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I’m not sure who named November National Diabetes Awareness Month, but it seems fitting, or maybe equally ironic that it falls squarely between Halloween and the holidays. Just as adults and kids alike begin to see their candy collection dwindle, the season of indulgence, celebration and apple pie arrives, along with a backdrop of health campaigns seeking to educate the public on the perils of diabetes. The good news is that diabetes is largely preventable and there is still plenty of room for the season’s treats. Given the seriousness of the condition and its effects on the quality of life of those we love, it’s worth spending some time clearing up some confusion on how best to prevent and manage it.

Diabetes Touches Us All
Here are the stats on diabetes prevalence. According to the American Diabetes Association, the condition remains the nation’s 7th leading cause of death, affecting 30.3 million Americans, or 9.4% of the population. (Just 20 years ago that number was just 2.8%!). Rates of pre-diabetes, where blood sugars remain elevated yet not high enough to diagnose full-blown diabetes, are even higher with estimates at 83 million Americans. That’s 1 in 3, many of whom don’t even know their risk! Besides staying active, diet is crucial, but there are several myths on what to eat that seem to have taken us off course and may be hindering best efforts at managing and preventing this condition.

Sugar Causes Diabetes…(and other myths)
Before we start myth-busting, let’s review the basics.

Type 2 Diabetes (aka “adult onset diabetes” but which is now impacting children in greater numbers) typically begins with insulin resistance. Insulin is the critical hormone responsible for escorting glucose (from the food we eat) into our cells for use as energy. Over time and in the presence of certain risk factors, insulin begins to lose its effectiveness, causing glucose to accumulate to unhealthy levels in the blood, aka hyperglycemia.

So how to answer the question, “what do I eat to prevent diabetes?” First let’s look at some of the conventional wisdoms that abound.

Myth #1: Carbohydrates, especially sugar, cause diabetes.

This is still held in wide belief as remnants of the low carb diet craze of the 90’s linger, but nope, false. The truth is, eating too much of anything can lead to weight gain and therefore insulin resistance. It just so happens that refined carbs and sugars taste very good and aren’t very filling, a combination that makes them easy to overdo. Eating them too often at the expense of other nourishing foods can also lead to uncontrollable cravings that makes them even harder to moderate, also impacting insulin sensitivity. Still, over restricting almost always leads to overindulging – leaving room for occasional sweets to help forego urges to binge is a good idea. Lastly, there’s plenty of reason to include high quality complex carbs, fruits and veggies to help prevent and manage diabetes (but more on that later).

Myth #2: More protein is better when it comes to controlling my blood sugars.

Fear of carbs seems to be waning (good news!), but our obsession with protein is still growing strong with many consumers still believing their diets lack sufficient amounts. That, coupled with the ever-increasing popularity of Paleo and other high protein diets, gives some rationale for the recent USDA data forecasts that per capita “disappearance at retail” of beef, chicken and pork are all expected to continue rising.

Carbohydrates do affect our blood sugars more rapidly than protein so it might be tempting to replace starchy foods with more meats, poultry and dairy. Unfortunately, this poses 2 problems:

1. More animal proteins means a lot more saturated fat and it’s well known that this type of fat actually promotes inflammation and increases insulin resistance. On the other hand, mono and polyunsaturated fats from olive oil, fatty fish and avocado increases insulin sensitivity.

2. Increasing protein can definitely aid weight loss which should theoretically improve insulin sensitivity. This study, however has shown the opposite effect. Eighty-nine participants were randomly assigned to a high protein or a low fat, high fiber diet. While those on the high protein diet lost more weight, they were still at considerably higher risk of developing diabetes – experiencing a whopping 19.3% reduction in insulin sensitivity!

What About Keto?
The ketogenic diet, originally intended to help control seizures in children with epilepsy, has gained more attention recently as a hack to weight loss and diabetes management. Instead of using glucose for energy, this high fat, low carb regimen leads to the production of ketones to generate energy. I don’t recommend this plan (or most “diets”) as a strategy for basic weight loss, especially given that achieving ketosis requires near complete avoidance of carbs (less than 30g/day), and therefore restricts wonderfully nutrient rich foods like fruits, vegetables, whole grains and legumes. There is also no clear discernment between quality of fat (saturated fats tend to be quite high). It is however interesting to consider the keto diet as a therapeutic approach to managing diabetes given that it can help improve insulin sensitivity. Still, no studies exist to determine the long term impact of this eating plan, mostly because it’s so darn restrictive and hard to stick with.

Plant-Based Diets Key To Diabetes Management and Prevention
It’s hopeful to see so much research, like this recent systematic review debunking some of the common myths around diabetes management. Plant-based eating patterns which tend to be exceptionally high in carbs (70%!) are high in fiber, antioxidants and magnesium, promote a healthy microbiome and satiety while improving mood and sense of wellbeing.

For those who have been on the low carb, high protein bandwagon, moving toward more plant-based eating doesn’t have to mean significant changes all at once!

Here are some basic tips to get you started:

1. Make ½ your plate veggies – this is an easy portioning trick that helps you fill up on the good stuff.

2. Determine how many meatless meals you eat each week and add one more.

3. Begin slowly reducing your portions of animal proteins – use them as a garnish or condiment and make plants the star of your plate.

4. Consider a breakfast salad – (yes, salad for breakfast! Check this one out, recently offered in one of our Sally robots – romaine lettuce, savory turmeric spiced granola and mango, topped with lemony Greek yogurt dressing).

Changing the way we eat (for the better!) is not typically something we are inspired to do during the holidays but it is a time of year many of us take stock and give thanks for our health and those we love. Above all, it’s really pretty simple – eat mostly plants, avoid strict dietary prescriptions, leave room for a little delicious indulgence and stay active to stay healthy, happy and diabetes free.