Diabetes Diet

Vegetarian and Low-Carb Diets for Diabetes

About a month ago I became a vegetarian. But I am staying with the very low-carb diet that I began in 2007. It makes it possible for me to manage my blood sugar levels and my weight. My motivation for further restricting the variety of foods that I eat was an ethical consideration.

Different people become vegetarians for various reasons. Some people choose to avoid meat, poultry, fish, and seafood for their own health and others for religious, ethical, and environmental concerns.

For me the issue is that I don’t want to be responsible for harming sentient beings as much as I can avoid it while still following a healthy diet. Several years ago I resolved all the questions about the health of a vegetarian diet for the management of my diabetes — with one exception.

Except by eating fatty fish, I didn’t know how to get a high enough level of the heart-healthy and anti-inflammatory omega 3 fatty acids. An international panel of experts in cardiovascular disease, infant nutrition, and mental health that the National Institutes of Health convened in 1999 concluded that adults need a minimum of 650 mg of combined DHA (docosahexaenoic acid) and EPA (eicosapentaenoic acid), and that at least 220 mg be in the form of DHA and at least another 220mg be in the form of EPA.

Getting enough of these two omega 3 fats was easy when I ate salmon and sardines. People can also easily get what they need from taking fish or krill oil capsules. And vegetarian sources of DHA that come directly from the algae where fish get it have been available for a long time.

But no EPA from a vegetarian source was available in March 2013 when I researched this question for my article here on “Omega-3 for Vegetarians with Diabetes.” At that time a spokesperson for one of the companies that sells a vegetarian source of DHA told me that “A vegetarian source of DHA/EPA oil just very recently became available.”

Now, some companies have just begun to offer capsules that contain both DHA and EPA from a vegetarian source. Most of them, however, don’t have enough EPA compared to their level of DHA. I did, however, find a new source that meets this requirement.

My other concern was the same one that I had in 2007 when I began to follow a very low-carb diet: whether I would get enough variety to stay the course. Actually, all that I had to eliminate from my diet at this juncture was the salmon and sardines. That turned out to be surprisingly easy.

This article is based on an earlier version of my article published by HealthCentral.

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32 Comments

  • Reply Sher Joyce August 11, 2015 at 8:59 am

    Thank you so much for posting this. Although I realize you posted this back in January, I just found it now, while googling “low carb vegetarian diets.” I too am going vegetarian starting tomorrow, and I know my blood sugar issues do best on a low/lower carb diet. But for ethical/environmental reasons, I just don’t want to eat any type of meat anymore. I wish there were more information on low carb vegetarians. You might be interested in this link I found by vegan dietician Ginny Messina: http://www.theveganrd.com/2009/06/the-atkins-diet-goes-vegan.html

    Anyway, please post more on how you’re doing veggie.

    • Reply David Mendosa August 11, 2015 at 9:19 am

      Good for you, Sher. You and I have similar reasons to follow both a very low-carb diet and a vegetarian diet. I keep on writing articles about diabetes, including how I am doing on my diet (and otherwise) — as I have for the past 20 years. Meanwhile, you may want to join the Facebook group “The Vegetarian Low Carb Diabetic Healthy Diet Society.”

  • Reply Philip Thackray August 8, 2015 at 5:37 am

    Dave,

    I’m seeing lots of articles about metformin (which you are very familiar with) and glucagon.

    Here are a few.
    This one is neutral on metformin but interesting take on diabetes-
    http://drmalcolmkendrick.org/2015/08/04/turning-diabetes-upside-down/

    These two talk about metformin for non-diabetics-

    http://itsthewooo.blogspot.com/2015/07/metformin-and-ampk-energy-replete-waste.html

    http://www.stockgumshoe.com/2015/08/microblog-aging-whats-all-this-about-preventing-or-slowing-it-down/?utm_source=8615&utm_campaign=DailyUpdate&utm_medium=email

    Regards,

    Phil

  • Reply Bill August 7, 2015 at 11:33 am

    Hello David,

    I’ve followed your writings for a while and was very interested to see your recent change to a vegetarian diet.
    I am very interested in increasing plant matter while reducing my intake of animal products.
    I very seldom eat meat, my diet consisting of poultry, and fish,eggs, veggies, berries and nuts and seeds.
    I’ve pretty much eliminated diary and grains.
    I noticed you mentioned egg white protien. Do you eat eggs and/or diary?
    I’m intrigued by your diet, and maybe at some point you could write a book, as there is so little info for people who want to try a low carb vegetarian diabetic diet.
    In good health.
    Bill

    • Reply David Mendosa August 7, 2015 at 3:19 pm

      Yes, Bill, I do eat eggs and dairy products, particularly yogurt and also some cheese. They provide most of the protein that I need. My diet is vegetarian and very low-carb. When you eliminate eggs and dairy from that, it becomes a vegan diet. That’s the difference, and I don’t think that a vegan diet that is very low carb is possible.

  • Reply rima March 6, 2015 at 9:31 pm

    So, with chana dal back in your diet, are you still able to keep your daily carb level under 50g?

    Also, I don’t get the sense that you’re especially focused on calories; but the way you’ve described your daily food intake above, it sounds like you must be consuming way less than 1,000 calories a day. Way less. Is that an issue? (I’m not being critical of you, by the way, but am curious about this as I think about applying some of it to myself.)

    • Reply David Mendosa March 6, 2015 at 10:01 pm

      Dear Rima,

      Certainly not on the days — like yesterday — when I have a soup made with chana dal and greens, like spinach! In fact, I have been thinking that I need to write about it. When we eat chana dal, which is so low on the glycemic index, it hardly spikes our blood sugar at all, it is really not like other carbs. It’s not true that “a carb is a carb is a carb.”

      You’re right that I do not focus on how many calories that I eat. Some days I don’t have many calories, but other days I do. Basically I just watch my blood sugar level and my weight.

      Thanks for asking!

      David

  • Reply madhusoodanan February 25, 2015 at 11:14 pm

    Dr Bernstein’s book is really a treasure.
    I personally believe, and very strongly that a vegetarian low carb diet coupled with yoga learned from a good teacher can help a great deal in coping with/ eliminating type2 dm.
    suggest that people can look up this for a starter.
    http://yogawithsubhash.com/2014/08/10/yoga-for-diabetes/

    • Reply David Mendosa February 26, 2015 at 2:31 am

      Dear Madhusoodanan,

      Thanks for your recommendations, particularly of yoga. Practices like yoga and tai chi have helped me too.

      With metta,
      David

  • Reply Lisa February 25, 2015 at 8:05 pm

    Thanks David. I hadn’t gotten as far as recognizing that this was a low-fat diet, likely because avocados, nuts, and seeds are allowed, but you’re right.

    After I read your response, I read an excellent critique of the first book on the Weston A Price Foundation’s website, additional critiques elsewhere. I’ve read a third of the newer book, The End of Diabetes, and am continuing to struggle with the statements he makes, more so when I look up and read the studies he refers to in his foot notes.

    I’ve decided to set this book aside and resume reading about and listening to lectures on the research on the low carbohydrate high fat diet.

    Today is day 18 on the diet, and it’s working well for me.

  • Reply Lisa February 24, 2015 at 12:10 pm

    David,

    I found your site when I did a search on “How bad is an A1C of 9.9?”, and immediately purchased the book, Dr. Bernstein’s Diabetes Solution. For the first time, I had hope as a Type 2 Diabetic. It is now part of my permanent health library. I refer to it often.

    I’m happy to report that I’ve been on the low carbohydrate high fat (LCHF) diet for two and a half weeks. On day 1, my weight was 156.4 pounds and my fasting blood glucose was 245 mg/dL. Today, day 17, my weight is 152 pounds, my fasting blood glucose 131 md/dL. The LCHF diet works, and since I upped my water intake and added a daily gram of salt to my diet, I feel fine and have no food cravings.

    I experienced similar weight loss on the South Beach Diet, perhaps 5 – 7 years, put stopped, due to the food cravings. I did however lose 20 pounds and kept it off.

    In all my readings to date about the LCHF diet, I haven’t once read the words, “anti-inflammatory”. This concerns me because inflammation plays a significant role in chronic diseases.

    A few days ago, in search of Stephen Phinney’s and Jeff Volek’s book, The Art and Science of Low Carbohydrate Living, I stumbled upon Joel Fuhrman’s book, The End of Diabetes.

    He’s strongly opposed to the LCHF diet, and the book contains a lot of misinformation about it, unfortunately. Interestingly, his type 2 diabetic patients also are achieving weight loss, normalization of blood glucose levels, and reduction or elimination of medication – (confirmed by diabetics who posted their results in reviews for the book on Amazon).

    Type 1 patients also were helped. They were able to reduce their insulin, and reduce or eliminate their other medications for diabetes and hypertension.

    My challenge is that I have a gluten-sensitivity that wasn’t diagnosed until three years ago. I’m in my mid-50’s now. That and the untreated diabetes has taken it’s toll on my body, though amazingly, my triglycerides are only 126 mg/dL.

    I’ve come to a Y in the road. I’m asking myself, “Do I continue with the LCHF diet? Or do I switch to Eat to Live diet which is far more nutrient dense and give it a 6 month trial?”

    If I do switch to the Eat to Live diet, I already know I will continue to eat meat, some dairy, eggs, and other sources of saturated fats, but in lesser amounts to allow for greater intake of nutrient dense vegetables, beans, seeds, nuts, and fruits, whole, unprocessed foods.

    I find it interesting that you’ve recently switched to a low carb, vegetarian diet. I’d like to hear what you think of Joel Fuhrman’s diet for diabetes as described in his new book, The End of Diabetes (2012).

    • Reply David Mendosa February 25, 2015 at 4:37 pm

      Dear Lisa,

      Dr. Fuhrman’s diet does seem to work for some people, at least to lose weight. But I can’t imagine how anyone with diabetes can benefit from it! While we generally have to lose weight, we always need to keep our blood sugar as low as possible. That is impossible on a low-fat diet. It’s as simple as that.

      Best regards,
      David

  • Reply Philip Thackray February 20, 2015 at 6:05 am

    David,

    A very interesting and unusual book on the subject of Vegetarianism is:
    The Vegetarian Myth by Lierre Keith.
    It can be faulted as not scientifically rigorous but it is very thought provoking.
    I do not offer this as an argument for or against a vegetarian life style I just think that anyone who eats food, cares about the planet and is thoughtful would enjoy this book.
    Personally, I am not diabetic, have been very low carb for almost 10 years and do eat meat, most of it raised by myself or my friends.
    Did you see this series of posts by Dr Kendrick?
    http://drmalcolmkendrick.org/2015/02/08/thinking-about-diabetes-once-more/
    and the two before this one.
    Regards,
    Phil

    • Reply David Mendosa February 22, 2015 at 9:20 pm

      Dear Philip,

      Yes, indeed. I read her book several years ago and she impressed me with her knowledge and understanding of the dangers of a vegan diet, which she had followed for a long time. While I am a vegetarian and believe that it can be healthy, I would never consider being a vegan, and I often recommend her book to people who are going that way.

      Best regards,
      David

  • Reply rima February 7, 2015 at 12:43 pm

    David, I went back and read the http://www.mendosa.com/blog/?p=212 post, but it didn’t seem to me that you actually were able to definitively attribute the spike to the barley. Am I missing something?

    • Reply David Mendosa February 7, 2015 at 3:21 pm

      Dear Rima,

      We both read the same thing and I don’t have any memory of it to add to it. So since we read it differently, just ignore it, and do the test yourself, please! And please let me know how it turns out.

      With metta,
      David

  • Reply rima February 7, 2015 at 12:43 pm

    David, I went back and read the http://www.mendosa.com/blog/?p=212 post, but it didn’t seem to me that you actually definitively attributed the spike to the barley. Am I missing something?

  • Reply Ana February 7, 2015 at 9:25 am

    Appreciate the reply. So this includes the newly added barley and/or chana dal?
    That is fabulous!
    Love to hear success stories.

    • Reply David Mendosa February 7, 2015 at 9:44 am

      Dear Ana,

      I have indeed added chana dal back into my diet. I may use some hullless barley, but it would have to be minimal, and I would have to find an organic source.

      With metta,
      David

  • Reply Ana February 6, 2015 at 12:15 pm

    Appreciate the feedback.
    As a dietitian, I would be curious what a post prandial (1 hour; 2 hours) value is in a mixed meal…if you are in the mood to check after eating such a meal, would love it if you could post the results.

    • Reply David Mendosa February 6, 2015 at 1:02 pm

      Dear Ana,

      My level is almost never above 90 mg/dl two hours after the first bite of my meals. And that is, of course, on my diet alone: no diabetes medication.

      With metta,
      David

  • Reply Ana February 6, 2015 at 9:55 am

    I am curious how your glucose values react when introducing the barely and the chana dal. I know they are low glycemic, but every body reacts differently. Would be interesting to hear how high your post prandials are after a meal with those.
    Love reading your blog.

    • Reply David Mendosa February 6, 2015 at 10:44 am

      Dear Ana,

      Good question! I used to eat hullless barley and reported one experience with it in 2007, just before I stopped eating grains to go on a very low-carb diet. That was not a good experience, as you can read at http://www.mendosa.com/blog/?p=212 but I obviously did not eat it alone, probably using milk, which adds to the carbs and perhaps even sugar. I don’t remember.

      I haven’t checking my BG level after eating chana dal and don’t plan to. It would mean cooking up plain chana dal and eating it without anything else, not quite as tasty as the way I make it! In fact, I will soon be making one of the recipes on my website, href=”http://www.mendosa.com/recipe9.htm”>Potakhe, now that ORGANIC chana dal is available, as I wrote at Chana Dal.

      You mention the low glycemic indexes of these two foods. I have written that the GI of barley is 21, the lowest of any grain. I’m confident that the GI of HULLLESS barley is even less, but it hasn’t been tested.

      Chana dal has been tested several times for its GI and it is perhaps the lowest of any food with a substantial amount of carbohydrates (the one exception that comes to mind is Nopal, prickly pear cactus, which may have a glycemic index of 7). Chana dal’s GI averages in several tests at 8 on the index where glucose = 100. That’s good enough for me.

      With metta,
      David

  • Reply rima February 5, 2015 at 12:14 pm

    David, I look forward to future posts about what you’re actually eating now that you’ve gone low-carb vegetarian (a typical day’s foods, maybe?), including recipes, if you cook. And whether you tweak your carbs-per-day allowance. I’m especially curious about yogurt consumption, since it tends to be fairly carby (and I do mean plain yogurt, not flavored).

    • Reply David Mendosa February 5, 2015 at 1:39 pm

      Dear Rima,

      My diet is basically a protein powder drink with unsweetened hemp milk for breakfast. The hemp milk is a recent discovery, thanks to the recommendation of a friend who also follows a very low-carb diet. It has only 1 gram of carbs/8 ounces, half of the amount in unsweetened almond milk.

      Lunch is a salad with oil and vinegar dressing (currently organic macadamia nut oil and Bragg’s apple cider vinegar).

      I am on an intermittent fast after lunch today, but dinner otherwise could be a vegetable soup, will the vegetables carefully chosen to be low carb, e.g. no grains, potatoes, etc. (same for the salad of course)

      Or dinner could be a fair sized bowl of Straus Organic Plain Whole Milk Greek Yogurt. I discovered it after writing http://www.healthcentral.com/diabetes/c/17/159400/yogurt-people-diabetes/ in which I wrote there that I couldn’t find any yogurt will those stellar qualities. In my opinion it is also the best tasting yogurt we can buy in a store.

      The Nutrition Facts label says that 1 cup has 15 grams of carbohydrate, which would appear to be a lot. But according to research that I cite in the post I link in the previous paragraph it is really only 5 grams of carbs per cup.

      Thanks for asking some great questions!

      Best regards,
      David

  • Reply madhusoodanan February 2, 2015 at 11:05 pm

    I find the following sites to be very good sources of info.
    http://ndb.nal.usda.gov/ndb/ excellent source for nutritional values

    http://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/LabelingNutrition/ucm064908.htm

  • Reply rima February 2, 2015 at 11:04 am

    So have you been off hull-less barley and chana dal since 2007? Do humans not need some fiber to aid, um, digestion? Don’t vegetables and fruit provide some needed nutrients not available from, say, eggs, yogurt and cheese? I’m more confused than ever these days.

    • Reply David Mendosa February 2, 2015 at 11:43 am

      Dear Rima,

      What a coincidence that you would mention hullless barley and chana dal! Indeed, now that I follow a vegetarian very low-carb diet, I am added chana dal (and perhaps hullless barley) back into my diet. They are two of the lowest glycemic carbs that we know about, and just this morning made a note to myself to buy it for the vegetable soup that I have started to cook. But I’m not sure that we need them for more fiber. I too am confused about how much fiber we need. See, for example, this funny and eye-opening piece by Dr. Michael Eades:
      http://www.proteinpower.com/drmike/fiber/a-cautionary-tale-of-mucus-fore-and-aft/

      With metta,
      David

  • Reply madhusoodanan January 31, 2015 at 11:57 pm

    Thanks David.

    Good place to see and exchange info.

    Regards.

    Madhu

  • Reply Jane January 31, 2015 at 3:32 am

    I’m vegetarian/vegan & type 2. Have been vegetarian over 20 years but type 2 since 2010. Where can I find your food plan here? I’m trying to figure this out also for eating the right amount of protein. I feel like a person needs to understand chemistry [I don’t] in order to put all the information together. Tried to be vegan in 2013 but have resumed eating fish for protein. Similar to you, I don’t want animals killed for my consumption. I know I should be able to get enough protein without fish so this article is timely. Thanks.

    • Reply David Mendosa January 31, 2015 at 6:51 am

      Dear Jane,

      Good for you, because you aren’t harming the planet and its animal, including yourself. Except for us vegetarians, almost all Americans are getting more protein than they need, although I won’t say that it’s too much. Up to a point (which hasn’t been determined in general, much less for us individually) more protein may be better, although it does of course add calories. Complicated chemistry, yes! So I focus entirely on how much we need and have written about it, particularly in this article last year: http://www.mendosa.com/blog/?p=2566

      I wish that I could say that I have a food plan! If it is a plan, it changes almost daily. Partly that’s because it’s important for me to explore new foods, since I limit so many of the foods that are mainstays of the Standard American Diet. I eat no grain or grain products, very few carbs (less than 50g/day), and no meat, poultry, fish, or seafood. Since becoming a vegetarian my breakfast is a protein shake (I prefer egg white protein because it has the most complete amino acid profile; the great resource for this is nutritiondata.com). Very recently I discovered that one brand of unsweetened hemp milk has half the carbs of the almond milk that I used to make it with and doesn’t have the suspected carcinogen carrageenan that the other brand has. My lunch is usually a salad, the ingredients of which are always changing, but do not include any high-carb veggies like carrots. I use oil and vinegar as my salad dressing, avoiding those oils that are high in omega-6 (here again we need to know something about chemistry, but you can check several of my articles about omega-3 and omega-6 fatty acids). Dinner varies a lot, including often Straus organic full-fat Greek yogurt, but I am starting to make more and more vegetable soups. Snacks are nuts, especially macadamias, which have the least omega-6 and I like most anyway, cheese, kimchi, SeaSnax. Hope this helps!

      With metta,
      David

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