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The Best and Worst Diets for Type 1 Diabetes: A Complete Guide by a Registered Dietitian

*Disclaimer: This article is not intended to provide medical advice, diagnosis, opinion, treatment or services. This blog is meant to provide general information for educational purposes only. The information provided in this blog is not a substitute for medical care and should not replace advice from your healthcare provider.*

infographic saying the best and worst diets for type 1 diabetes

When you have Type 1 Diabetes, it can be hard to know how you should eat and what diet you should follow. From completely forgoing grains, to skipping meals, to eating small amounts of carbohydrate throughout the day, various dietary regimens grabble for your attention. How do you know which diet is best for lowering A1C levels and managing blood sugar levels in a world of confusing and contradicting diet advice? Read on to find out!

Finding the Best Diet with Type 1 Diabetes

“Diet” is typically the term used to define a rigid set of rules around eating behavior. However, someone’s “diet” is actually what he or she chooses to consume. It includes much more than strict rules; important factors to consider include the individual’s food philosophy, access to food, food budget, overall health, and quality of life.

Food Philosophy

A personal food philosophy is the guiding foundation upon which someone bases their decisions around food. Whereas dieting is structured around rigid do's and don’ts, the principles of one’s food philosophy are flexible. Conventional dieting creates anxiety and a feeling of being trapped, whereas a personal food philosophy brings peace and creates a feeling of autonomy and self-trust. While dieting may say, “I can’t eat pizza because it's unhealthy” (the person likely will eventually “rebel” and binge on the pizza), a personal food philosophy that guides your diet may say, “I enjoy pizza in moderation, paired with a side salad.”

Access and Budget

Diet culture can make it seem like the only way to manage your blood sugars is by purchasing every product that is made from cauliflower or a keto-flour blend. But, these “healthified” or “superfood” products can be inaccessible or out of budget for most people. If you are struggling to purchase organic, keto, or other “healthified” foods, that doesn’t mean you’re a “bad diabetic” and can’t manage your blood sugars when eating conventional or less expensive foods. You can still consume a variety of nutrients and lower your A1C without buying the most expensive products.

Overall Health

It can be easy to fall into the trap of only focusing on food choices and how they affect your blood sugar. In reality, blood sugar management is just one aspect of health. Majority of diets will encourage people with diabetes to restrict or avoid foods or food groups that contain carbohydrates. While carbohydrates impact blood sugar levels, they also have a number of health-promoting benefits like vitamins, minerals, and fiber. Having an overall healthy, balanced diet will give you better overall health and have an even greater positive impact on your blood sugar levels. When you take a step back and look at the bigger picture, you realize that a way of eating that prioritizes your overall health also prioritizes your blood sugar management at the same time.

Quality of Life

Your diet should also take into consideration your quality of life. The guiding principles of the way you eat should be flexible to allow you to eat the foods you love in moderation because food brings people together, is part of many traditions, and is meant to be an enjoyable part of life. For example, your diet may consist of many highly nutritious foods, but there can still be room for pizza night with the family, an ice cream date with the kids, hot dogs at the ballpark, s’mores at the campfire, and grandma’s homemade cookies. Cherish the moment, and savor the taste.

At the end of the day, the best diet for people with type 1 diabetes is the one that you can enjoy effortlessly that is centered around balance and flexibility, not rigidity or restriction.

The Worst Diets for Type 1 Diabetes

Sometimes, people with diabetes will choose to follow extreme, restrictive diets in effort to manage their blood sugar levels. This management approach oftentimes starts out as well-intentioned in keeping blood sugars in range, but ultimately ends up backfiring by throwing off hormone levels, causing havoc to hunger cues, and increasing risk of disordered eating or eating disorder behaviors. There are a variety of ways to manage blood sugar levels that don't include restricting food groups, limiting nutrients, or eating within a certain time frame like the diets listed below.

Keto for Type 1 Diabetes

The keto or ketogenic diet is based on radical restriction of carbohydrates of less than 50 grams per day, high intake of fat, and adequate intake of protein. This diet is typically used in the treatment of epilepsy, but has gained popularity amongst the diabetes community in recent years due to the restriction of carbohydrates. By limiting carbohydrate intake, the body will use fat for energy rather than carbohydrates which leads to the production of ketones which ultimately lowers blood sugar levels and decreases insulin needs. This will cause the body to shift into nutritional ketosis. This differs from diabetic ketoacidosis, however, the combination of insulin deficiency and other factors can increase the risk of euglycemic DKA. Euglycemic DKA is characterized by DKA without hyperglycemia (high blood sugar) and is equally as threatening and can be challenging to diagnose.

The early treatment of type 1 diabetes included consuming a very low-calorie and low-carbohydrate diet. Through many advancements in type 1 diabetes management and insulin therapy, it is no longer clinically necessary for people to restrict their carbohydrate intake. Additionally, the current research on the use of the ketogenic diet in type 1 diabetes is extremely limited and has yielded mixed results. Many publications are case reports which are considered the lowest level of evidence.

Intermittent Fasting

Intermittent fasting is a diet that is founded on the principle of only consuming food during certain times and restricting oneself from eating during other times. Those who follow this diet have a rigid eating schedule, which can vary from person to person. For example, someone may only eat between 9am and 3pm, or may eat 5 days per week and fast 2 days per week.

When living with type 1 diabetes, intermittent fasting can increase your risk for hypoglycemia and hyperglycemia due to the prolonged fasting windows. When fasting for long periods of time, you will likely be skipping meals which increases your risk of low blood sugar. On the other hand, some people may experience the opposite impact with their blood sugar levels. When you skip meals or eat later than usual, the liver may release stored glucose into the bloodstream leading to high blood sugar levels. The blood sugar fluctuations from skipping or delayed meals makes intermittent fasting one of the worst diets for people with type 1 diabetes.

Mastering Diabetes

The Mastering Diabetes diet instructs its users to follow a low-fat, whole food plant based diet. Their protocol consists of consuming less than 30g of fat per day and minimizing or eliminating animal-based foods including red meat, white meat, dairy products, and fish. Additionally, clients are also encouraged to eliminate nuts, seeds, and vegetable oils completely and minimize intake of refined carbohydrate-rich foods and discouraged from eating foods containing added sugars, flours, and added salt. So, what foods are left over for you to eat? Basically, fruits, vegetables, whole grains, and legumes.

This extreme restriction of fat comes down to only 2 tbsp of olive oil per day and raises concerns for rapid weight and fat loss from the lack of dietary fats providing insulation to protect vital organs. It is not shocking that the only published research by Mastering Diabetes only received responses from only 253 of the 2,839 previous and current program participants. Having only 8.9% of participants respond to this study suggests that they did not have favorable outcomes while participating in this protocol and that this protocol is likely not sustainable long-term for most participants.

Dr. Bernstein’s Diabetes Solution

Yet another extreme diet is Dr. Bernstein’s Diabetes Solution, which is far from a long-term, sustainable solution for people with diabetes. This radically restrictive protocol was founded by Dr. Richard Bernstein who has been living with type 1 diabetes since the year 1942. The management of type 1 diabetes in 1942 was a lot different than what type 1 diabetes management is like today, especially with the advances in diabetes technology and insulin therapy. The methods that Dr. Bernstein encourages a combination of restricting daily carbohydrate intake to less than 30 grams per day, exercise, and small insulin doses which is consistent with diabetes management from the 20th century. Due to the intense restriction of carbohydrates, many foods like pasta, bread, most desserts, dairy, fruits, and starchy vegetables are off the menu. This protocol can deprive your body of a major source of energy, creates rigidity, and becomes a source of stress when low carb foods aren’t abundant. It is extremely outdated and is not necessary for the management of type 1 diabetes.

Why People with Type 1 Diabetes Shouldn’t “Diet”

While many popular diets and protocols may make promises for improved diabetes management and lower A1C for type 1 diabetes, these diets come with a number of downfalls. Dieting is just a band-aid fix and ends up causing more problems for most people in the long run. There is a sustainable way to manage your blood sugar levels while eating a balanced, healthful diet…that isn’t rooted in restriction! You don’t have to give up the foods you love in order to manage your blood sugar and when you sign up for the Eating Essentials for Type 1 Diabetes Course, you can become an expert on pairing your nutrition and insulin dosing strategies together so you can effectively manage your blood sugar levels, too!

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