As a follow up to the previous article about Diabetes Canada’s “Low Carb” 7-day Meal Plan, I was curious how much food there was at each meal, as well as the total amount of carbs per day. I decided to analyze Day 1, Day 3 and Day 5 to get a rough idea and this article is about what I found. Yes, these meals are <130 g of carbs per day — so technically “low carb”, but they are also “low fat”, and low or inadequate protein.
Note: This article is classified as both “science made simple” and an “editorial”, because the “Summary” and “Observations” are my commentary.
Where a recipe was not provided as part of the menu, I looked up the food item in Cronometer and used the nutritional information for the specified quantity.
Breakfast on Day 1 had a small glass of the “smoothie” (28.4 g carbs, 8.9 g pro, 5.2 g fat) and that was it until lunch! Given the high amount of ground-up* fruit in it as well as the low amount of fat and protein, the first thing I thought of was how soon an adult with diabetes would be ravenous after drinking this. Then I wondered how high would their blood sugar go?
[Note: February 5, 2021]: In an earlier article, I covered the effect of various types of food processing on blood glucose, including mechanical processing such as the pureeing of the fruit in this smoothie. While 60g of whole apple, 60 g of pureed apple, and 60g of juiced apple have the same amount of carbohydrate and similar Glycemic Index neither of these indicate how blood glucose responds to eating pureed fruit, versus intact fruit. We know from a 1977 study published in the Lancet (reference below) that when pureed fruit or juiced fruit is consumed, the glucose response 90 minutes later is significantly higher than if the fruit were eaten whole.
[Haber GB, Heaton KW, Murphy D, Burroughs LF. Depletion and disruption of dietary fibre. Effects on satiety, plasma-glucose, and serum-insulin. Lancet. 1977 Oct 1;2(8040):679-82. doi: 10.1016/s0140-6736(77)90494-9. PMID: 71495]
This is typical of what is seen with any ultra-processed carbohydrate. So, the first problem with someone with diabetes having a fruit smoothie such as this as a meal is that the fruit is ground up, and not whole. A smoothie will spike blood glucose much more than if the same food was eaten not pureed.
We also know from a 2015 study on the effect of food order on the response of glucose and insulin, that if carbs are eaten last, the glucose curve will be approximately 74% smaller, with a 49% smaller insulin spike.
[Shukla AP, Iliescu RG, Thomas CE, Aronne LJ. Food Order Has a Significant Impact on Postprandial Glucose and Insulin Levels. Diabetes Care. 2015;38(7):e98-e99. doi:10.2337/dc15-0429]
The second problem with someone with diabetes drinking a fruit smoothie like this for breakfast with no other food is that there is no way of having the carbs last!
Lunch on Day 1 was a small serving of vegetable frittata (3 g carbs, 13.6 g pro, 14.9 g fat), 1 slice whole-grain bread (13.2 g carbs, 4.5 g pro, 1.3 g fat) and 1 cup unsweetened plant based beverage such as Silk plain Oat milk (7.6 g carbs, 0.4 g pro, 0.3 g fat). A slice of frittata, a slice of plain bread and a glass of oat milk and that’s it for lunch. Maybe a nice lunch for child home from school?
Observations: The frittata is a great start to an actual low-carb lunch. Why not pair it with a nice big salad, with a bit of crumbled cheese, a few pumpkin seeds and a bit of avocado, and skip the bread? If they want, they can drink the plant-based drink or skip it, as it hardly provides a significant source of protein. Maybe instead of the plant-based beverage, have 3/4 cup of Greek yogurt with a few berries instead, which provides significantly more protein for the same amount of carbs?
Dinner was 1 cup of Indonesian tofu stew with vegetables (8 g carbs, 5 g pro, 8 g fat) and ½ cup (125 mL) cooked brown rice (24.2 g carbs, 2.8 g pro, 1.0 g fat). That’s it. This might be an adequate serving for an older adult with a small appetite.
Observations: What I would be concerned about is that a typical adult eating this for dinner would want to eat something before bed, because they would be hungry. While their blood sugar would go up slowly after this meal, dampened by the fiber in the rice as well as the few cooked veggies in the stew, it is simply not enough food. For a plant-based meal, double the serving of tofu stew, make it with regular coconut milk, add a nice Asian-style cucumber salad on the side, and forget the rice.
So what did this day provide in terms of carbohydrate and total protein?
Well, it was low carb (84.4 g) but it was also inadequate in protein — having only 35.2 g PRO. Based on “average” body weight and a minimum 0.36 g of protein per pound of body weight (0.8 g protein per kg), this is less than the 46g protein required for the average sedentary woman, and much less than the 56g of protein required for the average sedentary man.
Breakfast was small glass of the same smoothie (28.4 g carbs, 8.9 g pro, 5.2 g fat) and that was it until lunch!
Observations: since this is the second time the person would be having this for breakfast, they would already be wondering what else they could eat (or bring along with them to eat later) because they would have remembered how hungry they were an hour or so later, the last time!
Since they would have had Greek yogurt for breakfast a day earlier, why not suggest a nice omelette made with some leftover cooked veggies from the night before? They could even add an ounce of sharp cheddar to it, which would easily get them through to lunch.
Lunch was a “cup” of low fat cream of cauliflower soup that was actually only 3/4 cup / 175ml in size ( 10 g carbs, 7g PRO, 2g fat), 3.5 oz / 100 g grilled chicken breast (0 carbs, 41.7 g pro, 6.1 g fat) and a cup of unsweetened plant based beverage (7.6 g carbs, 0.4 g pro, 0.3 g fat). No salad, no side of veggies, that was it.
Observations: As part of a low carb meal, the cauliflower soup with a splash of cream and the grilled chicken breast would go every well with a nice helping of steamed veggies or mixed greens on the side — and why not? They are low carb, and high in micronutrients. The cooked ones would taste great with a dab of butter and the raw ones, with a squeeze of lemon and some extra virgin olive oil. Now there’s lunch!
Dinner was 1 serving (3 oz) of grilled fish fillet (pink salmon – 0 g carbs, 17.4 g pro, 3.7 g fat), ½ cup (125 mL) cooked quinoa (17.1 g carbs, 4.1 g pro, 1.8 g fat) and 1.5 cups green salad* with dressing (2.8 g carbs, 0.8 g pro, 2.5 g fat). What adult would find a small piece of fish, a small serving of quinoa and a small salad enough for supper — unless they had a big lunch?
*amount of salad chosen to bring total carb count for meal to the stated 20 g
Observations: I would probably encourage them to have more fish — especially a fatty fish like salmon, skip the quinoa entirely, and have a nice serving of grilled asparagus or roasted Brussel sprouts with it, along with the salad. Their blood glucose would be much more stable and the person would not be hungry before bed.
What did this day provide, in terms of carbohydrate and total protein? Well, it was low carb (65.9 g) and adequate (71.4 g) protein, but had very few vegetables, little healthy fat, and very small portions.
Breakfast was small glass of the same smoothie (28.4 g carbs, 8.9 g pro, 5.2 g fat) and that was it.
Observation: since the person would have had eggs the day before, they could have a nice big bowl of unsweetened Greek yogurt (which provides lots of protein), along with 1/2 of berries on top and a tablespoon or so of hemp hearts. This would provide them with lots of protein to keep them satiated, and the intact berries and yogurt prevent the glucose spike of the acellular (ground up) smoothie.
Lunch was 1 egg on 3/4 cup of Mexican baked black beans (19 g carbs, 12 g pro, 9 g fat) and 1 cup unsweetened plant based beverage (7.6 g carbs, 0.4 g pro, 0.3 g fat). Nothing else. No veggies, no salad, not even a dollop of guacamole!
Observations: The same black bean recipe could be made with black soybeans which have huge amounts of protein, and few carbs. Served with the eggs, a dollop of homemade guacamole and a nice Mexican-style salad, this could be a lovely low carb lunch.
Dinner was 1 serving (3.5 oz) of beef or pork meatballs without sauce (10.5 g carbs, 19.3 g pro, 16.6 g fat) and ¾ cup (150 mL) of plain cooked pasta (30.5 g carbs, 6.1 g pro, 1.0 g fat). How is this an appropriate “low carb” dinner for someone with diabetes? How is this a complete meal?
Observations: Sure, make the meatballs (homemade is always better) and serve them with a nice sauce made with sautéed mushrooms and a bit of tomato sauce and throw in some dried (or fresh) herbs. Skip the plain pasta and serve the meatballs on top of spiralized zucchini that is cooked quickly in the microwave, with top with nice grating of parmesan.
It was low carb (96.0 g) and adequate (46.7 g) protein for a sedentary woman but inadequate protein for even a sedentary man. It had few vegetables, very little healthy fat, and very small portions.
IMPORTANT NOTE: As I point out in the article “Don’t Try This at Home- the need for medication supervision“, if you are taking certain types of medication, do not begin to follow a very low carb (keto) diet — including the one which results with the example modifications above without first consulting with your doctor. These medications include;
(2) medication to lower blood glucose such as sodium glucose co-transporter 2 (SGLT2) medication including Invokana, Forxiga, Xigduo, Jardiance, etc. and other types of glucose lowering medication such as Victoza, etc.
(3) medication for blood pressure such as Ramipril, Lasix (furosemide), Lisinopril / ACE inhibitors, Atenolol / β₁ receptor antagonists
(4) mental health medication such as antidepressants, medication for anxiety disorder, and mood stabilizers for bipolar disorder and schizophrenia.
Tying it all Together
There are parts of this menu that are certainly usable, and it can be modified to make it into a lovely low-carb meal plan.
The frittata, for example could be a great start to a low-carb lunch when paired with a nice big salad, with a bit of crumbled cheese, a few pumpkin seeds and a bit of avocado — and skip the bread!
Double the amount of tofu stew and vegetables, and make a nice Asian style cucumber salad on the side and skip the rice!
The cauliflower soup with a splash of cream and the grilled chicken breast would go every well with a nice helping of steamed veggies or mixed greens on the side — and why not? They are low carb, and high in micronutrients. The cooked ones would taste great with a dab of butter and the raw ones, with a squeeze of lemon and some extra virgin olive oil. Now there’s lunch!
And why on earth would a person with diabetes be encouraged to drink that smoothie 3 times per week if not to promote the product of one of the menu’s sponsors? Why not suggest an omelette made with some leftover cooked veggies from the night before — and they could even add an ounce of sharp cheddar to it, which would easily get them through to lunch. Or, how about a bowl of Greek yogurt with 1/2 cup of blueberries and a tablespoon of hemp heart? That is a high protein breakfast with far fewer carbs than the smoothie and will keep a person going with stable blood sugars until lunch.
Ditch the carbs. Who needs the bread and pasta and rice — especially on a “low carb” meal plan?
People can get all the B-vitamins they need, including B1 (thiamine), B2 (riboflavin), B3 (niacin) and folate from real, whole food such as chicken liver, sardines, eggs and sunflower seeds. They can plenty of the most bioavailable iron from seafood and meat and get ample magnesium from nut, seeds, dark chocolate and avocados, and selenium from Brazil nuts and eggs.
The American Diabetes Association understands that a low carbohydrate diet “limits sugar, cereals, pasta, bread, fruit & starchy vegetables” and “consist mostly of protein foods like meat and dairy, fatty foods like oil, nuts, seeds, avocado, and butter, and non-starchy vegetables” .
Canadian with diabetes deserve to have a low carb menu based on these same principals, and which provides them with adequate protein, a good source of healthy fats and adequate size servings of food.
In Diabetes Canada’s Position Statement released this past May, they acknowledged that a low carb and very low carb (keto) diet is both safe and effective for adults with both type 1 and type 2 diabetes to follow. Under the Five Recommendations, it states;
“Healthy low carb or very-low-carb diets can be considered as one healthy eating pattern for individuals living with type 1 and type 2 diabetes for weight loss, improved blood sugar control and/or to reduce the need for blood sugar lowering medications.”
How does the “low carb” meal plan that Diabetes Canada has released help people with diabetes with improved blood sugar control or a reduced need for blood sugar lowering medication?
We can do better.
Canadians with diabetes deserve better.
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- Diabetes Canada, 7-day low carbohydrate meal plan, https://diabetes.ca/nutrition—fitness/meal-planning/7-day-low-carbohydrate-meal-plan
- American Diabetes Association, Diabetes Food Hub, Meal Prep: meals for any eating pattern, Low Carb, https://www.diabetesfoodhub.org/articles/meal-prep-meals-for-any-eating-pattern.html
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