Now that you know more about the different food groups and the impact these have on blood sugars, let’s take it a step further and look into more of the situations around ‘how’ we eat.
In addition to what you eat, how much you eat is another huge driver when it comes to glucose values. Since carbohydrates are the primary driving force behind blood glucose, more carbs = bigger glucose response, but overly large portion sizes of any food can become problematic. Keeping your portion sizes in check can make a big difference when it comes to glucose improvement, weight management, longevity, and so much more.
However, this can be much easier said than done! Getting the right ‘balance’ of adequate protein and nutrient-dense, non-starchy veggies on your plate can help you to feel full longer and avoid overeating. Some more strategies for navigating cravings and getting back in touch with your internal hunger and fullness cues will be explored in Section 3.
Reading nutrition labels can be a great way to stay on top of the total amount of carbs that you’re eating with each meal and snack, but it can be tricky if you don’t know what to look for. For example, foods that are ‘sugar-free’ are not necessarily always carbohydrate-free!
Since carbs have the biggest impact on blood sugars, let’s focus on the number of carbs on the nutrition label rather than getting bogged down by protein, fat, cholesterol, etc. The first thing to look for is the serving size. This represents the amount that you can eat to line up with the values listed on the rest of the nutrition label. If the serving size is 1/2 cup but you plan to eat a whole cup, you’ll need to double all of the values on the nutrition label.
In the above example, 1 tablespoon has 17 grams of carbs, so if you were to have 2 tablespoons, you would consume 34 grams of carbs.
Once you’ve determined what portion size you’re going to eat, you’ll want to look at total carbs (not just sugar). This includes added sugar, starches, and fiber. Work with your NutriSense nutritionist or your primary care team to determine the right amount of carbs that you should be targeting for each meal and snack.
When it comes to counting carbohydrates, you may have heard the term “net carbs” before. Let’s define total carbs versus net carbs. Total carbs include all the different types of carbs present in your food - starches, sugar, fiber, and sugar alcohol. On the flip side, net carbs are only looking at the digestible portion of the carbs and so it subtracts out fiber and sugar alcohols. Here’s a quick calculation:
Net Carbs = Total Carbs - (Sugar Alcohols + Fiber)
However, since we are all so different and have different reactions to food, it’s difficult to say if tracking total carbs or net carbs is more appropriate for you. It may be worth testing out and watching your response with your CGM to see what approach may be most helpful for you.
Another way to think about tracking carbs and meal planning for optimal blood sugar control is to use the exchange list. This system breaks down all types of carbohydrates into 15-gram portions (or carb “choices”), and while this isn’t an exact science, it can be a useful tool to make sure you’re getting an appropriate amount of carbs with each meal and snack and it allows you some flexibility to choose the foods that you enjoy eating!
You can work with your diabetes self-management team or your NutriSense nutritionist to come up with the right amount of carb exchanges or choices for you. But as an example, if you’re aiming for three carb choices at each meal and each carb choice is 15g of carbs, that equals out to 45 grams of carbs when reading a nutrition label.
This is an excellent breakdown of exchange lists to help you get started (also attached below). If you choose to use exchanges to help you with food choices, consider printing this list out or downloading it to your phone for easy access as you get used to this system.
If you’re more of a visual person, using the Diabetes Plate Method can be an easy way to create balance and encourage blood sugar control without having to measure portion sizes, count carbs, or completely change your meals.
With this strategy, there are no set recommendations for serving sizes. Instead, you’ll plan to build your plate according to the following layout:
1/4 plate protein
1/4 plate starchy carbohydrates (if choosing to include in your diet - continue reading for more on a lower carb, ketogenic diet)
1/2 plate non-starchy veggies
This simple method can help to increase the amount of nutrient-dense whole foods in your diet to help with satiety, consistent energy, and stable glucose values. This can also be a great tool to include some of the ‘less glucose-friendly’ food items in your routine. For example, if you enjoy tacos, instead of having a whole plate of three or more tacos, consider sticking to one or two tacos and then filling the rest of your plate up with a side salad. Or if pasta is your jam, stick to a quarter of your plate pasta, make sure to include some quality protein, and then fill half of your plate up with broccoli, zucchini, or whatever non-starchy veggies you enjoy!
Eating your foods in a specific order can be a great hack to minimize the impact of the carbohydrates in your meal. Since the body breaks down carbs into glucose pretty quickly, eating something with some protein, healthy fat, or fiber before eating carbs can help slow down your digestion just enough to blunt the subsequent spike from carbs. In addition to slowing down the digestion of carbs, specifically eating protein or fat before carbs also help to promote glucagon-like peptide-1 (GLP-1), a hormone that reduces the secretion of insulin and glucagon. This can support better glucose levels following a meal. GLP-1 also can help you feel full for longer which can be beneficial when managing cravings and working towards weight loss.
What this means is that if you eat something like a piece of fruit on its own, you’re likely going to get a much bigger spike than if you had an apple paired with some nut butter. Eating carbs on their own can also often lead to a subsequent reactive hypoglycemic event and an associated energy crash, so by doing some meal sequencing, you reduce the chances of having to deal with reactive hypoglycemia.
Some practical tips to use meal sequencing to your advantage are to eat protein first, start your meal with a salad (or whatever other non-starchy veggies you prefer!), or even try a handful of nuts before your meals.
Common Diets Often Used to Optimize Blood Glucose
Although no specific ‘diet’ is needed to help you achieve better glucose control, there are several diets that you may have heard about that are commonly discussed when it comes to living well with pre-diabetes or diabetes, such as:
Ketogenic - Commonly shortened to just ‘keto’, this diet is a low carb, high fat, moderate protein diet where the body starts to switch from using glucose for fuel to breaking down fat into ketones to use as fuel instead. To achieve this, many people need to keep their daily carbs to 50 grams per day or less (although this can vary to some extent based on age, sex, and other factors). To limit carbs that much, you generally need to avoid almost all traditional carb-based foods, including fruits, starchy veggies, grains, and legumes. One thing to be cautious of if choosing to pursue this diet is that there are many food products marketed as being ‘keto’ that are highly processed and full of additives. This may not be any better for you than a Standard American Diet. Prioritizing food quality and choosing more whole foods and less processed foods in general is still an important thing to keep in mind with this diet (or any diet). If you’re interested in learning more about a keto diet, consider checking out KetoMojo’s website for information, recipes, and more.
Carnivore - A carnivore diet is similar to other low-carb, high-fat (LCHF) diets like the keto diet in that the goal is to enter a state of ketosis to burn fat for fuel instead of glucose. However, the difference with a carnivore diet is that it takes this a step further and is primarily focused on animal-based foods (meat, fish, eggs, dairy) and entirely or mostly avoids plant-based foods like fruits and vegetables. The biggest concern with this diet is limited nutrient diversity, and it also is not appropriate for some people with specific health concerns, like chronic kidney disease. A good resource to check out if you want to learn more is the Carnivore MD.
Low Carb (Atkins, South Beach, etc.) - Several low-carb diets that have been popular over the years for weight loss purposes that may also offer some benefits when it comes to blood sugars. Since carbs are the primary drivers behind blood sugar values, these lower-carb eating patterns help by simply cutting down on carbs and primarily focusing on lean protein, healthy fats, and more whole-food carb sources.
Paleolithic - Often shortened to just “Paleo”, this diet is based on foods that are similar to what people may have consumed during the Paleolithic era (~2.5 million to 10,000 years ago). This focuses on lean meats, fish, fruits, veggies, nuts, and seeds and limits all foods common after the emergence of farming, such as dairy products, grains, legumes, refined sugar, and highly processed foods in general. Given the limit to things like grains and legumes, this diet can be an effective way to decrease overall carb intake, although one could potentially still overdo it on certain carbs like fruits that are allowed within the diet.
Mediterranean - This diet is based on traditional eating patterns native to the Mediterranean region. While it is typically prescribed for heart health, many people also lean towards this pattern of eating when trying to regulate glucose or simply optimize health in general. This eating pattern focuses on plant-based foods, like whole grains, veggies, nuts/seeds, fruit, herbs, and spices, and includes fish/seafood, dairy, and poultry in moderation. Another cornerstone of this dietary pattern is an emphasis on healthy fats like olive oil, nuts, seeds, and fatty fish over other fat sources.
Plant-Based (Vegan or Vegetarian) - Many people choose to follow a vegan or vegetarian diet for environmental, ethical, or other personal preferences, and their popularity has grown in recent years. While there are many variations to vegetarian diets that include eggs, dairy, and/or fish/seafood, a vegan diet is entirely plant-based and includes no animal products. These diets offer some unique challenges regarding glucose trends as it can be hard to meet protein needs. Additionally, many plant-based protein sources are also higher in carbs (think lentils, legumes, and quinoa). If following a vegan or vegetarian diet is important to you, this blog post offers some great tips for how to make it work while still working towards better blood sugar values.
Intermittent Fasting - Fasting has been getting more popular in recent years for a variety of different purposes. The science of fasting is still relatively new, so there’s no one ‘right’ way to fast, and there are several different fasting schedules that you may have heard about ranging from 16:8, 18:6, or periodic 24-36 hour (or even longer) fasts. Since all foods stimulate insulin to some extent, periodically abstaining from food can be a way to sustain very low levels of insulin, and as insulin levels decrease, insulin sensitivity regulates. Fasting is not appropriate for all health conditions or medications, so be sure to discuss this with your diabetes management team before beginning.
Low Glycemic Index - This method uses a ranking system to describe how a food affects blood glucose levels. Foods that have a high glycemic index (GI) are easily digested and metabolized and can cause significant spikes in glucose whereas those that have a lower GI tend to produce a slower, more sustained release of glucose. Following a low-GI diet means you will focus on eating low-GI foods more frequently and high-GI foods more infrequently. The biggest concern is that different people can have a wide range of responses to the same carb-containing food. Using a CGM can help you better understand your carb tolerance.
You can work with your NutriSense nutritionist to discover what dietary pattern may be most appropriate for you. Whenever you’re thinking about starting any new diet, it’s also important to run it by your primary care team first. That way, they can check to make sure there aren’t concerns with your medications, health history, or anything else and your chosen diet.
It’s also important to think about sustainability and consistency. Yo-yo dieting is a phenomenon in which a person repeatedly goes “on” and “off” different types of diets. It’s common to see progress while “on” the diet only to revert right back to where you started when you’re “off” the diet. This constant back and forth is very detrimental in the long run, so finding a more moderate and manageable approach that you’re able to sustain over time is often a better idea. Slow and steady wins the race!
Next: Why You Eat