By Karen Donaghy
Jan 11, 2020,
If you’ve emailed Clean Food Dirty Girl over the last couple of years, chances are I’ve replied to you. As the Virtual Office Manager for CFDG, I am on the backend fielding emails, improving our systems and working with our amazing team to keep things running smoothly. I am also in my second year of a Master’s program in Human Nutrition. Today, I’m going to venture into a role I’m both nervous and excited to dip my toes into.
At the end of 2019, Molly invited Meal Plan subscribers from our community to reply back if they had been following our whole-food plant-based meal plans and had improvements in a particular lab value called HbA1c (more on that shortly).
In this post, I’ll set the stage for a series of blog interviews born out of the many replies that Molly received. While anecdotal, the interview series is important because of the insight on how following a consistent whole-food plant-based (WFPB) meal plan that incorporates ingredient diversity, without regard for macronutrient (protein, fat, and carbohydrate) ratios, and despite not being designed to treat diabetes or any other disease, can still have a positive impact on diabetes and diabetes management.
We hope that this series inspires readers to talk with their doctors and other medical professionals about how making a shift to eating a diet filled with whole plant foods could impact their medical status.
We also hope that the series inspires medical professionals to want to learn more about whole-food plant-based dietary patterns so they are equipped to encourage and support patients who are motivated to change the way they eat.
If you are taking medication(s) and decide that you want to try a WFPB dietary pattern, it’s important to let your doctor know up front what you are doing. Changing what you eat can have an immediate impact on your metabolism and your medications may require adjustment quickly. Keeping your doctor informed so they can guide you on making medication adjustments will help you navigate safely.
While it’s a complex disease, at its core, diabetes is a problem of insulin: either you’re not producing any (or enough) insulin—known as insulin deficiency. Or, your cells are not responding to insulin the way they should—insulin resistance (Nahikian-Nelms & Sucher, 2020, p. 491-492).
Insulin is a hormone produced by the pancreas – it acts as a key for glucose, circulating in our blood, to enter cells (Greger, 2017). Blood glucose mostly comes from carbohydrates (aka carbs), but even protein and fat in the food we eat can be converted in our bodies to make glucose. Carbs can be simple or complex (many simple carbs linked together).
When we eat food with carbs, the food gets digested into simple carbs, like glucose, that we absorb. When we’re not eating, and our supply of glucose runs low, our liver steps in to make glucose to keep the work of the body going (Lieberman, Marks, & Peet, 2013, p. 562-563).
In the case of type 1 diabetes, the pancreas does not produce insulin so there’s a deficiency of insulin. In the case of type 2 diabetes, cells are resistant to insulin. In both cases, glucose builds up in the blood to levels that are considered beyond normal. It’s not good to have ongoing elevated blood glucose (National Institutes of Health, 2016).
If you’ve ever worked with good old white sugar, you know that once it gets wet, it’s a sticky mess. Sugar is made of glucose (and another simple carb called fructose) (National Center for Biotechnology Information, n.d.). Having lots of sticky glucose stuck in your blood, rather than sashaying into cells where it will be used to keep your body humming along, means damage to your blood vessels and organs.
As you might imagine, having high levels of blood glucose with no place to go is particularly worrisome in the case of pregnancy (gestational diabetes), where damage can be done to the growing fetus (Nahikian-Nelms & Sucher, 2020, p. 517-518).
Now that I’ve mentioned three types of diabetes, the rest of this post is written from the perspective of type 2 diabetes.
How do you know if you have diabetes? There’s a chance you may not know right away. The National Diabetes Statistics Report (Centers for Disease Control and Prevention, 2017) estimated that, of all the people who have diabetes in the United States, almost one quarter have no idea they have it. That’s because elevated blood glucose doesn’t result in noticeable symptoms until it gets super high, or until damage accumulates over many years.
One common test used to diagnose diabetes is a measurement called hemoglobin A1c (aka glycosylated hemoglobin, or HbA1c for short, or A1C for shortest) (Nahikian-Nelms & Sucher, 2020, p. 494). Without getting too technical…you might say “glycosylated” and think, “why, part of that word sounds a little like ‘glucose’.” And, you are right! Glycosylated is a science-y way of saying glucose is stuck on…in the case of A1C, glucose is stuck on hemoglobin.
If you aren’t familiar with the word hemoglobin, it’s just a regular ol’ red blood cell, yep, the cells that give color to your blood and carry oxygen from your lungs to the cells throughout your body. Any single red blood cell is likely to whip around your circulatory highway for months at a time. Like bugs on a windshield, blood glucose attaches to hemoglobin over time. The higher your blood glucose concentrations are, the more glucose attaches to your blood cells and the higher your A1C will be.
Now, if you happen to have your A1C measured and your doctor determines it’s higher than it should be, they will talk to you about diabetes management and lowering your A1C. Depending on how high your A1C is, you might be directed to do damage control and go on medication.
You might be referred to various medical professionals specializing in diabetes management that will consider your medical history and help you learn to manage your medications and make lifestyle adjustments, like eating what they consider to be healthier foods and moving your body more. The idea is to improve how your cells respond to insulin and, as a consequence, lower your blood sugar as close to normal concentrations as possible.
The medical guidance provided falls under standards of care based on published science that shows these standards help improve A1C (and improve other measures as well), thereby slowing the progression of diabetes.
Here’s where things get interesting.
Let’s say you are diagnosed with diabetes. The guidance provided to help you manage your diabetes includes things like:
- Take medications and/or insulin as prescribed by your doctor.
- Attend education sessions to learn about diabetes management and how to monitor your blood glucose, particularly critical if you are prescribed insulin.
- Learn a fairly complicated “carbohydrate exchange” system (also known as carbohydrate counting) for planning meals based on grouping foods by macronutrients and by serving/portion size (Carbohydrate Counting and Exchange Lists, n.d.).
So, what do you do?
The medication and insulin part is clear cut: you listen to your doctor. And hopefully, you take advantage of any education made available so you understand your diagnosis and have the best chance of slowing the progression of diabetes.
The food part is on you to implement. You might carry around a reference book of foods (or maybe you install an app on your phone) so you can look up what you plan to eat for each meal. Maybe you get really good at calculating and the system works great for you. Or, maybe you get a bit lax and you start to guess. Maybe you try to eat the same things day after day so it’s not so complicated. Or, maybe you go with the tried and true and start to rely on packaged foods that explicitly tell you how much protein, fat, and carbs are in a serving size.
One thing is for sure, carbophobia sets in fast. If you don’t do anything else, you think, “I must avoid carbs.”
On one hand, it’s understandable because of how damaging excess blood glucose can be.
On the other hand, it’s unfortunate because it means that nutrient-dense fiber-rich foods like lentils, squash and peas are looked at with the same lens as processed foods made with sugar and refined flours, like cookies, hamburger buns, and waffles. As we know, all calories are not created equal.
What if you didn’t have to treat meals like a mathematical equation to lower your A1C?
What if you could lower your A1C even though you eat more complex carbs than you ever have?
Now, we’re not talking conduits for simple carbs like cake or candy where your body sucks up the sugar without having to do digestive work for the energy. We’re talking about complex carbs found in beans, lentils, carrots, squash, whole grains, and all the starchy veggies (even potatoes!). And, even though it is rich in simple carbs, fruit, with all its fiber and other nutrients, is A-Okay too!
It seems counterintuitive to start eating more foods that break down into glucose, yet still end up with lower blood glucose concentrations over time.
Yet, we have people in our community following our meal plans that have had this exact experience happen to them.
How could this be?
More than likely, there’s not a single reason.
Weight loss in general is beneficial for insulin resistance (Barnard, et al., 2006). And, when a person starts eating a plant-based diet, cutting out animal and processed foods like cheese and pastries, chances are they will lose weight because the dietary pattern tends to have less calories overall (Greger, 2016).
Another key theme we hear in the sphere of plant-based eating is that it’s because whole-food plant-based dietary patterns tend to be lower in fat – after all, no oils are being used for cooking and animal sources of saturated fat are not present in this dietary pattern. So, what’s the connection? Apparently dietary fat can build up in our cells and directly contribute to insulin resistance (Greger, 2017).
Other possible factors include higher fiber intake from eating all the plants and, interestingly, lower iron stores typically found in vegetarians and vegans (Barnard, Katcher, Jenkins, Cohen, & Turner-Mcgrievy, 2009).
Although our plant-based meal plans are not designed to reverse or treat diabetes and our plans do not shy away from using whole food sources of fat, they are packed with health-promoting whole plant foods and they do not include animal-based foods or oil.
In the coming weeks, Molly will be sharing talks that she has had with some of our subscribers who have been able to lower their A1C by following our meal plans. One of them is a physician who was shocked when she was able to get her own A1C down!
Have you been able to reduce your diabetes meds or get off them completely by following a Whole-Food Plant-Based Diet? Bonus points if you follow our meal plans! We would love to know about it in the comments below.
Ingredients
- ¼ cup brown rice (50 g)
- ¼ cup brown lentils (50 g)
- ¼ cup steel cut oats (45 g)
- ¼ cup hulless barley (50 g)
- 1 cinnamon stick
- 2 cups water
- ½ teaspoon vanilla extract
Instructions
- Place the brown rice, lentils, oats and barley in a fine mesh strainer and rinse well with water. Tap the strainer against the sink to remove as much excess water as possible.
- Press the saute setting on your Instant Pot and heat up the inner pot for 2 minutes. Transfer the rinsed grain mixture along with the cinnamon stick to the Instant Pot and saute for 2 minutes, stirring frequently.
- Turn off the Instant Pot and add the water. Stir, and then lock the lid into place, making sure the nozzle is in the sealing position.
- Use the Manual (or Pressure Cooking) mode and set the timer for 12 minutes. Use the natural release method when the timer goes off.
- Remove the lid and add the vanilla. Cool to room temperature, then promptly store in your fridge. You can leave the cinnamon stick in for added flavor or take it out before storing.
- Once you have your grains made, heat up however much you want in a saucepan with some non-dairy milk. Place in a bowl and top with chopped nuts, fruit, non-dairy milk and a little sweetener of your choice.
Notes
- We haven’t tested it, but you can make this on the stove top by using 3 or 4 cups of water (same amount of grains / lentils) and simmering it for about 30-35 minutes until the rice and lentils are soft. You might start with 3 cups of water and add more if necessary.
- You can make this gluten free by using toasted buckwheat instead of barley and follow the same instructions. You could also use 1/8 cup more rice and 1/8 cup more oats and leave out the barley.
Wishing you a happy week. May it be filled with finding a better way.
Xo
Molly
References
Barnard, N. D., Cohen, J., Jenkins, D. J., Turner-Mcgrievy, G., Gloede, L., Jaster, B., … Talpers, S. (2006). A Low-Fat Vegan Diet Improves Glycemic Control and Cardiovascular Risk Factors in a Randomized Clinical Trial in Individuals With Type 2 Diabetes. Diabetes Care, 29(8), 1777–1783. doi: 10.2337/dc06-0606
Barnard, N. D., Katcher, H. I., Jenkins, D. J., Cohen, J., & Turner-Mcgrievy, G. (2009). Vegetarian and vegan diets in type 2 diabetes management. Nutrition Reviews, 67(5), 255–263. doi: 10.1111/j.1753-4887.2009.00198.x
Carbohydrate Counting and Exchange Lists. (n.d.). Retrieved January 10, 2020, from https://www.nal.usda.gov/fnic/carbohydrate-counting-and-exchange-lists
Centers for Disease Control and Prevention. (2017). National Diabetes Statistics Report, 2017. National Diabetes Statistics Report, 2017. Atlanta, GA.
Greger, M. (2016, January 4). Eating More to Weigh Less. Retrieved January 11, 2020, from https://nutritionfacts.org/video/eating-more-to-weigh-less/
Greger, M. (2017, January 6). What Causes Insulin Resistance? Retrieved January 10, 2020, from https://nutritionfacts.org/video/what-causes-insulin-resistance/
Lieberman, M. D., Marks, A. D., & Peet, A. D. (2013). Marks basic medical biochemistry a clinical approach (4th ed.). Philadelphia: Wolters Kluwer, Lippincott Williams & Wilkins.
Nahikian-Nelms, M. & Sucher K. (2020). Nutrition therapy and pathophysiology (4th ed.). Boston, MA: Cengage.
National Center for Biotechnology Information. PubChem Database. Sucrose, CID=5988, https://pubchem.ncbi.nlm.nih.gov/compound/Sucrose (accessed on Jan. 11, 2020)
National Institutes of Health. (2016, December 1). What is Diabetes? Retrieved from https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes.
32 Comments
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Hi Karen!
Beautiful explanation of the intricacies of diabetes and its relationship to food! I’m an RD/CDE and I love to see more people in the field of nutrition spreading the word about plant-based diets. Keep it up!! 🙂
Anna
Hi Anna! I am so very THANKFUL for your message. It is appreciated. Thank you for being an RD/CDE (my mom is a RN/CDE and I talked with her about this piece to do my best with it) – your expertise is so needed! Hopefully, I will join you as an RD with expertise in plant based dietary patterns next year. ~Karen
I have been following the WFPB lifestyle since June. I started as a Type 2 Diabetic on Metformin. I also took meds for high blood pressure. My daughter convinced me to join Lighten Up and go to Barnard Medical Center to meet with a dietician. I did this as well as attend sessions for Diabetics at Barnard Medical Center. Dr. James Loomis told me this week that if he had first met me, he would not say I had Type 2 Diabestes. Thanks to all the support I have received from Clean Food Dirty Girls, Lighten Up and Barnard Medical Center, I am no longer on Metformin or any blood pressure medications. Hurrah for amazing results from a new lifestyle ??
So happy for you, Janice. High fives to your daughter! The Barnard Medical Center is doing such important work with plant based medical treatment. Molly interviewed Dr. Barnard in 2017. Thanks so much for sharing and inspiring others. ~Karen
Great Blog. Was just talking with mini friend later night about this very thing. WFPB are amazing . Thank you, Karen! And for being a DG.
I am glad you liked it! Thank you so much, Brenda! ~Karen
My nurse practitioner told me if I didn’t improve my eating I would be diabetic within a year. I dug my heels in and refused at first since I loved my sweets and ate take out most every day. I bought an instapot on sale and in searching for vegan recipes for a vegan neighbor I wanted to cook for I found CFDG. I started the meal plans and within 4 months my glucose, cholesterol, and blood pressure were all in normal ranges. I didn’t need to lose weight but lost 30 lbs. For the first time in my life my belly fat (snack pack) went away. I also learned to love cooking. Something about not having yucky animal flesh in my kitchen has made it much more enjoyable.
Hi Deanna, Thank you for sharing. When sweets and convenience foods are regular in the diet, it can be such a challenge to move away from them. Congratulations to you for getting there and making huge change! I’ll always remember an intensive 3-day vegan cooking class I took in 2011-ish – it was the first time I tried tempeh, kabocha squash, burdock root, even natto, and I made my first tofu scramble. The chef talked about learning to love cooking – how it is an act of love for yourself and whoever you are cooking for. That perspective stuck with me – changed my attitude towards dirtying pots and pans and having to do dishes. I’m glad you’ve learned to love cooking, too! ~Karen
Thank you for a great explanation of diabetes, and for mentioning Type 1, which often gets left out of diabetes discussions. When I was diagnosed with Type 1, I went on a super low carb diet that did reduce my A1C, but was boring and hard to stick to. With trepidation, I went plant based, including former no-nos like beans, sweet potatoes, whole grains. My A1C is perfect, my blood sugar is pretty stable, and I love this way of eating.
Thank you for the nice note, Ann! And, thank you for sharing, your experience may help someone else living with type 1 diabetes consider if plant based could work better for them. ~Karen
Wow Ann big cudos from NZ and another dirtie.
Iv been on WFP eating for 6 mths feel full of beans energy wise and normal BP, bloods and Hb1 improving .
Metformin has been suggested and Iv declined ! On monthly checks with dr as complex medical history previously and shes over the moon !
Love plant food and being well. Keep it up as I will . We are blessed to have CFDG I
have found health, lost weight and getting stronger every day. XX
Ann did you eat nuts and nut recipes and avocados?
BROL. gonna be the new Hippie trend!!! Thanks ?
LOVE this post–so engaging, informative, and well-researched!!
I am smiling. Thank you, Buster! ~Karen
Thank you for explaining it all so simply. I never knew what people were talking about when they said A1C.
I don’t know how to make a heart emoji on the blog comments or I would post one…thank you, Julia! ~Karen
I loved this! Do you think it can be doubled and cooked for
the same time?
Hi there, Christa! The recipe should work fine if you double the ingredients, just make sure that you’re not over the “fill line” on the inside of the Instant Pot. The cooking time listed on the recipe should work for you, but you can always cook it for a little longer if the grains aren’t done. We hope you enjoy!
I tripled the recipe and it worked out great.
Yes, it scales nicely!
Hello, I am loving this blog and the trial mean plan so far! I just received an Instant Pot today after ordering one. Molly totally sold me on it! I have a lot of misc. whole grains in my cupboard, are there any I should be mindful of using to make this recipe in regards to cooking time? I’m talking farro, millet, buckwheat, rolled oats, quinoa, etc. Thanks in advance for any tips! (Also I made rice and beans today in the Instant Pot and it was amazing!)
Hi Lauren! I am so glad you are happy with the Trial Meal Plan! Oh, the Instant Pot is a game changer – glad you have already put it to use! Mine is 7 years old and still going strong. Any of the grains you’ve mentioned will work just fine in this recipe. Some grains do need longer cook times, like brown rice or wheat berries for instance. ~Karen
Hi Lauren,
If I use brown rice or wheat berries, I just soak everything overnight in water and then follow the recipe. It’s always worked for me.
Let me know what you think!
Oh, and I never use rolled oats, always steel cut oats, but I’m sure rolled oats would work too 🙂
xo
Molly
Thanks for the help Karen and Molly! So just to clarify, the recipe above calls for brown rice and I should soak that overnight before using? Also, I know that we should eat until satisfied but how much do you think I should make for 5 pre-run breakfasts? Oh and another question ;P my grocery store only had pearled barley in stock, will that be an ok substitution if I maintain the 12 minute pressure cooking time?
I fucking love this shit so much. This fills up my husband’s stomach in the morning way better than just regular steel cut oats with blueberries. I am much less likely to snack in the morning on junk when I eat this.
Thanks for the recipe love! It’s a solid nourishing breakfast. After seeing Molly’s Instagram video on this recipe a few weeks ago, I made a huge batch last week and had it each morning COLD with some non-dairy milk and toppings. It’s equally delicious cold with the savings of a little less prep time in the morning. ~Karen
Hello, Karen,
Thank you so much for sharing your information. But, one thing I do not understand when you wrote; “lower iron stores typically found in vegetarians and vegans.” Does that mean it’s a good thing to have lower iron stores from eating plants? I thought lower iron stores meant iron deficiency.
Thank you, again,
Marguerite
Hey Marguerite –
Molly has a post on iron and eating a whole food plant based dietary pattern that you can check out.
Iron status can be measured in different ways. There are medical considerations that go into which measurement(s) will best provide the true iron status of an individual.
One particular measurement, called serum ferritin, is commonly used to get a baseline measurement of iron status in people without other medical concerns. Ferritin is essentially a container for storing iron molecules. There’s an approximate ratio that estimates if a person has X amount of serum ferritin, then they likely have Y amount of stored iron. Though it is commonly used, serum ferritin is not a perfect indicator because it can be abnormally elevated if a person has inflammation from disease, and it can also underestimate total iron stores because serum ferritin is not necessarily representative of another type of ferritin, found in the liver, which can accumulate iron before serum ferritin is impacted. (Aggett, 2012)
In context of this post, “lower iron stores” still implies having normal iron stores. There’s a 5-fold difference in the range of what is considered “normal” iron stores as measured by serum ferritin. (Volpe, 2018) Whether you are on the low or high end of that range, as long as you are in that range, and barring other medical complications, you will likely be considered to have iron sufficiency. Sufficiency means you are making enough blood cells to deliver oxygen to cells in your body, and meet other biological needs for iron, and that you have a reserve. (Aggett, 2012)
For sure, you do not want to be iron deficient, or even iron depleted.
The Barnard et al. (2009) article I cite includes a section that highlights a number of research studies that have evaluated whether or not iron status might have a relationship to metabolic dysfunction, including T2DM.
The line of inquiry around iron stores and T2DM has to do with knowledge that people with a genetic alteration that causes them to over-absorb dietary iron, a condition called hemochromatosis, commonly develop T2DM; and, some studies have shown an improvement in insulin sensitivity in people who donate blood (which results in a lowering of iron stores).
The Barnard et al. (2009) article specifically mentions this 2001 study by Hua, Stoohs, and Facchini, that found increased insulin sensitivity in lacto-ovo vegetarians with lower iron stores (still in the normal range) compared to omnivores (also in the normal range). Other research has evaluated iron status in people before they develop metabolic dysfunction and afterwards and there is persuasive evidence that having higher stores of iron is associated with increased likelihood of developing metabolic dysfunction. Though, not all studies have found an association.
Because plants are sources of non-heme iron exclusively (animal foods tend to have both heme and non-heme iron), and non-heme iron is not as readily absorbed as heme iron, the suggestion is that plant based eaters could have a benefit because they are taking in less iron overall; and so, are less likely to accumulate high iron stores. Another study by Lee, Folsom, and Jacobs Jr. (2004), highlighted higher dietary heme iron intake and supplemental iron intake in postmenopausal women, particularly in those that consume alcohol, with an increased association of T2DM.
Just a reminder that our bodies are complex systems and, while iron status may be a piece of the puzzle when it comes to T2DM, there’s no doubt it’s a large puzzle. It’s important to not get hung up on a specific mineral or other nutrient and recognize that the overall dietary and lifestyle pattern is what is most important when it comes to preventing and/or managing T2DM.
~Karen
A note that I wrote this reply including additional reference information from: Aggett, P. J. (2012). Iron. In Present knowledge in nutrition (pp. 506-520). Oxford: Wiley-Blackwell and from: Volpe, S. L. (2018). Iron Metabolism. Lecture.
That is amazingly well written and informative. However, I did need to read it 5-10 times, ha ha. But it is very helpful. And, definitely enlightening. Thank you so much for taking the time to clarify for me. Kind regards , Marguerite
Hi Marguerite, thank you for this feedback – I struggle with a need to provide context without too much complexity. Something for me to work on.
I had to do some reading myself to provide a thoughtful reply – it’s complex for me, too.
Interestingly the possible relationship between iron and insulin sensitivity is not mentioned in my comprehensive nutrition reference book (10th Edition of Present Knowledge in Nutrition by Wiley-Blackwell, 2012). Nor was there a mention of a relationship in the Micronutrient Metabolism course I completed in 2018. Most likely there is just a gap in having enough evidence to confidently make this association, we’ll know more over time. ~Karen
It’s soooo fuc*ing good, I triple it 🙂