I was excited when I saw a thread on social media over the weekend about Diabetes Canada’s new 7-day Low Carb Meal Plan. After all, last May they released a Position Statement summarizing the evidence for the role of low carbohydrate diets (<51-130g carbohydrate/day) and very low- carbohydrate diets (<50g carbohydrate/day) in the management of type 1 and type 2 diabetes and I thought “great!” — they are going to be providing support for people with diabetes to be able to choose a low carb or very low carb (keto) diet as one of the available healthy eating patterns. Not quite.
This was the ad I saw on Facebook;
Clicking on the link associated with the ad, the text reads;
“Current evidence suggests that a low-carbohydrate diet can be safe and effective for people with diabetes. This dietary pattern can help with weight loss and blood sugar management. Keep in mind that a low-carbohydrate diet can also reduce the need for certain diabetes medications. People living with diabetes who want to follow a low-carbohydrate diet should seek professional advice from their healthcare provider to avoid any adverse effects, such as hypoglycemia (low blood sugar) or an increased risk for diabetic ketoacidosis (DKA).
This meal plan features healthy plant-based foods, low glycemic index carbohydrates, and less than 130 grams carbohydrates per day. ”
At the bottom of the meal plan it indicates;
While the promotion on Facebook indicated that it features ‘plant-based foods’, it is not a plant-based menu. It includes eggs and yogurt, fish (tuna, fish fillet, salmon), a (bun-less) cheeseburger, beef or pork meatballs, and chicken breast — along with tofu, legumes such as chick peas and black beans. Not surprisingly given one of the sponsors of the menu, each day includes one or more servings of plant-based beverages and recipes use canola oil.
The Diabetes Canada “low carb” meal plan is like no other I have ever come across, as it includes servings of starches such as bread, potato, rice, pasta and legumes.
Breakfast on day 1, 3 & 5 of the menu features a smoothie made with 200 ml of a sugar-sweetened soy beverage manufactured by one of the menu’s sponsors, along with 65 g of blueberries, 85 g of pomegranate and 2 g of ginger. This is hardly the best way for someone with diabetes (an inability to adequately handle carbohydrate) to begin the day — and that’s all there is for breakfast! One little glass of smoothie totalling almost 30g of carbs and only 9 g of protein.
Lunches and Dinners included either a slice of whole-grain bread, 1 small baked potato, 1/2 cup cooked brown rice, 3/4 cup (150 ml) cooked pasta, 1/2 cup (125 ml) mashed sweet potato or chick peas or black beans. Sure, small amounts of sweet potato can be appropriate as part of a real, whole food low carbohydrate meal plan, and a small amount of chick peas or black beans can be included from time to time, but there is no established “low carb” diet that includes bread, rice and pasta!
Low Carb — and low protein and fat too
I was curious how much food there was at each meal on this plan, as well as the total amount of carbs and protein per day, so I decided to analyze Day 1, Day 3 and Day 5 to get a rough idea.
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.
These meals were <130 g of carbohydrate per day — so technically these are considered “low carb“, but they are also low fat, and low or inadequate in protein.
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?
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.
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!
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.
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?
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.
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!
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?
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.
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.
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