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Note to the ReaderThis article is for you if you are a vegetarian who has just developed diabetes, or if you are a diabetic who would like to try a vegetarian diet. If you are a diabetic, be certain to work with a registered dietitian when planning your diet, especially if you are a new diabetic.
Short-term effects of hyperglycemia may include thirst, frequent urination, weakness, lack of ability to concentrate, loss of coordination, and blurred vision. With very high levels of blood glucose, loss of consciousness is possible.
As ominous as this sounds, there is good news about diabetes. Diabetes can be controlled. A look at the diet recommended for diabetics can help us to see why vegetarians may have the advantage in controlling this disease.
Type II diabetes, or non-insulin dependent diabetes mellitus (NIDDM), used to be called adult-onset diabetes. About 90% of all diabetics fall into this category. Obesity is believed to be a major risk factor for type II diabetes. Some type II diabetics produce insufficient insulin and may benefit from insulin injections. More typically however, these individuals produce sufficient or even excess insulin; but their cells are resistant to the insulin. These diabetics may take medications called "oral hypoglycemic agents" to help lower blood glucose. In many cases weight reduction alone will help to normalize blood glucose levels. Regardless of the type, diet is a critical factor in attaining normal blood glucose levels in diabetes.
There are two types of dietary fiber. Insoluble fiber has little effect on blood glucose. Soluble fiber, however, has been associated with improved blood glucose control in diabetics and with lowering of blood cholesterol levels. The best sources of soluble fiber are shown in the chart on the next page.
What level of dietary fiber should be used in the diabetic diet? Different amounts have been proposed. The American Diabetes Association recommends 40 grams of dietary fiber per day. For com- parison purposes, the average American consumes between 10 and 15 grams of dietary fiber per day. The American Diabetes Association does not make a recommendation for a specific amount of soluble fiber.
The panel of National Institutes of Health Consensus Development Conference on Diet and Exercise in NIDDM (Non-Insulin Dependent Diabetes Mellitus) believes the evidence for increasing fiber in the diabetic diet is inconclusive. However, Dr. James Anderson, whose research helped to establish a role for fiber in control of diabetes, recommends very high intakes of fiber. He states that the "ideal" diabetic diet could include as much as 70 grams of dietary fiber per day. Some health professionals suggest caution in the use of very high fiber diets. In some studies, dietary fiber, when consumed at very high levels, has been shown to bind minerals such as iron and calcium, making them unavailable to the body.
Although there is no consensus on the amount of fiber to be eaten, health professionals agree that many Americans do not eat enough dietary fiber. Vegetarians are more likely to achieve the recom- mended increase in fiber intake because of their reliance on plant foods. Replacing non-fibrous foods such as meat, cheese, and eggs with grains and legumes is an excellent way to increase dietary fiber. While a high-fiber diet is difficult for many Americans to achieve, it is a way of life for most vegetarians.
dry or cooked oat branNote: Dr. Anderson from the University of Kentucky has compiled data for the amount of soluble fiber in the above foods. However, since data on soluble and insoluble fiber in foods has not been agreed upon by experts on fiber, we have not included amounts per serving.
black eyed peas
baked potato with skin
Increasing your intake of soluble fiber is really quite easy. Be sure to include a serving of legumes in your diet daily -- they are the best food source of soluble fiber, and black eyed peas are the best of the beans! Tofu does not count since it does not include the fibrous portion of the soybean. Experiment with oat bran. See Bobbie Hinman's article in the March, 1989 Vegetarian Journal. Replace 1/4 - 1/2 of the flour in baked products with raw oat bran. Your product will be heavier, but delicious. Eat more berries. Experiment with grains and breads. Barley and corn meal both have more soluble fiber than brown rice.
Does this mean that there are no restrictions on sugar in the diet of diabetics? Well, not necessarily. For one thing, a number of studies have linked sugar consumption by diabetics with an increase in blood triglycerides, a type of fat. Although the actual significance of increased blood triglycerides remains controversial, unlimited use of sugar does not seem prudent.
What is more important is that foods high in sugar are often high in saturated fat and calories and low in nutrients. For this reason, diabetics, like everyone else, would do well to keep their intake of sweets to a minimum.
The National Institutes of Health Consensus Development Conference on Diet and Exercise in NIDDM states that it is acceptable for up to 5% of total calories to come from sugar. This means that for a person on a 1500 calorie diet, with 60% of calories from carbohyrate, approximately 2 and 1/2 teaspoons of sugar are allowable. While this is a fairly small amount of sweetener, the allowance for some desserts on the diabetic diet is a welcome and realistic one.
Your physician may allow occasional use of alcoholic beverages. If you do drink alcohol, keep the following in mind.
12 oz. regular beer 1 bread plus 2 fats 12 oz. light beer 2 fats 1-1/2 oz. distilled spirits 2 fats 3-1/2 oz. dry wine 1 1/2 fats
Diabetics who take insulin injections can certainly exercise also. However, precautions need to be taken. Rigorous exercise must be accompanied by an increase in food intake, or hypoglycemia (low blood glucose) may result. A dietitian can help you plan appropriate snacks for exercise. All diabetics should consult their physicians before beginning an exercise program.
Gestational Diabetes is diabetes that develops for the first time during pregnancy. It usually disappears after the baby is delivered. Women who develop gestational diabetes are at greater risk for developing Type II diabetes later in life.
Women Who Already Have Diabetes When They Become Pregnant will experience some changes in blood glucose control. If they are using insulin, they typically will experience a decrease in insulin needs during the first half of pregnancy, followed by an increase in insulin needs during the latter part of pregnancy.
Each diabetic pregnancy is treated individually. Pregnant diabetics need to be certain to consume adequate calories, eat frequent small meals, check their blood glucose frequently, and follow their doctor's advice. Well-planned vegetarian diets are appropriate for pregnant diabetics.
Diet planning with the help of a dietitian is especially important for these children. A plant-based diet for diabetic children should meet all of the above described needs while being acceptable to the child.
As interesting as the glycemic index is, most nutritionists consider it to be of little use. For one thing, equal amounts of foods were compared rather than normal serving sizes. Secondly, when foods are served as part of a meal, along with other foods, this index changes dramatically. Thus, a dinner of carrots alone might cause a surge in blood sugar; but a meal of brown rice, lentils, and carrots will have a very different response.
Note From the Editors: Since there is such conflicting evidence concerning the glycemic index, our dietitians questioned whether to include this section. However, we left it in, since the glycemic index is mentioned in some of the popular literature. We decided not to include glycemic index values, since they are considered more theory than fact at this time.
While few researchers actually recommend a vegetarian diet per se for diabetes, it is clear that the vegetarian pattern is closer to the recommendations than is the typical American diet. Research and nutrition educators are concerned that individuals will not be able to make the diet changes necessary to achieve a high-carbohydrate, high-fiber diet. For most vegetarians, this type of diet is a way of life. A strict or lacto-ovo vegetarian diet is not only allowable for diabetes, it may be the preferred diet pattern.
Since the diabetic diet is one which is low in saturated fat and cholesterol, look for cookbooks that emphasize low-fat cooking. Here are a few recommendations to get you started.
Eat Smart for a Healthy Heart Cookbook, Copley and Moore, Barrons, Woodbury, N.Y., 1987. Hardcover, $18.95
Dr. Anderson's HCF Diet: The New High-Fiber Low-Cholesterol Way to Keep Slim and Healthy, Anderson, J. Available from HCF Diabetes Foundation, Box 22124, Lexington, KY 40522. Softcover, $5.00.
Low-Fat Cooking, Foley, L. (ed), Meredith Corporation, Des Moines, IA. Hardcover, $6.95.
The Quick and Delicious Low-Fat, Low-Salt Cookbook, J. Williams and G. Silverman, Perigee Books, N.Y.C., N.Y. Softcover, $8.95.
The American Heart Association Cookbook, R. Eshleman, M. Winston, Ballantine Books, N.Y.C., N.Y.
The Oats, Peas, Beans and Barley Cookbook, E. Cottrell, Woodbridge Press, Santa Barabara, CA.
Jane Brody's Good Food Book, J. Brody, Bantam Books, softcover $12.95.
Bantle, John. "The Dietary Treatment of Diabetes Mellitus," Medical Clinics of North America, Vol. 72, No. 6, Nov. 1988, pp. 1285 - 1299.
Anderson, James, et al. "Dietary Fiber and Diabetics: A Comprehensive Review and Application," Journal of the American Dietetic Association, Vol. 87, No. 9, September 1987, pp. 1189 - 1197.
Wheeler, Madelyn. "Diet and Exercise in Noninsulin Dependent Diabetes Mellitus: Implication for Dietitians from the NIH Consensus Development Conference," Journal of the American Dietetic Association, Vol. 87, No. 4, April, 1987, pp. 480 - 485.
Snowdon, David and Phillips Roland. "Does a Vegetarian Diet Reduce the Occurence of Diabetes?" American Journal of Public Health, May, 1984, Vol. 75, No. 5, pp. 507 - 512.
The Surgeon General's Report on Nutrition and Health, 1988. U.S. Department of Health and Human Services
The Exchange Lists contain six food groups (starch, meat (or protein), vegetable, fruit, milk, and fat). Individuals are allowed a particular number of servings in each group at each meal.
A quick look at the Exchange Lists reveals that while they are usable by lacto-ovo vegetarians, their use by vegans is more complicated. This represents a shortcoming of the Exchange Lists -- not the vegan diet. The Lists are based on the habits of the average omnivore and are not the only means of achieving diabetic control. Vegan diabetics can use the list with some modifications and should insist on guidance from their health care provider in doing so.
Vegan Diabetics: Vegan diabetics may substitute soy milk for 2% cow's milk in the milk exchanges. However, if you do not use soy milk, you may eliminate the milk exchanges from your meal planning and use only the remaining five lists. Be certain to include plenty of tofu (with a calcium coagulant) and leafy green vegetables in your diet to ensure adequate calcium intake.
Exchanges for Special Vegetarian FoodsFOOD SERVING SIZE EXCHANGES brewer's yeast 3 TB 1 bread carob flour 1/8 Cup 1 bread kefir 1 Cup 1 milk + 1 fat Loma Linda Veggie Links 1 oz 1 high-fat meat Morningstar Farms Grillers 1 oz 1 high-fat meat miso 3 TB 1 bread + 1/2 lean meat seaweeds, cooked 1/2 Cup 1 vegetable soy flour 1/4 Cup 1 lean meat + 1/2 bread soy grits, raw 1/8 Cup 1 lean meat soy milk 1 Cup 1 milk + 1 fat tahini 1 teaspoon 1 fat tempeh 4 oz. 1 bread + 2 protein wheat germ 1 TB 1/2 bread (If you use large amounts, may need to add a fat exchange. Speak to your dietitian.)
Remember that most diabetics are non-insulin dependent, and most do not need to depend on exchange lists, though some may. While we are including information about exchange lists, note that for most peo- ple, Non-Insulin Dependent Diabetes can be controlled through a low-fat, high-carbohydrate meal plan with calorie control -- and these diabetics do not need to follow a rigid diet pattern using the exchanges. Consult your health care provider for more information on your situation, and for exchange lists if you need them.
Note to Dietitians: In my practice as a dietitian, I treat legumes differently than the American Diabetes Association Exchanges do. I always count 1/2 Cup of legumes as 1/2 protein and one bread exchange, while ADA just counts them as a bread. For a vegetarian, this needs to be modified.
The Vegetarian Resource GroupThe Vegetarian Resource Group (VRG) is a non-profit organization dedicated to educating the public on vegetarianism and the interrelated issues of health, nutrition, ecology, ethics, and world hunger. In addition to publishing the Vegetarian Journal, VRG produces and sells cookbooks, other books, pamphlets, and article reprints.
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For general information on diabetes, see www.diabetes.com.
February 2, 1998
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