Today I’m here to spill the beans on National Nutrition Month, sponsored by the Academy of Nutrition and Dietetics, who are trying to butter us up to better eating by inviting us to “bite into a healthy lifestyle.” OK, so the Academy writes cheesy ad copy, but do they know their onions?
OK. Sorry. I overdid it again, didn’t I? I promise to stop with the food puns before someone gives me a knuckle sandwich, or before I end up with egg on my face. Now that I’ve exceeded my eye-roll quota for the month, I know I need to the point before you think I’m nuttier than a fruitcake, because, really, I have bigger fish to fry.
Have you ever noticed how infused the English language is with food-related sayings, adages, and references? What is that telling us?
The way I see it, food is more the domain of the sociologist, psychologist, and the cultural anthropologist than it is the realm of the dietitian. Maybe most animals eat to fuel their bodies, but that’s not true of human animals. To us, food is more than food. Food is social and food is ritualistic. We are born, live, and die in a world of food. There’s food at baby showers, birthdays, and graduations. First dates often involve food. As do weddings, anniversaries, and, yes, even funerals. At the end of the day, instead of gathering around the campfire like our ancestors, we modern humans gather around the table. We share our day’s triumphs and tragedies as we break bread. Food builds family bonds, creates unity, and shares the common purpose of life.
And of course, those of us living with diabetes – and maybe other 'fun' experiences like celiac or gluten intolerance – have the adventure of food being an even more significant part of our lives.
With all of that in mind, we now have a call for change coming into this deeply imbedded mesh of family, society, culture, psychology, and religion.
The goal of this year’s Nut Month (as I like to call it):
“Consuming fewer calories, making informed food choices, and getting daily exercise in order to achieve and maintain a healthy weight, reduce the risk of chronic disease and promote overall health.”
I’m sure this will put me on the Academy’s most-wanted list (next March will be “Let’s take a bite out of Wil Month,” just you wait and see), but I don’t think changing people’s diet is good medicine. At least not in the way it’s usually done -- a scorched earth, change everything today, right now, kind of way.
I know I took some heat a while back for half-joking about how difficult changing your diet can be, but I believe that. Changing something as fundamental to human social and cultural environments as diet is to change who you are, and often in the face of resistance from those you hold most dear to your heart.
But diet does matter to diabetes. In fact, the No. 1 question patients ask me when they are first diagnosed with diabetes is: “What can I eat?”
The question is easy to repeat. What’s harder to convey with the written word is the desperation in tone, the fear in the eyes, the beaten-dog sag of the shoulders that accompanies the question.
How do you think most doctors respond? And how do you think members of the Academy of Nutrition and Dietetics would respond?
For generations the newly diagnosed, still reeling from the shock of a lifetime, have been handed a sheaf of dogged-eared Xerox pages telling them what they can’t eat. Which rituals to abandon. What love to sacrifice. What sex to forgo. No wonder medically ordered diet change so often fails.
So if we wanted to move towards better nutrition for Nut Month, what path should we take? As an educator, I’m often asked what I think of low-carb, vegan, gluten-free, and Paleo diets. I think if you do all four you’re left eating mud, right? Well, let’s take a look at those options…
Personally, I’d say eating on the lower-carb side is probably the best for diabetes – but it can also be the toughest to maintain, when it comes to willpower. I've written about that before in addressing the Dr. Richard Bernstein "solution," so I won't repeat what was said there.
Actually, our own MikeH here at the ‘Mine has been recently inspired to move toward a lower-carb diet. A longtime T1 since he was a kid, Mike tells me he’s had been putting on the pounds thanks to a combination of loving food and not exercising as much as he probably should. And while he’s been watching the “low carb” trend for quite some time, he’s been slowly leaning in that direction… But then earlier this year, another DOC friend shared his own Low-Carb High Fat (LCHF) experiences and that pushed Mike over the line.
He’s not giving up carbs by any means, but rather working to limit bread, snack on veggies instead of carb-heavy chips or crackers, and even phase out hamburger buns in favor of lettuce wraps. He's added in some turkey links and beef jerky, and at least a handful of almonds each day. And as Mike said recently: some of his meals have been so low-carb that the beer he’s enjoying with it was the highest-carb thing he ingested.
Still, echoing my point, Mike says the toughest part so far is just finding the willpower to keep up with this diet change. Thankfully he is having fun exploring new food options and reports that his blood sugar levels have been much more steady without post-meal spikes or subsequent hypos due to insulin on board. Some of those hypos (and overtreated Highs) are still striking as he navigates the insulin doses, but it's going pretty well so far.
Whatever works, my Friend. That’s my motto.
While I’m not keen on vegan, it is proven to help control diabetes if done right. And I feel the same way about modern Paleo: It works, but I personally don’t like it. Why don’t I like two approaches that work? Sustainability is a part of it, but I also tend to look at how humans are engineered: We have middle-of-the-road intestines, unlike other mammals that eat grass and fellow mammals and are more designed to eat those types of things. That tells me we’re engineered – or evolved to the point – of being fit for an omnivorous diet.
As to gluten-free: if you’re allergic to wheat like myself and 'Mine editor AmyT, or you have celiac, you really don't have a choice about whether or not to eat gluten-free. For the rest of you, I doubt there’s much benefit—but please keep the fad alive. As long as gluten-free is all the rage, people like Amy and I will have a better range of tasty choices.
All Food Leads to Rome
So what do I think is the best diabetes diet? "All roads lead to Rome," as the old saying goes. I think any “diet” that balances a PWD’s (person with diabetes) particular blood sugar patterns, activity level, and medications is fine.
When deciding on a diet change it's great to involve the nutrition experts, but also the PWD themselves, and the humans who live under the same roof with them. The change should be a slow, collaborative effort. And it should be both personalized and recognize that small, incremental changes are better than no change, or total failure.
I believe in starting where the PWD already is, as in: do more of what works, less of what doesn't. I believe in maximizing therapy around existing diets as much as possible (although generally liquid carbs have to go, as we do not currently have insulin fast enough or powerful enough to deal with that kind of sugar load). And then from there, move to a healthier balanced diet that works, one baby step at a time.
Because long-term success really is the icing on the cake.