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Pizza, everyone’s got their favorite. And no one’s afraid to share their opinion on what makes for a good pie. I’ve been told that in New York, it’s the sauce that makes or breaks a slice. In California, they say it’s the toppings. For people with diabetes, it seems like it’s the crust that matters — because of the blood sugar effects, of course.

One of the things that makes it so hard to nail down what makes a pizza good — or higher or lower in fat content — is the sheer variety of ingredients used.

Toppings can include many cheeses and nearly any kind of protein, from sliced salami to a fried egg. Vegetable toppings can be just as varied. While onions, bell peppers, and mushrooms are traditional, nothing says roasted Brussels sprouts or kale can’t be on the slice. Pineapple as a topping, however, remains controversial.

A red sauce may be the first thing that comes to mind when thinking about pizza. But white cream sauces and green pesto have become more common too. These days, even red sauces stray from the traditional marinara style, leaning into hot and spicy or barbecue flavors.

Crusts have gone beyond choosing between a thick, doughy bread and a crispy, thin base. Nowadays crust can be made from any number of nontraditional ingredients. Some aim for bread-like crusts made from alternative flours like almond or chickpea, that avoid gluten. Others aim for vegetable-based alternatives, like sweet potato, zucchini, or cauliflower, that promise lower carbohydrate counts.

Whatever the ingredients, pizza generally provides generous servings of carbs, protein, and fat. Each of these affects blood glucose levels in their own way. Carbs generally drive glucose levels up. Protein can counter this rise, flattening the curve so to speak. And fat can suppress the rise in glucose levels in a way that can delay their effect for hours.

The net result of all these competing forces makes it extremely difficult to anticipate how any given slice of pizza is going to affect glucose levels and for how long. This uncertainty makes it very difficult to figure out when and how much insulin to dose to consistently keep glucose levels in range when eating pizza.

In fact, folks in the diabetes DIY technology community have been working hard to build an algorithm that would help people on new automated insulin delivery systems to “nail pizza.”

But the first line of defense is trying to make pizza itself more diabetes-friendly.

Matching insulin doses to the food on our plate is difficult in its own right. Add to that the variety of ingredients that can be used to make pizza, along with their complex effect on glucose levels, and successfully dosing for pizza is no mean feat.

In the quest to better manage glucose levels when eating pizza, most people with type 1 diabetes (T1D) often go one of two routes:

  • Split up their bolus (mealtime) insulin dose for the pizza meal into two or more increments, spread out over time to extend the impact of the insulin, or
  • Substitute ingredients to change the pizza’s impact on glucose levels

Swapping out ingredients can seem like the easier route to take. Choose veggies over meat and you get less fat and more fiber. Choose an olive-oil—based sauce and get a healthy fat while avoiding the hidden sugar in tomato sauces. Choose an alternative crust and reduce the carbohydrates in bread dough.

Cauliflower-based pizza crust, in particular, has become wildly popular and is promoted as a diabetes-friendly alternative. As a cruciferous, nonstarchy vegetable, cauliflower is filled with nutrients like vitamin C and can be used as a substitute for grains. When compared to all-purpose flour, cauliflower contains a fraction of the grams of carbohydrates (95 g versus 5 g per cup of raw ingredient).

The most basic cauliflower pizza crust recipe to make at home is quite simple. After cooking and pressing out all the liquid, minced cauliflower is combined with egg, mozzarella, grated Parmesan cheese, and some seasonings. The mixture is formed into a flat crust and baked until crispy. Toppings are added and the whole thing goes into the oven to heat through.

From this stripped-down recipe, you get a very thin and crispy crust. More like a cracker than a loaf. But cauliflower crusts can end up being soggy if not all the moisture was pressed out before the initial bake. Cauliflower crusts can also be brittle and break from the weight of the toppings. And the bitter flavor of cauliflower can remain noticeable. For these reasons, not everyone is a fan of the homemade versions.

To make cauliflower crust stronger and the pizza more appealing, commercial producers most often add an alternative flour (made from corn, rice, or coconut, etc.) or a starch (based on potato or corn) to help the ingredients bind together better and neutralize the cauliflower flavor. But beware that these flours and starches increase the amount of carbohydrates present in the crust.

To see the effect this can have, compare the nutritional information for the refrigerated cauliflower pizza crust from Trader Joe’s with their frozen version.

The refrigerated version sticks to the basic recipe and delivers just 4 g of carbohydrates per serving. The frozen version lists cornstarch, potato starch, and corn flour among its ingredients and delivers 17 g of carbohydrates per serving.

While it’s hard to get a direct side-by-side comparison of the same pizza with cauliflower versus traditional crust, Costco does sell a frozen version of its food court combo pizza with a cauliflower crust under its Kirkland Signature brand.

Both versions offer the same toppings in what looks like comparable proportions. Because they are so closely matched, the flavor from the toppings is pretty much the same.

But the crusts are drastically different. The traditional combo from the food court comes with the classic soft bread crust that’s thin at the center (under the toppings) with doughy rise all around the edge. The cauliflower crust is uniformly thin with no raised edge. It bakes up like a cracker, which results in a crunchy, brittle crust. With no edges to hold the toppings on the slice, they tend to fall off easily. The ingredient list for the cauliflower version includes rice flour, tapioca starch, and rice starch.

Costco Combo Pizza (frozen)
Kirkland Signature Supreme Cauliflower Crust Pizza
Serving size: 1/12 pizza (approx. 6 oz.)
Calories: 380
Carbohydrates: 41 g
Total Fat: 15 g
Saturated Fat: 7 g
Sodium: 971 g
Fiber: 4 g
Serving size: 1/4 pizza (approx. 5 oz.)
Calories: 310
Carbohydrates: 31 g
Total Fat: 15 g
Saturated Fat: 8 g
Sodium: 900 mg
Fiber: 1 g
Source: Menu with PriceSource: Frugal Hotspot

Looking at the nutrition information side by side, there’s not that much difference between the two versions.

While the carb count for the cauliflower crust version is 10 g fewer than the traditional crust pizza, they both have the same amount of fat, and the traditional version has ever so slightly more fiber (3 g).

It’s important to remember that for people with celiac disease and gluten intolerance, cauliflower and other alternative crusts may be a godsend, allowing them to stop avoiding pizza altogether.

But for people with T1D, it simply presents another choice when it comes to eating pizza. By reducing carb counts, it gives some middle ground between simply saying “no” to all pizza or saying “yes” and taking your chances with the resulting glucose levels.

As the comparisons of nutritional info above show, simply choosing a cauliflower crust is not a guarantee of getting a substantially glucose-friendlier pizza — even when the toppings and sauce match. You still have to look at the ingredient list and figure in the counts for carbs, fat, and fiber.

Much of the conversation among people with diabetes about cauliflower pizza, however, centers on taste and texture. No one makes a serious argument that a cauliflower crust matches a traditional bread crust in taste and texture.

Because of this, cauliflower pizza is a hard no for many, including Mila Clarke, diabetes advocate and founder of

“While it’s sometimes a healthier option, it [cauliflower pizza crust] doesn’t usually provide the satisfaction you want when you have a pizza crust,” Clarke said. “I don’t think you can fake it ’til you make it with this particular swap.

“Personally, I don’t think it’s worth making foods diabetes-friendly if you’re going to take away the essence of what makes it great. I would rather balance a smaller portion of something that might be decadent than change an entire dish and eat something unsatisfying.

“If you’re looking for more fiber, vitamins, and minerals, you’re better off using cauliflower as a topping instead of trying to make a crust out of it.”

Many nutritionists recognize that the eating experience can be as important to people as the nutritional content of their food as well.

Mary Ellen Phipps, registered dietitian and author of The Easy Diabetes Desserts Cookbook, definitely agrees.

“I want people to enjoy food in the way that brings them the most joy,” Phipps said. “Whether they want to enjoy traditional dishes or make ingredient substitutions, there is always a way to make a dish more blood sugar friendly.”

For people who want to eat pizza without going the cauliflower crust route she suggests, “Focus on adding fiber-rich ingredients as toppings like nonstarchy veggies. We also have data to show that eating some non-starchy veggies or greens before eating pizza may improve the blood sugar response after eating as well.”

So maybe start with a crudité (raw veggie platter) or a green salad when choosing to have a slice, for the sake of your blood sugar levels.

Popular cauliflower pizza options

For those who do prefer gluten-free cauliflower pizza or want to try it, there are many popular brands to explore these days, including:

Store-bought brands

National restaurant brands

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