An Option to Consider
The road to health is paved with vegetables, fruits, beans, rice and grains. – Polly Strand
In the United States, vegetarianism has often been considered something of a fad or an aspect of an “alternative” lifestyle. In recent years, however, this way of eating has become more mainstream. Today, up to 10% of Americans call themselves vegetarians, although they don’t all define the word the same way. “Vegans” avoid all foods derived from animals and eat only plant-based foods. “Lacto-vegetarians” avoid meat, poultry, fish, and eggs but include dairy products in their diets along with plant foods. “Lacto-ovo vegetarians” eat eggs in addition to dairy products and plant foods. And “flexitarians” (sometimes called “semi-vegetarians”) follow a primarily plant-based diet but occasionally eat small amounts of meat, poultry, or fish.
The reasons people adopt a vegetarian eating style are varied and may include concern for animals and/or the environment, personal health, and culture or religion.
Following a vegetarian meal plan does appear to have health benefits. According to the American Dietetic Association, vegetarians are less likely than meat eaters to be overweight or obese or to have Type 2 diabetes. They also tend to have lower blood cholesterol levels and lower blood pressure, and they have lower rates of death from heart disease and prostate or colon cancer.
The features of a vegetarian meal plan that may reduce the risk of chronic disease include lower intakes of saturated fat and cholesterol and higher intakes of fruits, vegetables, whole grains, nuts, soy products, fiber, and phytochemicals (chemical compounds found in plants that may be beneficial to human health).
In many ways, the characteristics of a well-planned vegetarian meal plan are similar to the recommendations for meal planning for managing diabetes. That being the case, a vegetarian meal plan may be a good choice for individuals with diabetes.
Getting adequate nutrition
No matter what type of meal plan you choose follow, the most important thing is to ensure that it meets your nutrition needs. A vegetarian meal plan that relies heavily on white bread and cheese, for example, is unlikely to provide the same benefits as a plan that is based on dried beans, lentils, soy products, whole grains, and a variety of vegetables. When adopting a plant-based meal plan, therefore, there is more to consider than just avoiding meat.
Although there is no single best nutrition plan for people with diabetes, the American Diabetes Association (ADA) offers some recommendations for the proportions of protein, fat, and carbohydrate to include in one’s meal plan. The ADA’s recommendations are based on research studies that have shown these proportions to provide adequate nutrition while not increasing the risk of diabetes complications. However, the ADA’s guidelines caution that each person’s meal plan should be individualized according to his personal characteristics, including any complications he may already have.
Your body needs protein for healthy skin, bones, muscles, and organs. Protein intake should be about 10% to 20% of your total caloric intake. It was once thought that plant foods had to be eaten in specific combinations at the same meal to provide all the amino acids (the building blocks of protein) necessary for good health. It is now known that consistently eating a varied meal plan of nutritious plant foods can easily meet those amino acid requirements.
Good vegan sources of protein include soybeans and soy products such as tofu, tempeh, textured soy protein, soy milk, and some veggie burgers; dried beans and legumes such as lentils; whole grains (with some being much higher in protein than others); seitan (wheat gluten); and nuts, seeds, and nut and seed butters. (See “Cooking With Tofu” to learn more about this soy protein.)
Lacto-vegetarians can also include low-fat or fat-free milk products and low-fat cheeses as protein sources, and lacto-ovo vegetarians can additionally include egg whites.
Protein sources with a higher fat content, such as nuts, nut butters, full-fat dairy products, and whole eggs, should be eaten in moderation to avoid excessive calorie and fat intake. (Click here for a table offering a comparative look at various vegetarian protein sources.)
Generally, your total fat intake should make up less than 30% of your total calories consumed, with saturated fat limited to less than 7% of the total calories, trans fat minimized as much as possible, and a total cholesterol intake of no more than 200–300 mg per day. Limiting total fat intake can help a person attain and maintain a healthy weight, while limiting saturated fat, trans fat, and dietary cholesterol can help to keep the blood level of low-density lipoprotein (LDL or “bad”) cholesterol low.
Dairy products (except for fat-free products) and eggs are sources of saturated fat and cholesterol, but they can be replaced by such alternatives as low-fat or fat-free dairy products, egg whites, and egg substitutes, which contain less saturated fat and cholesterol, or none at all.
Plant-based foods such as canola and olive oils, avocados, seeds, and nuts are good sources of monounsaturated and polyunsaturated fats. These types of fats are considered healthier fats because substituting them for saturated fat may lead to lower total and LDL cholesterol levels. Monounsaturated fat may additionally raise high-density lipoprotein (HDL, or “good”) cholesterol level in the blood.
Omega-3 fatty acids are a particular form of polyunsaturated fat that can help prevent heart attack and stroke when consumed in adequate amounts (and as a high enough percentage of total fat in the diet). While vegetarian meal plans tend to be rich in other essential fatty acids, they can be low in omega-3 fatty acids. Therefore, it is important for vegetarians to consume foods that are rich in omega-3 fatty acids on a daily basis. Flexitarians may find this easiest, since high amounts of omega-3 fatty acids are found in fatty fish such as mackerel, lake trout, herring, sardines, albacore tuna, and salmon. For those who prefer plant foods, flaxseed, flaxseed oil, canola oil, tofu and other forms of soybeans, walnuts, and supplements made from microalgae are sources of omega-3 fatty acids. Soy milks and cereals fortified with omega-3 fatty acids are also available.
Like most Americans, vegetarians may tend to overconsume refined carbohydrates such as white rice, pasta, and many crackers, breakfast cereals, and breads. Carbohydrate foods made from whole grains are better choices for a number of reasons, including a higher fiber content, higher nutrient content, and a tendency to be digested more slowly, which can help normalize blood glucose levels after meals.
Most mainstream grocery stores sell such whole-grain products as brown rice, bulgur (cracked wheat), kasha (toasted buckwheat groats), oatmeal, pearled barley, popcorn, quinoa, wild rice, and whole-grain breads, breakfast cereals, crackers, and pastas. Health-food or natural-foods stores may additionally sell amaranth, millet, steel-cut oats, whole wheat berries, and others.
The other types of foods that should make up the bulk of carbohydrate in a vegetarian meal plan include vegetables of all types, dried beans and legumes, and fruit. Dairy products such as milk and yogurt also contribute carbohydrate in meal plans that include them. Less-nutritious sources of carbohydrate, such as sweets, should account for a smaller percentage of calories and carbohydrate.
Vegetarians who have diabetes need to be aware of which foods contain carbohydrate and to pay attention to how different types of carbohydrate-containing foods (and various portion sizes of those foods) affect their blood glucose level. Many people with diabetes find that keeping the amount of carbohydrate they eat for breakfast, lunch, and dinner consistent from one day to the next helps to keep their blood glucose level more consistent, as well. People who use insulin also need to learn to match their insulin doses with their carbohydrate intake. This may require some trial and error when incorporating new foods such as whole grains and dried legumes into your meal plan.
Vitamins and minerals
A well-planned vegetarian meal plan is adequate in most essential vitamins and minerals. The one possible exception is vitamin B12, which occurs naturally only in animal products, including fish, meat, poultry, eggs, milk, and milk products. Vitamin B12 is essential for red blood cell formation and for proper nervous system function. Vegans, who consume no animal products, therefore need to include foods fortified with vitamin B12 in their diets or take B12 supplements. Examples of foods that may be fortified with B12 include some brands of soy beverages, breakfast cereals, veggie burgers, and nutritional yeast.
Vitamin B12 deficiency is usually caused by a low intake of foods containing vitamin B12 or by an inability to absorb the vitamin from food. Malabsorption of vitamin B12 is common among adults over 80. Pernicious anemia and a variety of gastrointestinal disorders can also cause vitamin B12 deficiency due to malabsorption.
Several minerals also merit discussion when planning a vegetarian meal plan:
Calcium. Calcium is needed for healthy bones, muscle contractions, heart action, nervous system maintenance, and normal blood. Although many people associate calcium with dairy products, it is present in a wide range of foods, including certain green vegetables (particularly bok choy, broccoli, collards, Chinese cabbage, kale, mustard greens, and okra), nuts and seeds, dried fruit, and tofu. Calcium-fortified soy beverages and orange juice can provide as much calcium per serving as cow’s milk.
Iron. Iron is needed to form hemoglobin, a protein carried by the red blood cells that transports oxygen from the lungs to the rest of the body. The iron found in meat, fish, and poultry is more easily absorbed by the body than the iron in plant foods. However, there are two ways to increase the body’s absorption of the iron in plant foods: One is to consume small amounts of meat, fish, or poultry along with plant foods – an option for flexitarians. The other is to eat foods high in vitamin C (such as bell peppers, broccoli, cabbage, cauliflower, citrus fruits, mustard greens, strawberries, and tomatoes) along with plant sources of iron, which include fruits, vegetables, dried beans, nuts, and grain products.
Zinc. Zinc plays a role in growth and development, helps the immune system function properly, and is required for proper sense of taste and smell. The zinc in animal foods is more readily absorbed than the zinc in plant foods, but certain plant foods are still considered good sources of zinc. Those include nuts, pumpkin and sesame seeds, whole grains, green peas, and dried beans and legumes. Dairy products also contain zinc, and oysters, crab, and lobster are high in zinc.
What studies show
A few research studies have examined whether following a vegetarian meal plan may help to prevent or control Type 2 diabetes. One study, published in May 2009, followed 22,434 men and 38,469 women for several years. All of the study subjects were members of the Seventh-Day Adventist church, which encourages following a lacto-ovo vegetarian meal plan, and all filled out questionnaires stating how often they ate certain foods or food groups. They were then categorized as vegans, lacto-ovo vegetarians, pesco-vegetarians (if they ate fish), semi-vegetarians, or nonvegetarians. The study results showed that all of the vegetarian groups had a lower body-mass index (BMI) and a lower risk of developing Type 2 diabetes than the nonvegetarians. Vegans and lacto-ovo vegetarians had nearly a 50% reduction in the risk of developing Type 2 diabetes.
Another study, published in 2006, looked at whether a low-fat vegan meal plan could improve blood glucose levels and cardiovascular risk factors in people with Type 2 diabetes. In the study, 99 people with Type 2 diabetes were assigned to follow either a low-fat, vegan meal plan for 22 weeks, or a meal plan that adhered to the 2003 ADA guidelines. (The ADA periodically reviews its dietary guidelines and has updated them since 2003.) No meals were provided to either group, and participants were asked not to change their exercise habits during the study.
The vegan meal plan got about 15% of calories from protein, 10% from fat, and 75% from carbohydrate. Participants were told to eat vegetables, fruits, whole grains, and legumes; to favor foods with a low glycemic index (meaning they raise blood glucose levels slowly and moderately); and to avoid animal products and added fats. Portion sizes, calorie intake, and carbohydrate intake were not limited.
The ADA meal plan got 15% to 20% of calories from protein, less than 7% from saturated fat, 60% to 70% from carbohydrate and monounsaturated fat, and no more than 200 milligrams of cholesterol per day. Each person’s recommended meal plan was individualized based on body weight and blood lipid (cholesterol and triglyceride) levels, and all but three participants in this group were prescribed a calorie intake level intended to help them lose weight.
At the end of 22 weeks, both groups had improvements in blood glucose and blood lipid control. However, 43% of the vegan group were able to reduce their diabetes medication, compared to 26% of the ADA group. In addition, hemoglobin A1C (HbA1c), a measure of blood glucose control over 2—3 months, decreased by 0.96 percentage points in the vegan group and by 0.56 percentage points in the ADA group, bringing both groups closer to the ADA goal of an HbA1c level below 7%. The vegan group also lost an average of about 13 pounds, while the ADA group lost an average of 9 pounds.
Not only were the health benefits of following a vegan meal plan apparent, but participants in the vegan group found it a highly acceptable way of eating. A newer report related to an extension of this study showed that the benefits of following a vegan meal plan continued beyond a year, making it the longest research trial to date showing the benefits of following a vegan meal plan in the treatment of Type 2 diabetes.
Making the switch
Because switching to a vegetarian meal plan can lead to weight loss and lower blood glucose and cholesterol levels, your medication needs could change if you make this switch. That means it’s a good idea to speak with your health-care provider before beginning a vegetarian meal plan. People who use insulin may want to review how to adjust their premeal and basal insulin doses and how to prevent and treat hypoglycemia (low blood glucose). Some oral medicines can also cause hypoglycemia and may need to be reduced or discontinued if low blood glucose is occurring frequently. Oral medicines that can cause hypoglycemia include glyburide, glimepiride, glipizide, repaglinide (brand name Prandin), and nateglinide (Starlix).
A registered dietitian can help you create a meal plan that provides necessary nutrients, as well as advise you on whether to take supplements such as vitamin B12, iron, or vitamin D. While the participants in the low-fat, vegan diet study described earlier lost weight and saw improved blood glucose control without restricting portion sizes or counting calories, if you do not see the health benefits you desire after changing your eating habits, you may need to reduce your food intake.
When initiating any new meal plan, including a vegetarian one, it’s a good idea to monitor your blood glucose level more frequently. Checking your blood glucose level before and two hours after a meal will show you how your food choices are affecting it. If your new meal plan leads to weight loss, you may see lower blood glucose levels over time. Keeping a food and blood glucose log when starting a vegetarian meal plan will help you and your health-care providers both tailor your food choices and determine how to adjust the doses of any medicines you are taking.
Some people prefer to change their eating habits all at once, while others prefer to make gradual changes, eating several vegetarian meals a week at first. Whichever approach you choose to take, here are some tips for getting started on a vegetarian meal plan.
Alter your favorite recipes. Many meat dishes can be made into vegetarian dishes by using a meat substitute such as wheat gluten (seitan) or soy-based “crumbles” or “strips” in place of the meat. (Both of these products are sold in the refrigerated or freezer sections of the grocery store.) Dry texturized vegetable protein (TVP), made from soy flour, can also be used to replace ground meat in dishes such as lasagna, stews, sloppy joes, stroganoff, chili, tacos, and burritos. Firm, marinated tofu can be substituted for chicken in stir-fry dishes.
Seek out vegetarian recipes. Buy or borrow a vegetarian cookbook, or visit Web sites dedicated to vegetarian or vegan eating for recipes developed specifically for vegetarian ingredients. (See “Resources.”)
Try vegetarian convenience foods. When you don’t have time to cook, try the various types of convenience foods sold in most grocers’ freezers or refrigerator cases: veggie burgers; “chicken” patties; soy hotdogs; precooked, flavored tofu or tempeh; and vegetarian frozen entrÃ©es such as corn and bean enchiladas, lentil curry, and vegetarian pad Thai. Look in the refrigerated section for prepared hummus, baba ganoush, soy cheese, soy milk, and soy yogurt.
Learn to like beans. Beans are an inexpensive source of protein, and when purchased canned or frozen, they’re fast and easy to prepare. Look for edamame (green soybeans) and black-eyed peas in the freezer. Look for black beans, chickpeas, kidney beans, and pinto beans in the canned section, or, if you have time, buy dried beans and cook them yourself.
Try new grains. Grains are a natural partner to beans, providing complementary flavors, textures, and nutrients. Some whole grains take much longer to cook than refined grains, but not all: Whole-grain pasta, for example, cooks in about the same amount of time as regular pasta. Kasha, quinoa, and old-fashioned rolled oats can be ready in about 15 minutes. Pearled barley, amaranth, bulgur, and millet cook (or soak, in the case of bulgur) in about 30 minutes. Longer-cooking grains can also be cooked in large portions and stored in the refrigerator for at least several days for quick meal preparation.
Eat your vegetables. Starting a vegetarian diet is a great time to try new vegetables or to eat more of your favorites. Dark-green and dark-orange vegetables are particularly high in nutrients, so include those regularly in your meals.
Continue reading labels. When you buy packaged foods, check the Nutrition Facts panel on the label. Canned beans and vegetables may be high in sodium, and convenience foods such as meat substitutes and veggie burgers may be high in fat and/or sodium and low in fiber. Make good nutrition your priority.
Eat out in ethnic restaurants. Chinese, Mexican, Thai, Japanese, and Indian restaurants are likely to have vegetarian items on their menus, and even many American-style restaurants serve veggie burgers or other vegetarian entrÃ©es these days. If you’re not sure whether a restaurant has – or is willing to make – what you need, call ahead and ask.
Eating for good health
Following an individualized meal plan is an important part of diabetes management because eating the right foods in the right amounts can help you keep your blood glucose levels as close to normal as possible, achieve and maintain a healthy weight, and keep your blood pressure and cholesterol levels in a healthy range. All of these parts working together can lower your risk of heart disease, stroke, and other diabetes-related complications.
Because a vegetarian meal plan has been shown to be helpful in achieving these goals, vegetarianism may be another tool to consider as you travel the road toward optimal diabetes health.