The Vegetarian’s Dilemma
A meatless diet may offer significant health benefits. But is it right for someone managing diabetes?
Thinking about becoming a vegetarian? You aren’t alone; roughly 7.5 million American adults have chosen a plant-based way of eating. But when you have diabetes, the choice isn’t as simple as breaking up with the butcher. Switching to a vegetarian eating plan means more carbohydrate-rich foods, which can cause blood glucose trouble if you aren’t careful. However, armed with the right information and the motivation to improve your diet, going vegetarian—or just moving toward a more meatless style of eating—can help you manage your diabetes, control your weight, and leave you feeling better than ever.
The Science Says
Vegetables are good for everyone, and they’re even more important if you are a vegetarian who has diabetes. A 2012 study of people with type 2 diabetes (who all got about the same amount of calories from carbohydrates) found that those who ate 150 grams or more of leafy greens (that’s about 2 to 4 cups) each day, whether they were eating meat or not, had significantly lower average blood glucose levels over a three-month period.
And excluding meat altogether seems to offer benefits of its own. One meta-analysis (a scientific review of published studies) suggests that a low-fat vegetarian diet can bring A1C levels down. Another study shows a relationship between eating even a modest amount of red meat and higher rates of type 2 diabetes.
Overall, the existing body of research suggests that people with type 2 may benefit from a thoughtfully developed vegetarian eating plan, one that focuses on foods that are high in fiber and have a low glycemic load, which measures the quality and amount of carbohydrate in a food. Some good picks include beans and lentils, greens, and whole grains. The studies suggest a meatless diet can play a role in improving blood pressure, cholesterol, and triglyceride numbers as well as maintaining a healthy weight. Research shows that vegetarians tend to weigh less than meat eaters, and weight control is a central part of type 2 diabetes management, according to the American Diabetes Association’s 2017 Standards of Medical Care in Diabetes.
However, the effect of a vegetarian eating plan on those with type 1 diabetes isn’t as clear. “Human nutrition research is very hard and expensive to do,” says Hope Warshaw, RD, CDE, a dietitian, diabetes educator, and author of Diabetes Meal Planning Made Easy. There are many factors that make this kind of research so challenging. Among them are study subjects’ tendency to misreport what they eat and the expense and impracticality of keeping them under close supervision in a lab setting over the months and years it requires to collect meaningful, accurate data.
Also unexplored: vegetarian eating for children with diabetes. Nutrition experts don’t rule out meatless eating plans for kids—provided care is taken to ensure they are still getting adequate calories and nutrition. “Another concern is that sometimes a kid’s interest in eliminating foods can be a sign of an eating disorder,” says Sacha Uelmen, RDN, CDE, director of nutrition for the American Diabetes Association.
The ADA notes that there is no one-size-fits-all nutrition plan for people with diabetes. For some, especially those who aren’t eating enough nonstarchy vegetables or fiber-rich whole grains already, the transition to a vegetarian diet could be very positive.
The Carb Question
Foods rich in carbohydrate are notorious for raising blood glucose levels, so people with diabetes who are thinking about switching to a vegetarian eating plan may be concerned. But not all carbs are created equal, Uelmen says.
The difference between minimally processed whole grains and the refined carbohydrate (highly processed flours, added sugars) found in white bread, pasta, and many packaged foods is so considerable that it isn’t really fair to lump them into a single category labeled “carbs.” Regardless of the type of eating plan they follow, people should limit foods with lots of added sugars and refined flours. They are high in calories, lacking in nutrients, and low in fiber.
The carbs you should reach for as a vegetarian are the fiber-rich kind, especially beans and whole grains. “Fiber doesn’t break down into sugar,” says Uelmen. “I think of it as a sponge that actually absorbs some of the carbohydrates in the food.” You get a much less dramatic rise in blood glucose than you would from a low-fiber meal. She recommends replacing white rice with a whole grain like barley, which will not only reduce the impact of the carbs on your blood glucose but also leave you feeling fuller and more satisfied. Quinoa, bulgur and brown rice are other smart swaps.
That said, Uelmen cautions that you still need to be aware of portion sizes. “Going vegetarian is such a change. Sometimes people think, ‘This is a whole grain, I can eat as much as I want.’ But those things are calorie dense,” she says.
Even with high-quality carbohydrate, “you just can’t add an unlimited amount,” says Erin Palinski-Wade, RD, CDE, a dietitian and diabetes educator. Both experts strongly suggest filling half your plate with nonstarchy vegetables, preferably nutrient-rich leafy greens. It’s a smart way to keep the overall calorie and carb count of your meal down when whole grains and beans are also on the menu.
Getting enough protein is probably the most common nutrition concern for would-be vegetarians. But the angst is misplaced. “The typical American diet is so heavy on protein,” says Vandana Sheth, RD, CDE, a spokeswoman for the Academy of Nutrition and Dietetics. “An adult woman needs about 45 grams of protein per day. A cup and a half of beans has 21 grams. With an egg, a little yogurt, and a little cheese, you get more than enough without trying,” she says. Adult men need about 56 grams of protein daily. Because of their high protein quotient, beans are an especially important part of a meatless eating plan. Though they are a source of starchy carbohydrate, beans also have tons of fiber, which means they help keep blood glucose stable and keep you feeling fuller longer.
Other nutrients you should make sure you get on a vegetarian diet are iron, zinc, and omega-3s, says Jackie Newgent, RDN, CDN, author of The All-Natural Diabetes Cookbook. Vitamin B12, which helps keep nerve and blood cells functioning properly, prevents a type of anemia and is found only in animal sources. This can also be an issue if you are going light on dairy. According to Sheth, conscientious meal planning and a few choice supplements (fish oil for those heart-healthy omega-3 fatty acids, B12, and a multivitamin), if suggested by your health care provider, will go a long way to ensuring all your nutrient needs are met.
What you don’t want to do is switch to a meatless plan and replace healthy lean protein with junk food or processed substitutes. “If you are just trying to eat the same as you always have but eliminate meat, you will run into problems,” says Uelmen, who doesn’t have diabetes but speaks from experience. “When I was 19, I became a vegetarian and did it totally the wrong way—with pizza and mac and cheese and french fries.” Instead, she says, reach for legumes (especially lentils, which are easier to digest than larger beans), tofu, whole grains, and vegetables such as broccoli, spinach, and peppers.
Flipping the Switch
For people with diabetes who want to become vegetarians, taking it slowly is usually best. The first step can be simply changing your mindset and thinking of yourself as someone who eats a plant-based diet. Translation: Say so long to meat and hello to vegetables, beans, and whole grains. During the transition, it’s also important to experiment with the less-familiar foods you might use in place of meat. Knowing how you like to prepare your tofu or lentils, for example, will help you during the switch.
“Rather than saying, ‘Today I eat meat, tomorrow I’m a vegetarian,’ take it one meal at a time,” says Newgent. She recommends making your mornings meatless first, and when that becomes an easy habit, move on to lunch. “Do dinner last—that’s the hardest,” she says.
“It’s not a race to get there,” says Palinski-Wade. “If you usually eat meat five days a week, go to four.” She says that going incrementally more vegetarian lets you see positive changes, such as weight loss, while confirming that meatless meals aren’t going to send your blood glucose out of control.
For those on basal-bolus insulin therapy, be very careful about monitoring your blood glucose through dietary transitions. “They’ll have to work closely with their [health care team] to adjust their level of insulin, especially right when they are making the switch,” says Newgent. As more carbs are introduced, people may or may not need to increase insulin doses a bit.
Over time, many vegetarians with diabetes learn to love their meatless life. “A hearty, spicy chili made with lentils instead of ground meat can be very satisfying,” says Sheth. Newgent recommends embracing pizza night, but building your pie on a whole-grain crust and topping it with tons of fresh veggies. She also likes to swap a beef burger for a grilled portabella mushroom. “Just remember to add something with protein on the side, like an edamame salad,” she says.
A vegetarian diet isn’t the only way to be healthier or lose weight, says Uelmen. “I always say ‘yes’ to eating more vegetables, but there are a lot of ways to improve your diet.”
Vegetarian Diets, Defined
Here’s how the meatless factions identify themselves:
Following the strictest kind of vegetarian plan, vegans eat no animal products of any kind, including dairy, eggs, and honey.
This group avoids all meat, poultry, and seafood, but dairy products and eggs are allowed.
Like vegetarians, pescatarians abstain from all meat and poultry. But they also eat seafood, often for the heart-health benefits that come from fish.
This catchall phrase describes people who limit the meat, poultry, and seafood they eat without eliminating it completely.