The third video in our nutrition education series is designed to make sense of the continuous stream of information regarding popular eating patterns and how they apply to diabetes. Registered Dietitian and Certified Diabetes Educator Nicole Clowe will provide evidence-based information and recommendations around healthy eating as well as dive into Intermittent Fasting, the Keto diet and plant-based eating.
Speaker: Nicole Clowe, RD, CDE
Speaker: Nicole Clowe, RD, CDE
0:00
[Music]0:07
welcome to the third session in our0:09
nutrition education series for people0:11
living with diabetes today's topic is0:13
making sense of popular diets making0:16
sense of the continuous stream of0:18
information regarding popular eating0:20
patterns and how they apply to diabetes0:22
can be confusing registered dietitian0:25
and certified diabetes educator Nicole0:27
CL will provide evidence-based0:29
information and recommendations around0:31
healthy eating as well as dive into0:33
intermittent fasting the keto diet and a0:36
plant-based diet over to you Nicole0:39
hello everyone my name is Nicole CL I'm0:41
a registered dietitian and certified0:43
diabetes educator and today we're going0:46
to talk about making sense of popular0:48
diets so these are some of the topics0:51
and diets that we're going to review0:52
today uh including the Mediterranean0:55
diet intermittent fasting ketogenic diet0:58
and the plant-based diet so firstly to1:02
start off a little introduction so we1:04
know that food and nutrition is an1:06
important element of diabetes management1:09
it's often one of the first things1:10
that's discussed in your appointments1:12
with your diabetes educator you know1:14
potentially with your doctor and we know1:16
it's important to know how the foods1:19
that we eat impact our blood sugar1:21
however it can be really overwhelming1:23
because there's a lot of misinformation1:25
out there about the benefits of specific1:28
diets specific Foods what you can eat1:31
what you can't eat and this can become1:34
really overwhelming to weed through as a1:36
person living with diabetes so we do1:39
know that there's no one- siiz fits-all1:41
approach to eating and diabetes1:44
management um and there are huge things1:46
to consider when deciding what eating1:49
pattern is going to work best for you it1:51
has to align with your values obviously1:54
your food preferences and what your1:56
goals are for your diabetes management1:59
so you know you may have small changes2:01
to make um that can have an impact on2:04
your diabetes and there may be big2:06
changes that you're hoping to work2:08
through um by slowly making some2:10
Behavior change so the first thing uh2:13
that we're going to talk about today is2:15
the Mediterranean diet so this is a2:19
primarily plant-based diet you know it's2:21
one that's been heavily researched and2:23
around for a long time you know we know2:25
the Cornerstone of this diet is an2:28
abundance of plant foods and trying to2:30
really avoid processed foods as much as2:32
possible we use healthy fat such as2:35
olive oil as the principal source of fat2:39
and protein is focused on lean protein2:42
options and having red meat a lot less2:45
often so red meat would be things like2:48
beef pork or processed Meats made from2:52
them like bacon baloney ham you know2:54
those kind of things so choosing those a2:57
lot less often and focusing on2:59
plant-based protein and lean proteins3:02
like fish and seafood Dairy is consumed3:05
in small amounts in this diet as well3:08
but still focusing on water as the3:10
primary source of fluid um and along3:14
with limiting processed foods we're3:15
limiting sweets like added sugar and3:18
sodium you can see here in the picture3:21
that wine is acceptable in this diet in3:24
moderation so this might be something to3:26
consider when you're thinking about a3:27
lifestyle change you know if wine is3:30
something that you wanted to include in3:32
your lifestyle moving forward it3:34
certainly doesn't make sense to choose a3:36
diet that restricts that because then3:38
you may end up you know not being able3:40
to sustain that diet because it doesn't3:42
align with your3:44
values this diet encourages those3:46
plant-based proteins by asking us to eat3:50
legumes beans lentils at least three3:52
times a week so this can be something uh3:56
new for people in terms of their cooking3:58
preferences so you want to make sure you4:00
get proper education and know how to4:02
work these Foods into your diet now4:05
let's look a little bit at the benefits4:07
and then potential things to consider4:09
when we're thinking about this diet and4:11
living with diabetes so the research4:14
does show there's improved blood sugar4:16
management when following the4:17
Mediterranean diet you know we see a lot4:20
of protein we see a lot of healthy fat4:22
and a lot of vegetables you know things4:24
that we know correlate with improving4:26
your blood sugar management um for those4:29
reasons as well with the reduced red4:31
meat intake the higher healthy fat4:33
intake and lots and lots of fiber we see4:36
reduced risk of heart disease reducing4:39
your cholesterol and blood pressure um4:41
reducing inflammation so when you look4:44
at a plate of food or a daily intake4:47
from this type of diet you will notice4:49
lots of different colors so the more4:51
colors of fruits and vegetables we see4:54
the more antioxidants that we're seeing4:57
and therefore you know we can see4:59
reduction in5:00
inflammation also reduction in certain5:03
complications of diabetes so retinopathy5:06
which is one of the first complications5:08
that can sometimes present itself in5:11
people living with diabetes there has5:13
been shown a reduction in um you know5:15
retinopathy outcomes when following this5:18
diet and then of course we may see5:20
potential weight loss depending on what5:22
eating pattern you're moving from to the5:24
Mediterranean diet you might see those5:27
benefits some potential things to watch5:29
four you know this diet which makes it5:32
unique from a lot of other diets these5:34
days is that it does have a heavy5:36
emphasis on grain products we know5:39
grains are a source of carbohydrate and5:42
sometimes can be a little scary you know5:44
when we're looking to include these5:45
Foods on a daily basis so as the5:49
previous slide showed we are looking for5:51
whole grains you know these grains are5:53
high in fiber um and low in refined5:57
sugar however portions still matter you6:00
know when we're looking at the6:01
carbohydrate amount in your meals so6:04
it's really the quality of the grain6:06
that's important and keeping in mind the6:08
portions because uh any amount of6:10
carbohydrates will impact your blood6:12
sugar it's just how much you're having6:14
and what you're including alongside of6:16
that also healthy fats are not unlimited6:20
you know fats in olive oil and nuts and6:22
seeds are often quite concentrated these6:25
are nutrient-dense foods meaning that6:27
you don't need to eat a lot of them them6:30
to get a high caloric intake so any6:33
additional caloric intake um you know is6:35
something that we want to be aware of6:37
when managing diabetes so just being6:39
mindful of the portions of your grains6:41
the portions of your healthy fats and6:44
then kind of balancing that with those6:45
other Foods the fruits and vegetables6:48
the whole grains and the proteins and6:50
plant-based6:53
proteins so moving on to intermittent6:56
fasting so intermittent fasting is6:58
something that's really really um being7:00
talked about a lot these days and you7:03
know potentially some patients say hey7:05
I've been doing this all along I haven't7:06
been eating breakfast for five years or7:08
10 years um so really that's what7:11
intermittent fasting is it's just not7:13
eating or drinking anything that7:15
contains calories for a specific period7:17
of time there are many different um7:20
patterns of intermittent fasting that7:23
you can do you can go 16 hours without7:25
eating and then eat for an8 hour window7:29
you can do it on um periodic days of the7:32
week so maybe you do intermittent7:34
fasting for two days and then you take7:36
five days off or vice versa so it really7:40
doesn't have anything to do with the7:41
foods that you're eating it's just a7:43
restricted period where eating is7:46
allowed so for some you know this may7:49
work for them because they choose not to7:51
eat breakfast prior in their life it7:53
worked with their lifestyle um and for7:56
others this might be a helpful7:58
transition if you're looking to limit8:00
you know some challenging times of day8:02
where you may be eating foods that you8:04
would rather not eat so remember there8:07
are many different Arrangements of this8:09
type of diet if it's something that you8:11
want to look into check with your8:13
healthcare provider about what would be8:15
the best um way to approach it for8:18
yourself um and we want to keep in mind8:20
as well in this smaller window of eating8:24
what you're eating still matters when it8:25
comes to health and diabetes uh it8:28
doesn't mean you can have you know8:30
unlimited portion sizes or you know8:33
other qualities of food that might not8:35
be recommended for normal healthy eating8:37
with diabetes so overall intake still8:40
matters but the real premise of this8:42
diet is a restricted window of time that8:45
you're able to eat8:47
in so let's look at the benefits and8:49
drawbacks or potential drawbacks of8:52
intermittent fasting when it comes to8:54
diabetes so the research does show some8:57
weight loss and maintenance with this8:59
form of um eating pattern you know we're9:03
always have a difficult time9:05
contributing you know where exactly did9:08
this weight loss or weight maintenance9:09
come from was it the intermittent9:11
fasting itself was it that doing this9:14
changed the quality of foods that were9:16
eaten during the eating window uh it's9:19
difficult to assess for sure but again I9:22
think the biggest take-home message is9:24
making sure that it aligns with your9:26
values and your lifestyle and something9:28
that you can M so we see improved9:31
insulin sensitivity so this is something9:34
really important in type 2 diabetes9:37
where we're often battling insulin9:39
resistance um which is the body's you9:42
know inability to use insulin as9:44
efficiently as we'd like it too and9:47
therefore that improves blood glucose9:48
levels so when you're more sensitive to9:50
insulin and that allows your body to use9:52
insulin better and therefore improve9:55
your blood glucose we also see9:57
Improvement in blood cholesterol and9:59
triglyceride levels so this could be10:02
linked to the quality of foods eaten10:04
during that eating window could be10:06
contributed to weight loss or10:08
improvements in blood sugar um all of10:11
these things are kind of10:13
interrelated so what are some things to10:15
watch out for so with diabetes you know10:18
if you're on high-risk medications10:20
meaning medications that could increase10:22
your risk for hypoglycemia you want to10:25
make sure that you're monitoring your10:26
blood sugar really closely either by10:29
capillar so by pricking your finger or10:32
if you're wearing a continuous glucose10:34
monitor you know if you're on10:36
medications suited to your current10:38
lifestyle and all of a sudden you start10:40
fasting for 16 hours a day you could run10:43
into hypoglycemia which therefore you10:46
would have to treat and break that fast10:49
um so if you're planning on embarking on10:51
intermittent fasting it's good to check10:53
with your health care provider first to10:55
see if you're on any of these high-risk10:57
medications and they need to be adjusted11:00
before you start intermittent11:02
fasting so it's more difficult to get11:04
all the key nutrients that you need when11:06
you're eating window is shorter you know11:08
some of us struggle to get uh all our11:11
nutrients in a normal day a 12-hour day11:14
a 14-hour day what have you so imagine11:17
trying to get all those same nutrients11:19
vitamins minerals protein uh fiber in a11:23
smaller window so it takes real11:26
purposeful planning of your meals um and11:29
maybe you know checking with a11:30
registered dietitian to ensure you can11:33
do that you can get in all your11:35
nutrients and you know maybe two meals11:37
as opposed to11:39
three be aware of you know triggers for11:42
oving or emotional eating you're going a11:45
long period of time without eating this11:48
could increase your physical hunger and11:50
then sometimes that makes it more11:52
difficult to stop at you know a11:54
reasonable portion so you go again this11:57
is a good thing to assess if it fits11:59
with your lifestyle you know if you12:01
don't struggle with that and you're able12:03
to still maintain a balanced plate like12:06
we've seen on the introduction slide12:08
then this may work for you but we do12:10
need to consider that portions still12:12
matter um and then managing side effects12:16
so this can be confusing you know you12:18
may notice if you miss your lunge you12:20
get stuck in a meeting it's 1:00 it's12:22
2:00 you may start feeling a little12:25
dizzy a little lith headed you know12:27
these are similar symptoms to12:29
hypoglycemia so we need to to delineate12:32
is this because I haven't eaten in 1612:35
hours or am I experiencing a low blood12:37
sugar so just something to watch out for12:40
you know when you have diabetes and12:41
you're embarking on this eating12:46
pattern so the next uh diet that we're12:48
going to talk about is the ketogenic12:51
diet so it's likely you've heard of this12:54
diet it's very mainstream there's lots12:56
of books on it um lots of information12:59
and12:59
misinformation um but down to the core13:02
this diet is simply very low in13:05
carbohydrates um low enough that your13:08
body needs to utilize another energy13:10
source and doing that can produce13:13
ketones in your body so this is13:15
something to be mindful of so this diet13:18
not only is low in carbohydrates but13:20
therefore it is a lot higher in fat and13:23
protein so the ranges for fat and13:25
protein can vary based on you know your13:28
potential other comorbidities based on13:32
your nutrition goals and your eating13:34
preferences so regardless we've got very13:37
low carbohydrate and then a higher13:39
percentage of fat and protein so13:42
typically about 55% fat 35% protein and13:46
10% carbohydrate so when we compare this13:50
to like Canada's food guide or a typical13:53
balanced eating plan carbohydrates are13:55
typically 45 to13:58
55% protein maybe 20 to 25 and fat14:02
around 30% so you can see the big14:04
difference here um in the balance of14:07
nutrients and therefore in what your14:09
plate looks like so to get this low of14:12
carbohydrates we have to eliminate14:14
virtually all grains and some most14:17
fruits and some higher carbohydrate or14:20
starchy vegetables so you can see this14:23
plate here it has lots of protein we14:26
have nuts we have some meat it looks14:28
like pork we have a boiled egg maybe14:30
some avocado some cucumbers some spinach14:34
um four grapes and a couple blueberries14:37
so you know we're getting a very low14:39
amount of carbohydrates this meals14:41
probably less than14:43
10% amount of protein and fat um which14:47
hopefully will keep you full and14:48
satisfied but your body can't utilize14:51
glucose for energy so it has to break14:54
down um fat to use for energy and that14:57
produces ketones so ketones may be a15:00
familiar word to you if you have15:02
diabetes especially type 1 diabetes so15:06
we want to make sure that it's15:07
understood that diabetic keto acidosis15:10
is different from nutritional ketosis or15:13
the ketones that you would produce when15:16
using fat for energy and and thus on the15:19
keto diet so diabetic keto acidosis is15:22
an emergent situation it's uncontrolled15:25
um you're having symptoms you know15:27
you're not feeling well your blood sugar15:29
is potentially High um you may need to15:31
visit the hospital um so for this reason15:34
you need to monitor ketones and your15:36
intake very carefully um and it isn't15:40
recommended you know if you have other15:42
comorbidities such as kidney disease you15:45
know very mindful when you have type 115:47
diabetes and as well when you're15:49
pregnant it should be um really checked15:51
with your health care15:53
provider so some drw and some potential15:57
for uh the ketogenic diet and diabetes16:01
um so weight loss and weight maintenance16:03
as well is seen in these research16:05
studies for people who follow the16:07
ketogenic diet we often see reduced use16:10
of medications so is this because16:12
there's a much lower intake of16:14
carbohydrates we don't need as much16:17
insulin or medications that increase16:19
insulin production to lower blood16:22
glucose um we see lower blood glucose16:24
levels with this higher protein higher16:27
fat and lower carbohydrate intake uh and16:30
some research actually does show16:32
improved blood cholesterol and blood16:34
pressure so I think one important thing16:36
to consider is that we want to ensure a16:39
well formulated ketogenic diet where our16:42
meals look Sim similar to that plate on16:44
the previous slide as opposed to you16:47
know potentially being a lot of higher16:49
fat Meats processed Meats um these would16:53
still you know um allow you to be in the16:55
ketogenic diet and produce ketones but16:58
may not be the best for your overall17:00
health so some potential things to watch17:03
out for are ensuring you're monitoring17:06
your blood sugars closely again a very17:08
low carbohydrate intake if your17:10
medications are adjusted based on you17:13
know a previous higher carbohydrate17:15
intake that will need to be adjusted17:18
impact on insulin and other medications17:20
as I mentioned so lower insulin is17:23
needed to maintain ketosis because if17:25
your insulin is higher you have to17:27
consume more carb hydrates to maintain17:30
your blood sugar eliminating food groups17:33
a whole food group really carbohydrates17:35
is being uh potentially you know mostly17:37
eliminated so this could lead to vitamin17:40
and mineral deficiencies and it's really17:43
hard to get to the fiber amount that you17:45
need when choosing this pattern of17:47
eating because even with non-starchy17:50
vegetables if we eat them in high17:52
volumes they're going to contribute some17:54
carbohydrates so it's difficult to get17:57
the fiber amount that you need when17:59
following a ketogenic diet so there's18:02
potential for increased saturated fat18:04
intake like I mentioned if your diet18:06
isn't well formulated um which is18:09
difficult to do then you may face you18:12
know this higher risk for cardiovascular18:15
events um higher intake of saturated fat18:18
is linked with increasing your18:20
cholesterol um there is an increase18:22
potential for increasing insulin18:24
resistance in some patients that's seen18:27
in the research you're remember in the18:29
previous diets we saw an improvement in18:32
insulin sensitivity so in this case you18:35
know some uh potential for increase in18:37
insulin resistance and because of the18:40
low carbohydrate intake and increased18:42
risk of18:43
hypoglycemia so all things that are18:46
useful to consider right when balanced18:48
with the benefits of this18:52
diet so now along to plant-based eating18:56
patterns so plant-based eating kind of18:59
self-explanatory but lots of fruits and19:02
vegetables whole grains and we're19:05
getting our necessary protein from beans19:08
and legumes nuts and seeds soy products19:12
um you know lots of inclusion of these19:14
healthy plant-based proteins healthy19:17
fats similar to the Mediterranean diet19:19
like Olive Oil from nuts and seeds from19:23
avocado um and there's a very limited19:25
amount of animal-based products so this19:28
would be similar to a vegetarian diet19:30
not necessarily a vegan diet which19:33
wouldn't include any animal-based19:35
products so lots of colorful fruits and19:38
vegetables in this diet plan lots of19:40
healthy fats and plant-based19:44
proteins so for the plant-based diet we19:47
see a lot of fiber so what the ketogenic19:50
diet was lacking the plant-based diet is19:53
giving us a lot of so all kinds of19:55
different colors lots of antioxidants19:58
lots of protective nutrients and lots of20:00
fiber so we know in a normal uh healthy20:04
diet for diabetes we see better blood20:06
sugar control with higher fiber intake20:10
uh more feelings of fullness which can20:12
lead to maintaining a healthy body20:14
weight and with the you know mostly20:17
elimination of animal products a big20:19
reduction in your intake of saturated20:21
fat which is really positive for your20:23
heart health and we know diabetes20:26
independently increases your risk for20:27
heart disease so that's why we keep20:29
going back to you know these benefits or20:32
potential watchos when it comes to20:35
cholesterol and saturated fat intake uh20:38
so some gut health benefits so related20:41
to all these antioxidants related to all20:44
this fiber you can see improvements in20:47
digestion no trouble meeting your fiber20:49
requirements in this eating pattern so20:53
some potential things to watch out for20:55
so some highly processed um like non non20:58
meat Alternatives can be higher in21:01
calories and fat so you know to be21:04
vegetarian to be free of animal protein21:07
doesn't always mean it's going to be21:09
perfectly healthy so receiving education21:12
on how to appropriately read labels and21:15
ingredients list is really good21:17
knowledge to have if you're going to be21:19
purchasing some of these meat21:21
substitutes um and it really requires a21:24
well formulated diet to ensure you can21:26
meet your nutrient and your21:28
micronutrient needs when cutting out21:31
Meats we have to consider you know your21:32
B vitamins your iron so something that21:35
should be assessed by a registered21:38
dietitian to make sure that if you21:40
choose this eating pattern you know for21:42
a long time the rest of your life that21:45
you're not going to run into21:47
deficiencies in21:50
nutrients so the bottom line we just21:52
reviewed all of those different patterns21:55
of eating some have some overlapping um21:58
principles and some have a lot of big22:01
differences but the biggest thing you22:03
want to First consider is which one is22:05
going to work for you your values and22:07
preferences and your health or treatment22:09
goals so when we find a diet that Al22:12
aligns with our values it's much easier22:15
to maintain you don't feel restricted22:18
you don't feel like you're eating a way22:20
that just for you you're not eating22:23
separate meals from your family you're22:25
not feeling left out in those ways so22:28
consult with with a registered dietitian22:30
or your diabetes Healthcare team before22:32
starting any new eating pattern because22:35
like we mentioned they can impact blood22:37
sugar control and your medications I22:40
hope you gained some useful Insight22:41
today on some popular22:52
diets
[Music]0:07
welcome to the third session in our0:09
nutrition education series for people0:11
living with diabetes today's topic is0:13
making sense of popular diets making0:16
sense of the continuous stream of0:18
information regarding popular eating0:20
patterns and how they apply to diabetes0:22
can be confusing registered dietitian0:25
and certified diabetes educator Nicole0:27
CL will provide evidence-based0:29
information and recommendations around0:31
healthy eating as well as dive into0:33
intermittent fasting the keto diet and a0:36
plant-based diet over to you Nicole0:39
hello everyone my name is Nicole CL I'm0:41
a registered dietitian and certified0:43
diabetes educator and today we're going0:46
to talk about making sense of popular0:48
diets so these are some of the topics0:51
and diets that we're going to review0:52
today uh including the Mediterranean0:55
diet intermittent fasting ketogenic diet0:58
and the plant-based diet so firstly to1:02
start off a little introduction so we1:04
know that food and nutrition is an1:06
important element of diabetes management1:09
it's often one of the first things1:10
that's discussed in your appointments1:12
with your diabetes educator you know1:14
potentially with your doctor and we know1:16
it's important to know how the foods1:19
that we eat impact our blood sugar1:21
however it can be really overwhelming1:23
because there's a lot of misinformation1:25
out there about the benefits of specific1:28
diets specific Foods what you can eat1:31
what you can't eat and this can become1:34
really overwhelming to weed through as a1:36
person living with diabetes so we do1:39
know that there's no one- siiz fits-all1:41
approach to eating and diabetes1:44
management um and there are huge things1:46
to consider when deciding what eating1:49
pattern is going to work best for you it1:51
has to align with your values obviously1:54
your food preferences and what your1:56
goals are for your diabetes management1:59
so you know you may have small changes2:01
to make um that can have an impact on2:04
your diabetes and there may be big2:06
changes that you're hoping to work2:08
through um by slowly making some2:10
Behavior change so the first thing uh2:13
that we're going to talk about today is2:15
the Mediterranean diet so this is a2:19
primarily plant-based diet you know it's2:21
one that's been heavily researched and2:23
around for a long time you know we know2:25
the Cornerstone of this diet is an2:28
abundance of plant foods and trying to2:30
really avoid processed foods as much as2:32
possible we use healthy fat such as2:35
olive oil as the principal source of fat2:39
and protein is focused on lean protein2:42
options and having red meat a lot less2:45
often so red meat would be things like2:48
beef pork or processed Meats made from2:52
them like bacon baloney ham you know2:54
those kind of things so choosing those a2:57
lot less often and focusing on2:59
plant-based protein and lean proteins3:02
like fish and seafood Dairy is consumed3:05
in small amounts in this diet as well3:08
but still focusing on water as the3:10
primary source of fluid um and along3:14
with limiting processed foods we're3:15
limiting sweets like added sugar and3:18
sodium you can see here in the picture3:21
that wine is acceptable in this diet in3:24
moderation so this might be something to3:26
consider when you're thinking about a3:27
lifestyle change you know if wine is3:30
something that you wanted to include in3:32
your lifestyle moving forward it3:34
certainly doesn't make sense to choose a3:36
diet that restricts that because then3:38
you may end up you know not being able3:40
to sustain that diet because it doesn't3:42
align with your3:44
values this diet encourages those3:46
plant-based proteins by asking us to eat3:50
legumes beans lentils at least three3:52
times a week so this can be something uh3:56
new for people in terms of their cooking3:58
preferences so you want to make sure you4:00
get proper education and know how to4:02
work these Foods into your diet now4:05
let's look a little bit at the benefits4:07
and then potential things to consider4:09
when we're thinking about this diet and4:11
living with diabetes so the research4:14
does show there's improved blood sugar4:16
management when following the4:17
Mediterranean diet you know we see a lot4:20
of protein we see a lot of healthy fat4:22
and a lot of vegetables you know things4:24
that we know correlate with improving4:26
your blood sugar management um for those4:29
reasons as well with the reduced red4:31
meat intake the higher healthy fat4:33
intake and lots and lots of fiber we see4:36
reduced risk of heart disease reducing4:39
your cholesterol and blood pressure um4:41
reducing inflammation so when you look4:44
at a plate of food or a daily intake4:47
from this type of diet you will notice4:49
lots of different colors so the more4:51
colors of fruits and vegetables we see4:54
the more antioxidants that we're seeing4:57
and therefore you know we can see4:59
reduction in5:00
inflammation also reduction in certain5:03
complications of diabetes so retinopathy5:06
which is one of the first complications5:08
that can sometimes present itself in5:11
people living with diabetes there has5:13
been shown a reduction in um you know5:15
retinopathy outcomes when following this5:18
diet and then of course we may see5:20
potential weight loss depending on what5:22
eating pattern you're moving from to the5:24
Mediterranean diet you might see those5:27
benefits some potential things to watch5:29
four you know this diet which makes it5:32
unique from a lot of other diets these5:34
days is that it does have a heavy5:36
emphasis on grain products we know5:39
grains are a source of carbohydrate and5:42
sometimes can be a little scary you know5:44
when we're looking to include these5:45
Foods on a daily basis so as the5:49
previous slide showed we are looking for5:51
whole grains you know these grains are5:53
high in fiber um and low in refined5:57
sugar however portions still matter you6:00
know when we're looking at the6:01
carbohydrate amount in your meals so6:04
it's really the quality of the grain6:06
that's important and keeping in mind the6:08
portions because uh any amount of6:10
carbohydrates will impact your blood6:12
sugar it's just how much you're having6:14
and what you're including alongside of6:16
that also healthy fats are not unlimited6:20
you know fats in olive oil and nuts and6:22
seeds are often quite concentrated these6:25
are nutrient-dense foods meaning that6:27
you don't need to eat a lot of them them6:30
to get a high caloric intake so any6:33
additional caloric intake um you know is6:35
something that we want to be aware of6:37
when managing diabetes so just being6:39
mindful of the portions of your grains6:41
the portions of your healthy fats and6:44
then kind of balancing that with those6:45
other Foods the fruits and vegetables6:48
the whole grains and the proteins and6:50
plant-based6:53
proteins so moving on to intermittent6:56
fasting so intermittent fasting is6:58
something that's really really um being7:00
talked about a lot these days and you7:03
know potentially some patients say hey7:05
I've been doing this all along I haven't7:06
been eating breakfast for five years or7:08
10 years um so really that's what7:11
intermittent fasting is it's just not7:13
eating or drinking anything that7:15
contains calories for a specific period7:17
of time there are many different um7:20
patterns of intermittent fasting that7:23
you can do you can go 16 hours without7:25
eating and then eat for an8 hour window7:29
you can do it on um periodic days of the7:32
week so maybe you do intermittent7:34
fasting for two days and then you take7:36
five days off or vice versa so it really7:40
doesn't have anything to do with the7:41
foods that you're eating it's just a7:43
restricted period where eating is7:46
allowed so for some you know this may7:49
work for them because they choose not to7:51
eat breakfast prior in their life it7:53
worked with their lifestyle um and for7:56
others this might be a helpful7:58
transition if you're looking to limit8:00
you know some challenging times of day8:02
where you may be eating foods that you8:04
would rather not eat so remember there8:07
are many different Arrangements of this8:09
type of diet if it's something that you8:11
want to look into check with your8:13
healthcare provider about what would be8:15
the best um way to approach it for8:18
yourself um and we want to keep in mind8:20
as well in this smaller window of eating8:24
what you're eating still matters when it8:25
comes to health and diabetes uh it8:28
doesn't mean you can have you know8:30
unlimited portion sizes or you know8:33
other qualities of food that might not8:35
be recommended for normal healthy eating8:37
with diabetes so overall intake still8:40
matters but the real premise of this8:42
diet is a restricted window of time that8:45
you're able to eat8:47
in so let's look at the benefits and8:49
drawbacks or potential drawbacks of8:52
intermittent fasting when it comes to8:54
diabetes so the research does show some8:57
weight loss and maintenance with this8:59
form of um eating pattern you know we're9:03
always have a difficult time9:05
contributing you know where exactly did9:08
this weight loss or weight maintenance9:09
come from was it the intermittent9:11
fasting itself was it that doing this9:14
changed the quality of foods that were9:16
eaten during the eating window uh it's9:19
difficult to assess for sure but again I9:22
think the biggest take-home message is9:24
making sure that it aligns with your9:26
values and your lifestyle and something9:28
that you can M so we see improved9:31
insulin sensitivity so this is something9:34
really important in type 2 diabetes9:37
where we're often battling insulin9:39
resistance um which is the body's you9:42
know inability to use insulin as9:44
efficiently as we'd like it too and9:47
therefore that improves blood glucose9:48
levels so when you're more sensitive to9:50
insulin and that allows your body to use9:52
insulin better and therefore improve9:55
your blood glucose we also see9:57
Improvement in blood cholesterol and9:59
triglyceride levels so this could be10:02
linked to the quality of foods eaten10:04
during that eating window could be10:06
contributed to weight loss or10:08
improvements in blood sugar um all of10:11
these things are kind of10:13
interrelated so what are some things to10:15
watch out for so with diabetes you know10:18
if you're on high-risk medications10:20
meaning medications that could increase10:22
your risk for hypoglycemia you want to10:25
make sure that you're monitoring your10:26
blood sugar really closely either by10:29
capillar so by pricking your finger or10:32
if you're wearing a continuous glucose10:34
monitor you know if you're on10:36
medications suited to your current10:38
lifestyle and all of a sudden you start10:40
fasting for 16 hours a day you could run10:43
into hypoglycemia which therefore you10:46
would have to treat and break that fast10:49
um so if you're planning on embarking on10:51
intermittent fasting it's good to check10:53
with your health care provider first to10:55
see if you're on any of these high-risk10:57
medications and they need to be adjusted11:00
before you start intermittent11:02
fasting so it's more difficult to get11:04
all the key nutrients that you need when11:06
you're eating window is shorter you know11:08
some of us struggle to get uh all our11:11
nutrients in a normal day a 12-hour day11:14
a 14-hour day what have you so imagine11:17
trying to get all those same nutrients11:19
vitamins minerals protein uh fiber in a11:23
smaller window so it takes real11:26
purposeful planning of your meals um and11:29
maybe you know checking with a11:30
registered dietitian to ensure you can11:33
do that you can get in all your11:35
nutrients and you know maybe two meals11:37
as opposed to11:39
three be aware of you know triggers for11:42
oving or emotional eating you're going a11:45
long period of time without eating this11:48
could increase your physical hunger and11:50
then sometimes that makes it more11:52
difficult to stop at you know a11:54
reasonable portion so you go again this11:57
is a good thing to assess if it fits11:59
with your lifestyle you know if you12:01
don't struggle with that and you're able12:03
to still maintain a balanced plate like12:06
we've seen on the introduction slide12:08
then this may work for you but we do12:10
need to consider that portions still12:12
matter um and then managing side effects12:16
so this can be confusing you know you12:18
may notice if you miss your lunge you12:20
get stuck in a meeting it's 1:00 it's12:22
2:00 you may start feeling a little12:25
dizzy a little lith headed you know12:27
these are similar symptoms to12:29
hypoglycemia so we need to to delineate12:32
is this because I haven't eaten in 1612:35
hours or am I experiencing a low blood12:37
sugar so just something to watch out for12:40
you know when you have diabetes and12:41
you're embarking on this eating12:46
pattern so the next uh diet that we're12:48
going to talk about is the ketogenic12:51
diet so it's likely you've heard of this12:54
diet it's very mainstream there's lots12:56
of books on it um lots of information12:59
and12:59
misinformation um but down to the core13:02
this diet is simply very low in13:05
carbohydrates um low enough that your13:08
body needs to utilize another energy13:10
source and doing that can produce13:13
ketones in your body so this is13:15
something to be mindful of so this diet13:18
not only is low in carbohydrates but13:20
therefore it is a lot higher in fat and13:23
protein so the ranges for fat and13:25
protein can vary based on you know your13:28
potential other comorbidities based on13:32
your nutrition goals and your eating13:34
preferences so regardless we've got very13:37
low carbohydrate and then a higher13:39
percentage of fat and protein so13:42
typically about 55% fat 35% protein and13:46
10% carbohydrate so when we compare this13:50
to like Canada's food guide or a typical13:53
balanced eating plan carbohydrates are13:55
typically 45 to13:58
55% protein maybe 20 to 25 and fat14:02
around 30% so you can see the big14:04
difference here um in the balance of14:07
nutrients and therefore in what your14:09
plate looks like so to get this low of14:12
carbohydrates we have to eliminate14:14
virtually all grains and some most14:17
fruits and some higher carbohydrate or14:20
starchy vegetables so you can see this14:23
plate here it has lots of protein we14:26
have nuts we have some meat it looks14:28
like pork we have a boiled egg maybe14:30
some avocado some cucumbers some spinach14:34
um four grapes and a couple blueberries14:37
so you know we're getting a very low14:39
amount of carbohydrates this meals14:41
probably less than14:43
10% amount of protein and fat um which14:47
hopefully will keep you full and14:48
satisfied but your body can't utilize14:51
glucose for energy so it has to break14:54
down um fat to use for energy and that14:57
produces ketones so ketones may be a15:00
familiar word to you if you have15:02
diabetes especially type 1 diabetes so15:06
we want to make sure that it's15:07
understood that diabetic keto acidosis15:10
is different from nutritional ketosis or15:13
the ketones that you would produce when15:16
using fat for energy and and thus on the15:19
keto diet so diabetic keto acidosis is15:22
an emergent situation it's uncontrolled15:25
um you're having symptoms you know15:27
you're not feeling well your blood sugar15:29
is potentially High um you may need to15:31
visit the hospital um so for this reason15:34
you need to monitor ketones and your15:36
intake very carefully um and it isn't15:40
recommended you know if you have other15:42
comorbidities such as kidney disease you15:45
know very mindful when you have type 115:47
diabetes and as well when you're15:49
pregnant it should be um really checked15:51
with your health care15:53
provider so some drw and some potential15:57
for uh the ketogenic diet and diabetes16:01
um so weight loss and weight maintenance16:03
as well is seen in these research16:05
studies for people who follow the16:07
ketogenic diet we often see reduced use16:10
of medications so is this because16:12
there's a much lower intake of16:14
carbohydrates we don't need as much16:17
insulin or medications that increase16:19
insulin production to lower blood16:22
glucose um we see lower blood glucose16:24
levels with this higher protein higher16:27
fat and lower carbohydrate intake uh and16:30
some research actually does show16:32
improved blood cholesterol and blood16:34
pressure so I think one important thing16:36
to consider is that we want to ensure a16:39
well formulated ketogenic diet where our16:42
meals look Sim similar to that plate on16:44
the previous slide as opposed to you16:47
know potentially being a lot of higher16:49
fat Meats processed Meats um these would16:53
still you know um allow you to be in the16:55
ketogenic diet and produce ketones but16:58
may not be the best for your overall17:00
health so some potential things to watch17:03
out for are ensuring you're monitoring17:06
your blood sugars closely again a very17:08
low carbohydrate intake if your17:10
medications are adjusted based on you17:13
know a previous higher carbohydrate17:15
intake that will need to be adjusted17:18
impact on insulin and other medications17:20
as I mentioned so lower insulin is17:23
needed to maintain ketosis because if17:25
your insulin is higher you have to17:27
consume more carb hydrates to maintain17:30
your blood sugar eliminating food groups17:33
a whole food group really carbohydrates17:35
is being uh potentially you know mostly17:37
eliminated so this could lead to vitamin17:40
and mineral deficiencies and it's really17:43
hard to get to the fiber amount that you17:45
need when choosing this pattern of17:47
eating because even with non-starchy17:50
vegetables if we eat them in high17:52
volumes they're going to contribute some17:54
carbohydrates so it's difficult to get17:57
the fiber amount that you need when17:59
following a ketogenic diet so there's18:02
potential for increased saturated fat18:04
intake like I mentioned if your diet18:06
isn't well formulated um which is18:09
difficult to do then you may face you18:12
know this higher risk for cardiovascular18:15
events um higher intake of saturated fat18:18
is linked with increasing your18:20
cholesterol um there is an increase18:22
potential for increasing insulin18:24
resistance in some patients that's seen18:27
in the research you're remember in the18:29
previous diets we saw an improvement in18:32
insulin sensitivity so in this case you18:35
know some uh potential for increase in18:37
insulin resistance and because of the18:40
low carbohydrate intake and increased18:42
risk of18:43
hypoglycemia so all things that are18:46
useful to consider right when balanced18:48
with the benefits of this18:52
diet so now along to plant-based eating18:56
patterns so plant-based eating kind of18:59
self-explanatory but lots of fruits and19:02
vegetables whole grains and we're19:05
getting our necessary protein from beans19:08
and legumes nuts and seeds soy products19:12
um you know lots of inclusion of these19:14
healthy plant-based proteins healthy19:17
fats similar to the Mediterranean diet19:19
like Olive Oil from nuts and seeds from19:23
avocado um and there's a very limited19:25
amount of animal-based products so this19:28
would be similar to a vegetarian diet19:30
not necessarily a vegan diet which19:33
wouldn't include any animal-based19:35
products so lots of colorful fruits and19:38
vegetables in this diet plan lots of19:40
healthy fats and plant-based19:44
proteins so for the plant-based diet we19:47
see a lot of fiber so what the ketogenic19:50
diet was lacking the plant-based diet is19:53
giving us a lot of so all kinds of19:55
different colors lots of antioxidants19:58
lots of protective nutrients and lots of20:00
fiber so we know in a normal uh healthy20:04
diet for diabetes we see better blood20:06
sugar control with higher fiber intake20:10
uh more feelings of fullness which can20:12
lead to maintaining a healthy body20:14
weight and with the you know mostly20:17
elimination of animal products a big20:19
reduction in your intake of saturated20:21
fat which is really positive for your20:23
heart health and we know diabetes20:26
independently increases your risk for20:27
heart disease so that's why we keep20:29
going back to you know these benefits or20:32
potential watchos when it comes to20:35
cholesterol and saturated fat intake uh20:38
so some gut health benefits so related20:41
to all these antioxidants related to all20:44
this fiber you can see improvements in20:47
digestion no trouble meeting your fiber20:49
requirements in this eating pattern so20:53
some potential things to watch out for20:55
so some highly processed um like non non20:58
meat Alternatives can be higher in21:01
calories and fat so you know to be21:04
vegetarian to be free of animal protein21:07
doesn't always mean it's going to be21:09
perfectly healthy so receiving education21:12
on how to appropriately read labels and21:15
ingredients list is really good21:17
knowledge to have if you're going to be21:19
purchasing some of these meat21:21
substitutes um and it really requires a21:24
well formulated diet to ensure you can21:26
meet your nutrient and your21:28
micronutrient needs when cutting out21:31
Meats we have to consider you know your21:32
B vitamins your iron so something that21:35
should be assessed by a registered21:38
dietitian to make sure that if you21:40
choose this eating pattern you know for21:42
a long time the rest of your life that21:45
you're not going to run into21:47
deficiencies in21:50
nutrients so the bottom line we just21:52
reviewed all of those different patterns21:55
of eating some have some overlapping um21:58
principles and some have a lot of big22:01
differences but the biggest thing you22:03
want to First consider is which one is22:05
going to work for you your values and22:07
preferences and your health or treatment22:09
goals so when we find a diet that Al22:12
aligns with our values it's much easier22:15
to maintain you don't feel restricted22:18
you don't feel like you're eating a way22:20
that just for you you're not eating22:23
separate meals from your family you're22:25
not feeling left out in those ways so22:28
consult with with a registered dietitian22:30
or your diabetes Healthcare team before22:32
starting any new eating pattern because22:35
like we mentioned they can impact blood22:37
sugar control and your medications I22:40
hope you gained some useful Insight22:41
today on some popular22:52
diets
Category Tags: Diet & Nutrition, General Tips, Healthy Living;