Clearly, people with type 1 diabetes need to be careful about what they eat. But that doesn’t mean they can’t enjoy a great variety of foods.
There’s so much conjecture and “conventional wisdom” out there about what you should and shouldn’t eat… We’ve set out to set the record straight with six important truths about nutrition and T1D.
MYTH: You can never have carbohydrates again. They’re toxic.
FACT: Too much of anything can be ‘toxic.’ Just because you need to take insulin doesn’t mean you can never have carbs.
Just because you need to take exogenous insulin to help metabolize dietary carbohydrate doesn’t mean you can never enjoy carbohydrates again.
As explained in my recent article “When a Low Carb Diet Backfires for Type 1 Diabetes,” a person with diabetes can achieve optimal blood sugar control on any diet along the carbohydrate spectrum, low or high. An adult is free to choose whatever dietary pattern they prefer.
I am personally a fan of a lower carbohydrate dietary pattern for most individuals with diabetes, but can in no way scientifically say that all carbohydrates are toxic. Dietary restriction of carbohydrates is very different than saying, “No carbs!”
If you’re avoiding all forms of carbs, you will likely run into some nutritional deficiencies (like in long-term ketogenic diets for epilepsy). And you may suffer from gastrointestinal complaints like constipation or gastroesophageal reflux (GERD).
For most individuals, a more moderate approach of balanced nutrition will help them stick to their goals and manage blood sugar better than living in the extremes.
Pennsylvania dietitian and diabetes health coach Kylee Pedrosa recommends working with a registered dietitian to plan meals and snacks with a combination of carbs, fat, fiber, and protein to slow a rapid rise in blood sugar and allow insulin to keep up.
Kimberley Rose-Francis, another registered dietitian and certified diabetes educator based in Florida, says that “carbohydrates provide the body with a source of energy and a diversity of vitamins and minerals which are used by the body for growth, repair, and maintenance. They do not poison, but rather sustain the body.”
From a behavioral perspective, over-restriction of any one dietary component generally does not end well for most individuals. Research shows that those who engage in rigid dieting are likely to have higher rates of disordered eating behaviors and eating disorder symptoms. This is especially important to think about in regard to children, as they do not make the food decisions for the household.
The authoritarian feeding style, which uses restriction or pressuring, generally ends in higher rates of negative behaviors like sneaking food and binging, and eventually leads to higher rates of obesity and related health issues.
So it’s important to think hard about the dietary patterns you impose on your child if they have diabetes. Short term gain of a “good” A1C result can be short-lived if once they get out of the house, they rebel against everything that was forced upon them. This is an all-too-common scenario that pediatric endocrinologists and certified diabetes educators observe.
Of course some medical conditions require avoiding a specific food, like gluten in celiac disease or peanuts in a peanut allergy. But a person with diabetes can technically safely consume any and all carbohydrates with the appropriate dose of insulin.
MYTH: It doesn’t matter what you eat to treat hypoglycemia. It just has to be carbs.
FACT: Carbs with fat are a bad choice for treating hypos.
A common misunderstanding related to hypoglycemia (low blood sugar) treatment is that it “just has to have carbohydrates.” Yes, all carbohydrates will eventually increase blood sugar. But for someone experiencing rapidly dropping blood sugar, it is paramount that whatever is consumed to treat the episode can be quickly digested.
It takes 15 to 20 minutes for dietary carbohydrates to reach the small intestine. Additional fat, fiber, and protein will slow down this process and delay glucose appearing in the bloodstream, which delays normalization of blood sugar levels.
According to sports dietitian and certified diabetes educator Hayden James in Salt Lake City, Utah, “Simple carbohydrates are the gold standard of hypoglycemia treatment.” Simple carbs refer to those that digest quickly like glucose tabs, juice, honey, and fat-free milk. “Commonly, individuals will treat these episodes with granola bars or peanut butter sandwich crackers that contain too many carbs, fiber, protein, or fat.” Check out this list of 10 real foods to treat hypoglycemia for more appropriate choices.
It should be noted that the amount of carbohydrates needed to raise blood sugar, per James, is “not a one-size-fits-all.” She cites research that supports a weight-based approach to determining the amount of carbs you may need to raise your own blood sugar. Severity of the low blood sugar will also determine how much glucose/fructose is needed to treat.
MYTH: You should go gluten-free with diabetes because that’s ‘healthy.’
FACT: Most gluten-free products contain high calories, sugar, and fat. More whole foods are better for everyone.
Says dietitian James, “Whether or not a food contains gluten tells you nothing about its nutrient density or health profile.” Gluten-free processed food products like breads, muffins, or crackers tend to be higher in calories, sugar, and lower in fiber than their gluten-containing counterparts. This can make glycemic control more challenging, as fiber helps buffer the rise in blood sugar by slowing down digestion. Going gluten-free could be healthy if you focus more on vegetables, fibrous fruits, and unprocessed starches as your main carbohydrate sources.
Of course some people are forced to avoid gluten because of a medical condition. It is well known that people with type 1 diabetes have higher rates of celiac disease, which is also an autoimmune disease. According to the Celiac Disease Foundation, 6 percent of people with T1D also live with celiac, compared to just 1 percent of the general population in the United States.
FYI: It’s now a pediatric standard of practice per the International Society for Pediatric and Adolescent Diabetes and the American Diabetes Association to check for celiac disease via blood work at diagnosis, and then at 2 and 5 years post-diagnosis. It is important to note that since only 10 percent of children with celiac and T1D actually demonstrate the gastrointestinal symptoms related to celiac disease, the disease may be hard to diagnosis based off symptoms.
Both of these associations recommend more frequent screening should take place for individuals who have symptoms of celiac disease or a first degree relative with celiac disease. As such, some pediatric endocrinology clinics include celiac disease lab work with the other yearly or bi-yearly labs that are checked as part of ongoing care.
Nonceliac gluten sensitivity is another condition where an individual may have symptoms of gastrointestinal distress from consuming foods with gluten, but this is likely more related to the carbohydrate portion of the food containing gluten. For instance, wheat has a carbohydrate called a fructan that can be overfermented in the intestines of some individuals and cause bloating, flatulence, or diarrhea.
But the bottom line is that there is not enough research to support that every individual with type 1 diabetes ought to go gluten-free. Again, packaged gluten-free products are often higher in calories and sugar.
MYTH: Going ultra low carb or ‘keto’ means you’ll never have a post-meal glucose spike again.
FACT: Carbs are not the only macronutrient that breaks down into glucose.
There is no magic bullet to eliminate post-meal glucose spikes entirely. While minimizing carbs per meal, especially simple carbs that go straight into the bloodstream, can help. But even a high-protein diet can result in post-meal blood sugar spikes at times.
Many individuals with type 1 diabetes will vouch for experiencing a rise in blood sugar hours after a protein-rich meal, especially in the context of a low carb diet. A common belief is that 50 to 60 percent of protein turns into glucose, but this is not supported by hard data.
One 2016 study showed that for individuals with type 1 who consume whey protein without carbohydrates or fat, there was no increase in post-meal glucose until they consumed at least 75 grams of protein per meal.
According to Ann Scheufler Kent, a registered dietitian nutritionist and certified diabetes educator in Colorado, “Fat and protein also raise blood sugar levels, but their effect is much slower because the liver has to convert these nutrients into glucose. Thus, a meal with very few carbs and only fat/protein will not cause a fast spike in blood sugar, but you may notice blood sugar rise 4 to 6 hours after the meal.”
This phenomenon is highly individual and requires careful calculation and monitoring to try and dose insulin to control the post-meal rise in glucose.
T1D individuals will often have to bolus insulin for protein to cover the post-meal rise in glucose that occurs, even if the rise in glucose is slow.
Those on a very low carbohydrate ketogenic diet will sometimes experience what is termed “physiological insulin resistance.” This pertains to the metabolic shift of the body favoring fatty acids and ketones as energy in the absence of carbohydrates. This phenomenon is not harmful and prevents muscle tissue from being metabolized as energy.
If someone on a very carbohydrate-restricted diet were to take a glucose tolerance test used to diagnose gestational diabetes, they would potentially “fail” due to this physiological insulin resistance. This form of insulin resistance is temporary and can be reversed with the reintroduction of carbohydrates.
MYTH: You should favor snacks that have really low ‘net carbs.’
FACT: Net carbohydrate counts are misleading, in a number of ways.
Nutrition labels derive net carbohydrate by subtracting dietary fiber and some sugar alcohols from the total carbohydrate content. Many diabetes experts debunk this methodology as purposely misleading, to make products appear healthier and more low carb than they actually are.
These products are generally made with sugar alcohols like sorbitol and malitol that are designed to be malabsorbed, thus the carbohydrates supposedly don’t get processed in your body and therefore “don’t count.”
In fact, these sugar alcohols are still carbohydrates and can still raise the blood sugar if consumed in excess. This is especially important to know when calculating insulin doses for the food item at hand.
Also, malabsorption can lead to symptoms like bloating, cramping, gas, and diarrhea.
Another important note about products advertised as low sugar or sugar-free is that they are not necessarily healthier or beneficial for weight loss. Many of these food products still contain fat and protein, which can pack a big caloric punch. These products generally do not taste as good as the real thing, and can lead to cravings for more food.
Dietitian and diabetes education specialist Pedrosa says, “Many sugar-free treats have as much (or sometimes even more) carbohydrates as the full-sugar versions and, due to the sugar alcohols, can cause tummy troubles.” She recommends enjoying sweet treats in moderation as part of a usual balanced, healthy diet and cover the carbohydrates with insulin.
Finally, it’s important to note that artificial sweeteners like aspartame, sucralose, and saccharine often found in diet sodas and “calorie-free” beverages are not sugar alcohols. They contain no carbohydrates, so they do not increase the blood sugar. This is also true for novel sweeteners, another group of non-caloric sweeteners that are derived from natural sources like plants. Examples include stevia, trehalose, or tagatose. For more information on these sweetener choices, see here.
MYTH: Taking supplements and eating ‘superfoods’ will protect you from illness.
FACT: Vitamins and minerals are good for you, but they won’t necessarily keep you from getting sick.
Vitamins and minerals and phytochemicals like vitamin A, vitamin C, vitamin D, zinc, curcumin, and ginger are all generally good for your health, but they won’t necessarily keep you from becoming ill.
You can actually overdose on vitamins, especially the fat-soluble vitamins like vitamin A, vitamin D, and vitamin E.
So-called superfoods like dark leafy greens, berries, eggs, and spices like curcumin (turmeric) and ginger, are also touted for their anti-inflammatory and antioxidant properties. But the amount of these foods needed to see meaningful “clinical benefits” are quite large.
In terms of the present COVID-19 pandemic, the best thing you can do to boost your immune system is keep washing your hands, don’t touch your face, and social distance.
Other important factors like sleep and stress management have an important effect on immunity, though these may be difficult to manage right now with the uncertainty of the future.