practice mostly in West Palm Beach, FL and yet can see diabetic patients across the entire state of Florida via a unique telehealth platform which also allows him and his team to track patient progress and be available at all times.

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