Sometimes it feels like there's a new revolutionary diet or list of superfoods being "discovered" every other day, especially during Spring, when everyone is getting ready for swimsuit season! Weight issues plague both people with type 1 diabetes and type 2 diabetes, but some of these diets can be tricky to understand. When you have diabetes and are trying to balance blood sugars, it can be difficult to know whether any given diet is a good choice. For National Nutrition Month, we're examining a four diet plans that have gotten the most hype: the South Beach Diet, the Paleo Diet, the DASH Diet, and Juice Cleanses.
Of course, the word "diet" is almost a misnomer these days, because it implies that the eating plan will eventually end. The fact is, most of these diets have long-term "maintenance" phases, so you never really stop dieting. It becomes a lifestyle, not a diet — which can be a good thing, as long as it's truly sustainable.
South Beach Diet
The South Beach diet is extremely popular, because there are no special foods to eat, calories to count, or points to count, and the format is easy to follow, with just three phases. The first phase attempts to curb cravings and jumpstart weight loss. Folks skip all starches, like potatoes, fruit, bread, cereal, rice, pasta, beets, carrots, and corn for the first two weeks. You can eat lean meats, eggs, cheeses and other dairy, vegetables, and healthy fats like nuts and avocado. Alcohol is also a no-no.
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The second and third phases introduce more food into the diet. Healthy whole grains, fruit and starchy vegetables are allowed back, but foods with added sugar or refined carbs are still off limits. In the third, maintenance phase, which begins when you reach your healthy weight, you continue with the same foods as phase two, but there are more allowances for indulgences.
So how good is this diet plan for PWDs?
"There are elements of the South Beach program that are basic principles many nutritionists would agree with, like the reduction in refined carbohydrates, inclusion of high fiber fruits and vegetables," says Robyn Webb, Food Editor for the ADA's magazine Diabetes Forecast. "However, the emphasis on the amount of protein will not work for everyone and some of the unnecessary restrictions will also not work for everyone."
The restrictions especially in the first phase can make PWDs feel like they have to "cheat" when treating lows with juice or sugar, which can be a slippery slope because we all know that it's hard to stay motivated once you feel like you've "fallen off the wagon." And we PWDs often experience more lows when altering our diets to try to lose weight.
A few years ago, Amy gave the South Beach diet a try and noted that even though the second phase seems easier, it can be a slippery slope too because, "As welcome as it sounds, I know this is where things get tricky. Once we get a taste, we want more than a little (extra carbohydrate), don't we now?"
Nora Saul, CDE and Manager of Nutrition Services at Joslin Diabetes Center, actually advises PWDs at risk of hypoglycemia against using phase 1 of the South Beach Diet because of the restrictions. "It's best if they skip over that section," she says.
The Paleo (or Paleolithic) Diet is based on the simple premise that we should all be eating exactly how our ancestors, the cavemen, ate. That is, we should eat anything that can be hunted (fish and grass-fed animals) or gathered (vegetables, fruit, roots, and nuts).
Off the list are whole grains, dairy, legumes (beans and nuts), salt, refined sugar and oils. Proponents of the diet theorize that some of our problems (including type 2 diabetes) were born out of the rise of agriculture in our society, and that we humans were never meant to eat grains.
The Paleo diet has a huge number of fans and a large number of resources, including its very own magazine. We even found one PWD who has devoted his blog to his experiences with the Paleo diet. Mark Koekemoer, a type 1 PWD in South Africa, was diagnosed in 1996 and started following the Paleo diet in November 2011 after hearing about it at his local gym.
Mark says, "By cutting out carbs, I immediately reduced my total daily dose of insulin by more than half. I found immediately that with less insulin in my body, the rate of fluctuation of my sugars decreased. So I have had fewer highs and fewer lows, my sugars became more consistent and the standard deviation smaller. Pre-Paleo, my A1c was 6.2%, which is pretty good, but 3 months after switching to Paleo my A1c was down to 5.9% and I know it'll be even better next time."
He also notes, "You have to cook. Eating the Paleo way requires more preparation and cooking than the convenient sandwich or cookies would. But I feel that if it makes me feel the way I do and gets me the control I'm after, it's all worth it."
Experts aren't so sure these restrictions are necessary, mainly because the Paleo Diet cuts out legumes and whole grains, and relies heavily on lean meats, which can be dangerous for folks with cardiovascular issues (aka lots of PWDs). Also, some researchers question the historical validity of Paleo and whether or not it's necessary to go back to that diet in order to be healthy.
"While the Paleo program includes good foods such as lean proteins, nuts, vegetables and fruits, it's also a limited program and I question the accuracy of the evolutionary logic," says ADA Food Editor Robyn. "It eliminates beans, which I think has no basis. The elimination of refined sugars is a good idea, but overall I think the program may be difficult for one to follow."
The Dietary Approach to Stop Hypertension (DASH) Diet
This diet was named No. 1 in U.S. News and World Report's Best Diets 2012, and counts the National Heart, Lung and Blood Institute, the Mayo Clinic, and the American Heart Association among its supporters.
The DASH Diet is not primarily a weigh-loss diet; it was developed to promote (as you can imagine) heart health. This diet is simple to follow and has few restrictions, focusing on lots of fruits and vegetables, low fat or nonfat dairy, whole grains, lean meats and fish, and nuts and beans. The main restrictions are processed and red meats, sodium, and sugary drinks.
Is it good for PWDs? DASH relies more on whole grains than other diet plans, and those of us who struggle with the effects carbohydrates on blood sugar may have issues there.
But the experts we spoke to are big fans of DASH.
"Now we're talking!" says Robyn. "The DASH Diet is the most sensible one listed here. The reduction in sodium is a wise approach. The 'diet' is a healthy, balanced food program with great variety and emphasis on low sodium. It will naturally have one eating lean proteins, fruits, vegetables and whole grains."
"The DASH diet is great," says Joslin nutrition expert Nora. "Very high in fruits and vegetables. Low in saturated fat, and low in sodium. The diet was designed to lower blood pressure and it's a good diet for diabetes. It's higher in carbohydrates, but the carbs included are good choices."
There's even scientific evidence that DASH is good for type 2 diabetes. A 2011 study in Diabetes Care showed a modest weight loss and a nearly 2% drop in A1c for people with type 2 trying DASH. Another study in the Archives of Pediatric & Adolescent Medicine showed that 9-year-old girls who followed a diet very similar to DASH were the least likely to be overweight after 10 years.
Strictly speaking, a juice cleanse is not a diet. The idea behind it is to "cleanse" the body of toxins and nastiness by drinking juices made from liquified fruits and veggies, plus water. Similar to phase 1 of the South Beach Diet, a juice cleanse, like the popular BluePrintCleanse, can help jump-start a new healthy diet by spending a few days to a few weeks detoxing yourself from any addictions or cravings to carbs and sweets. In theory, it sounds great, but in practice? It can be very, very difficult due to the extreme restrictions and total 180-degree turn you make on your lifestyle. It's also somewhat unnecessary, Nora tells us, as your body cleanses itself of toxins just fine on its own.
The Huffington Post has a whole list of dangerous side effects of juice cleanses. And in a New York Times article, Marianne Gillow, a psychiatrist who counsels patients with food issues, says, "My biggest concern about juice cleanses is that they fuel obsessive thinking. People who have trouble managing their weight tend to be all or nothing about things. Cleansing doesn't allow you to make peace with real food."
It can also rob you of important nutrients that your body needs. The juice cleanses are not meant to be used long-term, but they can still cause damage if used too often.
"Some people derive spiritual benefit from cleansings and fasts so that part can be good for people," says the Joslin Center's Nora. "There's a tiny bit of research that says that when you do fast, you break down fat, and when you do that, that's possibly a way to get rid of toxins that are stored in fat. But there's really no need for regular fasting or juice, and if you're drinking massive amounts of juice, your blood sugar is going to spike." Uh-huh.
Choosing Your Diet
So how do you know which diet is right for you? First thing you can look for is whether or not a diet is nutritionally sound. Anything that requires you to eliminate entire food groups or deprives you of nutrients is not a good bet. You also want to make sure it doesn't promise you magical results, like losing 17 pounds in 5 days. No matter how you do that, it's not healthy!
You also need to make sure that you're ready for the changes, and that the changes are something you can live with.
"It has to be something that fits into a person's lifestyle," Nora says. "If you eat out all the time and you're following a diet that makes you use very complicated recipe, that probably won't work for you. If you love pasta or some other food, and you're on a low-carb diet, long term that probably won't work for you."
Nora's comments are heartening: hopefully gone are the days when "old school" nutritionists just passed out diet sheets regardless of a patient's lifestyle choices. These days, working with a good nutritionist or dietician who listens to you can be valuable, especially if you're unsure of how a diet will impact your diabetes.
"Everyone with diabetes is different," says the ADA's Robyn. "I have some patients with kidney disease so they will need restriction in potassium and protein. I have some people who wish to be vegetarian. So I have all types of clients. Basically I design a well-rounded, high-fiber, low-fat food program that fits realistically into my client's life." Way to go, Robyn!
Have you tried any of the diets we highlighted today? Or do you have another fave that you want to tell us about? We're always looking for better ways to eat healthy ourselves, so we're all ears!