New Nutrition Guidelines for Type 1 Diabetes: Introduction to Eating Patterns

One aspect that people with type 1 diabetes often struggle with is what “diet” is best for them. Should you go keto or Paleo? Are carbs okay, and if so, which ones? It’s all just so confusing. And that’s certainly understandable. After all, the “diet” for diabetes has changed over the decades.

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Early diet for diabetes

The ancient Greeks attempted to treat type 1 diabetes through excessive exercise to reduce the amount of glucose in the urine (they were definitely on to something!). Over the centuries, various dietary regimens were used that were creative, if unpalatable. They consisted of rancid animal food, veal and mutton, opium, herbs, and milk and barley water boiled with bread. None of these diets were successful.

Fast forward a few centuries and still there was no successful treatment for diabetes. In the early part of the 20th century, Drs. Allen and Joslin promoted the “Allen Diet,” which was essentially a low-carb diet that bordered on starvation. For some people, the allotted calorie level was 400 per day. Obviously, the Allen diet was not a cure for diabetes: it merely prolonged the lives of some people. The discovery of insulin in 1921 was a truly a medical miracle, allowing people with type 1 diabetes to not only survive, but to thrive, living healthy, long lives.

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Diabetes diets evolve

When it came to diet, you’d think that things would settle down once insulin was discovered. And for a while, they did. The general dietary recommendation for diabetes was based on macronutrient composition: 50% of calories from carbohydrate, 20% of calories from protein and 30% of calories from fat. An 1800 calorie “diabetic diet” was pretty standard for most people with type 1 diabetes. Obviously, this dietary prescription didn’t work for a lot of people.

In 1994, the American Diabetes Association (ADA) broke from strict, one-size-fits-all dietary prescriptions, and issued guidelines that emphasized an individualized approach. These guidelines introduced the term “medical nutrition therapy,” replacing “diet therapy” and made obsolete the term “ADA diet.” The focus centered on a team approach to diabetes management, including a dietitian who was (and still is) the primary provider of medical nutrition therapy. The key to success? The involvement of the person with diabetes.

Current nutrition guidelines for diabetes

Treatments for both type 1 and type 2 diabetes continue to evolve. Just as there are new medications, new forms of insulin delivery, and new forms of monitoring glucose levels, there are new nutrition recommendations, as well.

The newest nutrition guidelines were published in 2019 and their contents may be somewhat surprising to you. Among many things, they outline the goals of medical nutrition therapy (MNT) for people with both type 1 and type 2 diabetes:

To promote and support healthful eating patterns, emphasizing a variety of nutrient-dense foods in appropriate portion sizes, in order to improve overall health and specifically to:

· Improve A1C, blood pressure, and cholesterol levels (goals differ for individuals based on age, duration of diabetes, health history, and other present health conditions).

· Achieve and maintain body weight goals.

· Delay or prevent complications of diabetes.

· To address individual nutrition needs based on personal and cultural preferences, health literacy and numeracy, access to healthful food choices, willingness and ability to make behavioral changes, as well as barriers to change.

· To maintain the pleasure of eating by providing positive messages about food choices, while limiting food choices only when indicated by scientific evidence.

· To provide the individual with diabetes with practical tools for day-to-day meal planning. (source: Diabetes Care, April 2019)

OK, so MNT is a big deal when it comes to diabetes management. But what about those macronutrients (aka carbs, protein and fat)? Surely these guidelines lay out the amount of carb someone with type 1 diabetes should be eating, right? Not really. Here’s what the guidelines have to say about that: There isn’t an ideal percentage of calories from carbohydrate, protein and fat for all people with or at risk of diabetes. In other words, the “ideal percentage” of macronutrients boils down to what works best for the person, and takes into consideration preferences, eating patterns and metabolic goals. Pretty novel concept!

But what about carbs?

Here’s what we know about carbohydrate (carb):

· It’s a readily available source of energy for the body.

· Of the three main nutrients, carb has the most effect on blood glucose.

· The recommended minimum daily amount is 130 grams per day for adults age 19 and older, but the amount of carb someone needs for optimal health is unknown.

· And…other processes in the body can help meet the brain’s requirement for glucose, including ketogenesis in the context of a very-low-carb diet.

Eating patterns

The term “eating patterns” is relatively new when it comes to diabetes nutrition guidelines. An eating pattern is a combination of food or different food groups that is acceptable for the management of diabetes. Eating patterns aren’t “diets,” but they can help guide the person with diabetes when it comes to food choices and at the same time, take into consideration individual dietary preferences.

Here’s what to know about eating patterns:

· They help you decide what, when and how much to eat on a daily basis.

· They emphasize non-starchy (low-carb) veggies. Leafy greens, cucumber, broccoli, tomatoes and green beans fall into this category.

· They downplay added sugars and refined grains, such as white bread, white rice and white pasta.

· They focus on choosing whole foods rather than processed foods as much as realistically possible. As an example, it’s best to go for eating an apple rather than drinking apple juice.

· Whichever eating pattern you choose to follow, reducing carb intake has the most evidence for improving glycemic control in people with diabetes. Note that reducing carb intake doesn’t mean eliminating carb altogether.

So what are these eating patterns? You likely are familiar with a few of them. The eating patterns reviewed for the current nutrition recommendations are as follows:

· USDA Dietary Guidelines for Americans

· Mediterranean-style

· Vegetarian or vegan

· Low-fat

· Very-low-fat

· Low-carbohydrate

· Very-low-carbohydrate

· DASH (Dietary Approaches to Stop Hypertension)

· Paleo

The good news? You have options! In future posts, we’ll take a closer look at these eating patterns. Hopefully this will be helpful for you as you decide (with input from your diabetes care team) which eating pattern works best for you.

Want to learn more about eating well with diabetes? Read “Improving Your Recipes: One Step at a Time,” “Top Tips for Healthier Eating” and “Cooking With Herbs and Spices.”

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