What to eat to prevent type 2 diabetes - totally confused

[diabetesdiet]

Hello!

I had severe gestational diabetes in my last pregnancy and have been told I have the usual 50% risk of going on to develop type 2 diabetes. However I am utterly confused about what I should be doing with my diet to try to avoid this:

1. The doctor advised me to move to a wholegrain-only, vegan diet. This sounds extreme and would be extremely difficult for me to maintain. I used to be a vegetarian and had severe anaemia. I’m also unsure about whether I should be eating things I know spike my blood sugars (or did when I had diabetes), like porridge or bananas (and even to some extent wholegrain bread).

2. Loads of people online seem to say low-GI is the best idea. Again this sounds like it would be difficult to maintain. But I’m also wondering whether cutting out carbs and eating lots of meat and eggs and cheese is a good idea when those are the things the doctor has told me are worst for diabetes risk.

Basically there seem to be people with good credentials saying all of the following will increase diabetes risk: carbs, sugar, meat, eggs and dairy. What does this leave?!!

Another potentially relevant factor is that I’m not and have never been overweight – my BMI is currently 20 and usually closer to 19. I’ve been advised not to gain weight but also I don’t want to lose weight.

I will probably get a dietitian's advice but I wondered if someone could help me get this all clearer in my head because whatever the dietitian advises it will conflict with at least one of the two options above and I will always wonder if I’m doing the wrong thing. Help!!

Low GI is fairly easy. If you have a choice of apple juice or an apple, choose the apple. If you have a choice of mashed potatoes or boiled potatoes, choose boiled. Basically, the longer it takes to break down the carbs to sugar, the lower GI it is.

Complex whole grain based carbs- Brown rice, dark seedy bread.
Never eat a carb without a protein.
Meat, fish, eggs, Avocados. Salads, Celeriac and roasted cauliflower rather than too much potato. Protein Bread, Warburtons make good protein bagels. Cheese, nuts. All the non carby veg, Dark chocolate with nut butter. If you don’t have dogs xylitol is a great sweetener with no horrible aftertaste. With fruit focus on fresh berries. Greek yogurt. I try to minimise all white refined carbs. You can make great homemade ice cream with eggs, cream, xylitol and dark chocolate which is very low carb and won’t spike your blood sugars. Natures choice do peanut and chocolate protein bars than do not spike blood sugars.

Get the Michael Moseley Blood Sugar Diet book it explains really well the mechanics of diabetes and how the body works with food.

The second part of the book is really good recipes to use for low carb and also meal suggestion plans.

Even when not trying to lose weight the weekly planner is helpful when I can’t think what to have for dinner!

@CaraherEIL

Complex whole grain based carbs- Brown rice, dark seedy bread. Never eat a carb without a protein. Meat, fish, eggs, Avocados. Salads, Celeriac and roasted cauliflower rather than too much potato. Protein Bread, Warburtons make good protein bagels. Cheese, nuts. All the non carby veg, Dark chocolate with nut butter. If you don’t have dogs xylitol is a great sweetener with no horrible aftertaste. With fruit focus on fresh berries. Greek yogurt. I try to minimise all white refined carbs. You can make great homemade ice cream with eggs, cream, xylitol and dark chocolate which is very low carb and won’t spike your blood sugars. Natures choice do peanut and chocolate protein bars than do not spike blood sugars.

I was given strange advice by the nurse at my GP practice 4 years ago, when my blood sugar was close to diabetic - later found out that it was very out-dated, based upon old recommendations for diabetics. I did my own research, and generally got into a diet similar to the one CaraherEIL mentioned above.

I did lapse, but am now back on it and as long as I'm prepared, it's quite pleasant. I'm not too strict, but hopefully enough to avoid medication.

It's not difficult. We have now reversed our diabetes (both me & my husband).

It's about knowing which food groups your body processes as sugar. The facts may surprise you.

Bread made with any wheat flour is as bad as sugar. Rice and potatoes are also as bad as sugar.

What you are aiming to do is swap things out.

I now eat celeriac, roasted, grated, in a gratin instead of potatoes.
I eat cauliflower rice in place of rice, and hovis do a lower carb bread that is acceptable in small quantities. I limit myself to a single slice a day.
I replace corn breads with home made almond bread. I also use almond flour to make muffins and scones.
Puddings on this way of eating are delicious.

No sugar at all but alcohol derived sweetener (ending in an 'ol') are ok.
Avoid fruit unless it's a form of berry.
Root veg with caution but still eat them, the majority of your veg should be above ground.

Fill up on everything else. All cheese, veg, salads, meats, fish, nuts, cream.

You'll find you aren't hungry as you'll be breaking the sugar & hormone cycle. You won't get big surges in blood sugar resulting in increased insulin resulting in feeling hungry an hour later.

You'll also find that the inflammation that comes with too much sugar also goes and you'll feel fitter that ever.

It's not until we realise that sugars are not healthy that we can start to eat for health and recovery.

Absolutely totally what @purplebagladylovesgin says!

I got a meter when I was diagnosed and I discovered what foods increased my blood sugars (assume you’ll have been given one with your GD) so I know I can have two slices of Nimble bread a day, that I can’t eat carrots, petit pois or sweet corn in addition to the normal carbs, or have a hot drink with my lunch, but I can eat mushy peas and Lidl’s chocolate!!

Read dr Michael Moseley. He shows all the latest research. Full fat dairy reduces risk of diabetes.

What @purplebagladylovesgin said! She knows her stuff 😀

I eat low carb too
Download the carb manager app and you'll see all the hidden high carb foods.. it really helped me see the wood for the trees

If you've got a meter, then test before you eat, and 2 hours later. Eat to your meter. Keep a diary if you can be arsed so you can track what spikes and what does not. I'm T2 and I can eat potato in small quantities. Wholegrain bread spikes me horribly. I just trialled some far out and solid sprouted grain bread and got the worst spike I've had for months. Other people swear by this bread. Fortunately it was utterly horrible so it's easy to bin it. Proper sourdough is OK in small amounts for me.

I'm sorry, my OP must not have been very clear. I am familiar with the approach @CaraherEIL and @purplebagladylovesgin describe and it's what I did when I had diabetes (@CaraherEIL I have eaten my weight in those protein peanut bars!). I think it is also somewhat similar to Michael Mosley's approach (?) but I'm not fully familiar with his position. So low carb but not no carb.

What I'm confused about is that this approach (which seems to be the general approach recommended by the NHS) is NOT what I have been advised to do to avoid contracting type 2 diabetes. My endocrinologist advised me to avoid refined/white carbs but her primary advice was to go vegan and drop all meat, cheese and dairy. Meanwhile online research suggests that a large number of type 2 diabetics swear by low-GI (by which I don't mean making choices between mashed and boiled potatoes as @Lougle suggests but rather effectively as close to no carb as possible - so no potatoes, rice or bread (even wholegrain), no "good" carbs like porridge, and loads of meat, cheese and dairy). So now I'm struggling to work out what I should be doing (apart from avoiding white carbs and sugar which is clear) as I'm being told to do 3 different things in addition:

1. Do not cut out carbs, meat, dairy or eggs, eat carbs in moderation with protein etc (usual NHS advice)
2. Cut out carbs (Lots of diabetics are adamant this works best)
3. Cut out meat, dairy and eggs (My endocrinologist's advice).

This is why I am confused and I wondered if anyone could shed light on this...

There are a few different approaches, as you are discovering. The approach your endocrinologist has recommended is based on the theory that the cells are full of fat and can't accept insulin. There is a diet to meet this which also can control diabetes but with the aim of reducing your insulin resistance. In this diet you eat sensible low carbs from plants only with the addition of oily fish. It's basically vegan with oily fish added in.

I've been reading a lot about this recently as it's a fairly new approach. So good on your endocrinologist if she's advocating this way.

However, many find they can't easily control their blood sugar doing this way of eating, although I believe it's the way to address insulin overproduction.

The other way is to eat moderate low processed carbs. And only your meter will tell you what moderate means for your body. I do this way whilst researching the above way!
I can keep healthy (my morning bloods are now 4.7) but I'm also curious to see if I can improve my metabolic function and improve my insulin response.

The most given outdated advice, sadly given by a lot of doctors is just to take medication and not eat sugar. Which isn't very helpful if you want to live a long healthy life.

I'll see if I can find the book on my kindle for the way of eating your endocrinologist suggested. It's interesting reading.

Low carb is the way to go.

Thanks so much @purplebagladylovesgin - you are the first person to say that you see where she is coming from re the veganism recommendation, when I've run this past friends who are diabetic or doctors they have said it's nonsense and I should ignore it. But the endocrinologist is very experienced and well-qualified so I suspected she didn't pull this out of nowhere. The problem is with the care being NHS she was pressed for time so it was "You are at 50% risk of type 2, I'm discharging you to your GP, don't gain weight, go vegan, goodbye"! She did say that if I have any questions I should watch "Knives Over Forks" on Netflix so that's on the to do list...!

I wonder if the reason she recommended veganism and not low carb for me is that I am not (touch wood) currently diabetic so the issue of insulin production is more important than blood sugar control? I don't regularly monitor my bloods anymore as they seem to always be in range. By the same token I don't know if I should be avoiding healthy foods that don't spike me now but did spike me when I was diabetic, like porridge or bananas?

I appreciate that there is more than one way to skin a cat... I just think I need to understand all of this better so I don't feel like pretty much everything I eat contravenes some "rule"! I am also not keen on cutting out all carbs or all meat, dairy and eggs (I hate fish!) unless this is truly necessary because it would really be inconvenient for the whole family and difficult for me to sustain. Also surely I would be likely to lose weight doing either of these things which wouldn't be ideal, and the veganism would likely cause anaemia given my previous experience. Low-carb would be more doable...

You shouldn't get anaemia with a vegetarian or vegan diet. Beans, lentils, nuts, seeds and many vegetables have quite a lot of iron in them.
www.healthline.com/nutrition/iron-rich-plant-foods#TOC_TITLE_HDR_1
Many dishes are family friendly, the others get a carb portion and you get more vegetables. Your carbs are tied up with protein in the beans and lentils.
Research it, it does seem to work.
www.forksoverknives.com
Try not to get entangled with the enthusiastic vegans.

@Postdatedpandemic I know I "shouldn't" become anaemic but as I said in the OP, I did! I was a vegetarian for 20 years. I had to stop because I became badly anaemic despite a diet rich in veggie sources of iron and prescription supplements. I felt much healthier after starting to eat meat (I eat chicken 4-5 times a week and minced beef 1-2 times, no other meat).

It would also be a great inconvenience to be vegan firstly because I don't like vegan food (I prefer to eat meat but also when vegetarian I generally needed proper dairy, eggs or cheese to enjoy a meal, I would never choose a vegan option) and secondly because neither my husband nor small children would eat vegan food (and nor would I want them to). It was inconvenient enough when I was a vegetarian who ate refined carbs.

As I said I am going to research that Forks over Knives thing but I suppose what I'm interested in is not whether giving up all refined carbs, meat, fish, eggs and dairy improves diabetes risk (I'm willing to accept that it does) but whether it is necessary to do something so drastic to reduce my diabetes risk. If I had a sore toe then amputating my foot would solve the problem, but...!

Meat and Dairy are both strongly inflammatory so there is sense in what she is saying and Type 2 Diabetes develops after the body has been in a highly inflammatory state for a long time. I can’t cope with the idea of long term vegan either so I try to do a mixture of all of it- no white refined carbs, sugars. Limited meat and dairy, if I do eat it eat small amount free range/organic as it will not be pumped full of antibiotics etc. Then the fish, lentils, chickpeas, veg, nuts cheese etc. As you are very slender you may sit more in the LADA diabetic camp rather than Type 2. Have you had blood tests for diabetic antibodies? A lot of people who have reversed Type 2 have had weight to lose and have just rebooted their systems by weight loss so their cells /insulin response improves etc. That might not be as possible for you. So for the long game a strongly anti inflammatory diet would be the best option but only you can decide what is truly sustainable longterm.

Here's a science paper about the plant based diet and diabetes www.ncbi.nlm.nih.gov/pmc/articles/PMC5466941 for a bit more research.

Ultimately the diet that you can sustain for the rest of your life is the one for you.

While you are researching check out some vegan food, maybe minestrone, just a meal or two a week. It will help you work out what you and your family like and are likely to stick to. Vegan beany soup for lunch with chicken and loads of vegetables for dinner may be your path.

Most NHS dieticians seem to be sticking with the slightly low carb approach, some agree with your endocrinologist. Expect to get conflicting advice.

Your doctor sounds like a looper... ask them to refer you to a dietician.

Low GI isn’t hard - it doesn’t mean super low carb like Aitkins or Keto or anything like that. You can have carbs, just whole grain and a bit less. Higher protein is good too.

Lots of low GI books on Amazon and have a look at Second Nature - NHS approved low-Ish carb diet programme aimed at those at risk from diabetes. If you aren’t overweight you could take a milder approach.

There’s no one piece of research that conclusively points to one specific diet. The biggest problem with the method she’s suggesting is the difficulty in compliance. It’s a limited diet and requires a lot of planning of meals, snacks, days out, etc.

This is the abstract of an article that looked at what (more rigorous) research there was on a few types of diet, and pooled the data to see which might be most effective. Maybe the Mediterranean diet would suit you better if you are concerned about cutting out whole food groups.....

www.sciencedirect.com/science/article/abs/pii/S0939475319300547

The diet that works for you to keep your levels low is the one you can live with. I know many people find keto or low carb to be enough to keep their levels good and the A1C at non-diabetic levels.

I really think a vegan diet is overkill for a person with a 50% chance of diabetes. Jason Fung is worth a read.

Being referred to a dietician is no panacea either. You will find lots of dieticians still subscribe to the carbs are fine school of thought as long as the carbs are wholegrain. You need a dietician who is informed about keto/low carb and possibly the vegan option.

I've had Type 2 for nearly twenty years .

I've been low carbing for almost ten years [the medical profession didn't seem to know about it before then ~ pasta, rice, bread, potatoes and sugar are the biggest culprits. Wholegrain won't spike your blood sugar as much as white as it takes longer to digest but should still be limited.

Root veg have more carbs, 'above ground' veg don't have as many. The best fruits to eat are any ending in 'berry'.

I've never been told to avoid dairy foods and they don't raise either mine or diabetic friends' levels much.

You need to get a meter to test ~ an hour after you've eaten will generally be when your bs is at it's height, it should be back to normal after two hours.

Having said all the above, you should bear in mind that we're all individuals ~ what spikes one person's bs may not affect another's as much. That's why you need to test, so you can work out which foods are best for you.