Eating Is Controversial

I previously opined about how physical activity is not controversial because almost everyone can agree that being active is good for your health and longevity. As for food, everyone has to eat in the short run to stay alive. Eating—at least in general—is not controversial. Rather, the controversy around food and nutrition lies in what you should eat. Whether your goal is good health, weight loss, or managing what ails you, choosing what is best for you to eat is not always so straightforward.

Just like with physical activity trends, dietary fads and guidelines shift and change over time, and they also vary for cultural, ethnic, and practical reasons. They’re all some variation of macronutrients, amounts, food timing, and preferences, but diet is not a one-size-fits-all issue. Are you old enough to remember when all fats were “bad”? Food companies came out with fake fats so people could eat “fat” without all the feared negative consequences. Since then the pendulum has swung in directions of avoiding all carbs, overdosing on protein, eating unlimited fat, and restricting when you eat.

Even the dietary issues we thought were uncontroversial have not remained that way. Are saturated fats bad for health? (No, not all of them.) Does eating cholesterol raise your blood levels? (No—and eggs are back in style.) Are all carbs to be avoided? (Definitely not.) Do you need to eat huge amounts of protein? (Not likely.)

Then there are all the fad diets to lose weight. Let me just summarize them all generally by saying that following a diet that restricts you from eating an entire macronutrient group (carbs, fat, or protein) is usually not the best way to lose weight and keep it off (the latter being harder than the former), and you will likely be eliminating some essential nutrients. What’s more, Paleo man actually ate around 100 grams of fiber daily and hunted for and ate lean game and gathered his own food, and if you’re not doing those things on the “Paleo diet,” then you’re not really doing it right.

As for some of the more recent dietary trends like intermittent fasting and keto diets, the evidence is still emerging. Will intermittent fasting cure your diabetes or make you lose weight? Its impact on your blood glucose and body weight depends on your definition of “intermittent,” but it’s not likely to be a long-term cure for anything. As for eating “keto,” it will invariably raise your intake of fats when you cut carbs almost completely out of your diet, and some studies have shown that following such eating patterns may raise the bad (LDL) cholesterol levels in some people.

Some nutrition facts are not in dispute. Veggies are good for you, and most of the “green” ones like lettuce, kale, broccoli, green beans, and more are generally lower in carbs and full of fiber and nutrients. In addition, plant-based protein sources are generally healthier for you. Eating highly refined foods—both carbs and meats—raises your risk for many health problems.

That said, eating is particularly controversial when you have diabetes. You have to focus on your diet because you simply can’t manage your blood glucose or your overall health effectively without taking into consideration what and when you eat and drink, but what and when you should be eating is still up for debate and may need to vary by person.

When I developed type 1 diabetes back in 1968, the dietary guidelines for people with diabetes called for eating balanced meals and measuring out all portion sizes. You had to eat a certain amount in each category of carbs, fat, and protein at the same time of day and for each meal or snack. Of course, you couldn’t adjust your insulin doses back then for what you ate because there were no blood glucose meters, so it made sense to try to keep the food intake predictable since you were eating to feed your insulin rather than taking insulin for the food you ate.

Today’s “diabetes diet” is less rigid given that it’s basically a recommendation to eat healthier and distribute your calories among carbs, fat, and protein however you want to. In surveying hundreds of active individuals with all types of diabetes recently, I found that some ate low-carb and some ate enormous amounts of carbohydrates daily. It really is an individual preference. Personally, I would lose all interest in eating altogether if I had to cut out all the plant-based, carb-heavy foods that I enjoy on a daily basis (such as hummus). (I also don’t care much for animal meats, poultry, or fish, so going low-carb is virtually impossible for me.)

At present, the American Diabetes Association has a “diabetes plate” that shows half the plate filled with non-starchy veggies, with protein foods filling one quarter and starchy foods in the last quarter (preferably whole grain). However, I know so many individuals with diabetes who choose to eliminate all but non-starchy carbs from their diet since carbs require the most insulin to manage blood glucose and the greatest spikes in glucose after eating. Many others are simply carb-conscious, meaning that they moderate their intake—particularly of highly-refined carbs that can raise glucose quickly and are lower in nutrients (most made with white flour, white sugar, or white rice). Rapid-acting insulins like Humalog, Lyumjev, and others can cover a lot of those food spikes, however, and eating carbs with a lower glycemic index can often result in getting low before your blood glucose levels rise later. But it depends on how many carbs you eat, how fast you digest them, the timing of your insulin (if you use it) and which type you use, and when you eat. It’s not simple to juggle all those variables all the time.

What if you want to transition to a more plant-focused diet or go totally vegan? Depending on how they are prepared, most non-starchy veggies are nutrient-dense and excellent sources of fiber, vitamins, minerals, phytonutrients (such as lycopene in tomato products), probiotics, and prebiotics. In other words, they are essential for great health. But plants—except for olives, avocados, nuts, and seeds—are mostly carb-based foods, so how can you eat vegan or even vegetarian when you’re trying to go low-carb? It gets even more complicated when you have to manage your blood glucose or have other food issues that affect what you can eat (like having to avoid all gluten).

So, what should you eat? In my decades teaching about nutrition and exercise and living with diabetes myself, I have found that taking even small steps in the direction of a more healthful diet—regardless of its content of carbs, fat, and protein—will benefit you. Maybe try eating one more plant-based meal each week. Loading up on non-starchy veggies every day as well can benefit your blood glucose, body weight, and nutrient status all at the same time. Limiting your intake of highly processed foods of all types is a sure step towards better health. What have you got to lose by giving any or all of these small dietary changes a try?